Answer to chest Xray…

June 2, 2013

Chest XR, Non-Trauma, Respiratory, XR

The other day I posted this Chest Xray on an individual with cough, fevers:


The xray shows diffuse interstitial infiltrates concerning for an atypical pneumonia.  The patient had several weeks of weight loss, fatigue, fevers and he had profound hypoxia into the 40s on room air.  The differential diagnosis in this situation is broad and can include common atypical bacterial pneumonia organisms (Mycoplasma, chlamydia sp, legionella, etc).  ARDS can present like this with diffuse infiltrates and hypoxia.  Influenza is also on the list of pathology.  However, the significant hypoxia also brought up Pneumocystis Jiroveci pneumonia.  An LDH was added and came back at 439 U/L (normally <200).  The patient was empirically covered with common community-acquired antibiotics plus TMP/SMX, steroids for PJP and admitted to the hospital.  His CD4 count came back 10 and a broncheoalveolar was positive on immunofluroescence testing for Pneumocystis Jiroveci.

Author:  Russell Jones, MD

Image Contributor:  James Chenoweth, MD


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EMREMS: Radiology in Emergency Medicine

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