It is important to look at the "blind areas" of the CXR in order not to miss important clues. These areas are under the diaphragm, behind the heart, the hilum, and the soft tissues. This CXR shows a lucency over the liver density. The lucency does not conform to the usual bowel configuration. In this clinical context, an important differential diagnosis to be considered is a ruptured liver abscess. This can be confirmed either by bedside ultrasound or CT (Fig. 3.2). Liver abscesses are usually due to organisms like Klebsiella or Amoebiasis. All patients with Klebsiella bacteremia of unknown origin should have imaging studies of the abdomen to rule out a liver abscess.
Case 4. This elderly male has exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. His CXR is shown (Fig. 4.1).
Was this article helpful?