(New case) PA x-ray: unclear (pleural) mass.

chron pleural empyema

What would we do to diagnose without CT?
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See 62.

Little change in projection.

Bild 62

better proiection

How is the patient rotated? What do we clearly see in this projection?
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We see rotation slightly in the direction of a LAO projection. It clearly demonstrates the calcified outer and inner wall of the mass:
classical persistent effusion with calcified inner and outer wall.

This new 43-year-old patient  suffered a Grenade splinter injury 36 years ago and had a persistent pleural empyema. The process remained clinically silent. - Repeatedly without knowing older radiographs a new pneumonia was diagnosed. History was not adequately examined.

Bild 63

pleural not parenchymal

Is it really a pneumonia?
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Irregular shadowing but no aerobrochography. We want to see a different projection and/or CT.

This is a conventional tomography; the patient, lying on his back, lifts his right hemi thorax so he reaches a RAO-position.

Bild 64

tomography pleural

What do we see?
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We see a mass enveloped by irregular calcifications;
we see the classical distancing from the chest wall. The neighbouring lung is free.

65.This patient’s CT with this small persistent
empyema (with a shrinking trend).

Bild 65

CT small pleural cavity