September 29, 2009

Sudden onset SOB with pleuritic chest pain

a 40 years old Malay man with known case of TB suddenly develop shortness of breath associated with left sided pleuritic sided chest pain

1) Describe the findings in the above X-ray
2) What is the most probable diagnosis?
3) Outline your management to this patient

For answer & discussion to this question please click [here]


  1. 1-there are consolidation area at the right side of the lung..pleural space seem contain liquid..
    2-empyema secondary to tuberculosis
    3-give antibiotics(xigt dh apa ab dia..huhu)

    so,apa skema jwpn dia??

  2. you got it wrong pal. try to look harder. dont give up. i'll post the answer and disccussion later

  3. well, I never seen this before,

    Maybe pneuomothorax, but i don't see the lung become smaller.

    the dark area on the lung indicate presence of liquid right?

    The heart seems to shift to the right from its original position,
    maybe due to pressure from the left lung.

    Even the right hemidiaphragms was elevated, or the right hemidiaphragms was pushed downward

    For tuberculosis shouldn't it be opacity in the area of lung apical?
    So I don't think its tuberculosis.

    well, I'm just a second year medical students, just trying to learn here..


  4. Nice try adibah,

    well this is a pneumothorax and the left lung is collapsed . that's why you can not appreciate it.

    in x-ray we used term radio-opaque (white) and radio-lucent (black). so in according to densities it will appear from radio luscent to radio-opaque in this following manner;gas, fat, fluid, bone and metal densities

    so the dark area that u see is actually a massive pleural gas.

    i agree with you that the left hemi diaphragm is slightly depressed when we count it base on anterior rib.

    for TB, you have to re-revise it. apical TB usually indicate re-activation of TB. new tb should be at the primary focus. but in this case, it is post TB. probably the TB already healed. just the scar leaved by it more easily broke

    dont worry, you are doing just fine..

  5. syukran jazilan Akhi Naim..

    Thanks 4 reminding me of primary and 2ndry TB.
    I just remember my PBL case recently where there is radio-opaque at the apical part of the lung.

    so in his case, the diagnosis is broken scar from healed TB?

    what is the best management?


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