Presentation
Persistent cough.
Patient Data
Normal heart size.
Increased retrocardiac opacification with loss of the silhouette of the left medial hemidiaphragm, suggesting left lower lobe collapse/consolidation. Left basal atelectasis laterally as well.
The right lung and pleural space are clear.
Blunting of the left costophrenic angle suggests a small left pleural effusion.
Small metal clips projected over the left supraclavicular region result from the previous excision of a lipoma.
Chest X-ray (8 years prior)
Normal heart and mediastinum. Minimal left basal atelectasis, the lungs are otherwise clear and the left hemidiaphragm is clearly outlined apart from a short medial segment.
No pulmonary embolus was identified. No significant right heart strain.
Left lower lobe consolidation with ipsilateral small simple pleural effusion and a 12mm ipsilateral hilar lymph node. Bilateral lower zone atelectasis. No concerning lung nodules or endobronchial lesions. No other lymphadenopathy.
Below the diaphragm, no gross pathology was demonstrated within the visualized upper abdominal viscera.
No aggressive bone lesion.
Case Discussion
These findings suggest left lower lobe pneumonia with parapneumonic effusion causing loss of silhouette sign, affecting the left medial hemidiaphragm. Comparison with the prior radiograph confirms that this is a new finding. CTPA confirmed collapse/consolidation in the left lower lobe and pleural effusion. A follow-up CT was recommended to ensure resolution.
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