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Monday, June 26, 2017

Congestive Cardiac Failure As Seen On Chest X ray

An elderly male presents with a history of exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.

His chest x ray is shown below:


Diagnosis : Congestive cardiac failure

Discussion: The Chest X Ray shows classic evidence of left ventricular failure, i.e.

  • cardiomegaly (cardiothoracic ratio >50%), 
  • upper lobe pulmonary venous diversion, and 
  • Kerley B lines (which indicate distension of lymphatics). 

In addition, there is evidence of sternotomy wires, suggesting previous coronary artery bypass surgery (CABG).

Followup Of this Patient: Following diuresis, the pulmonary infiltrates have cleared . (X ray shown below).
Only fluid and blood on the chest radiograph can clear rapidly (within days). This patient also has a right internal jugular central venous line.


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