The CXR shows bilateral calcified pleural plaques, especially over the diaphragmatic pleura. The mid-zones show en face calcification (holly leaf sign). This is typical of asbestos exposure. Previously asbestos was commonly used as an insulating material. Asbestos exposure can also result in benign pleural effusion, round atelectasis, pulmonary fibrosis (asbestosis), or malignant mesothelioma. Differential diagnosis of pleural calcification includes previous hemothorax, empyema, and tuberculosis. CT also demonstrates the calcified pleural plaques (Fig. 37.2).
Case 38. This elderly male was bed-bound because of a massive stroke. Over the past week, he developed a low-grade fever and became tachypneic and hypotensive, requiring resuscitation and mechanical ventilation. What is the radiological sign (Fig. 38.1)? What is the diagnosis?
The CXR shows an oligemic right upper lobe (Westermark's sign) due to acute pulmonary embolism. Other causes of a hyperlucent lung include a right pneumothorax or huge bullae. Other radiological signs of pulmonary embolism are wedge-shaped infarct (Hampton's hump), plate atelectasis, enlarged pulmonary arteries, or small pleural effusion. The CXR may also be normal. CT confirms the clot in the right main pulmonary artery (Fig. 38.2).
Case 39. This middle-aged male was asymptomatic. What is the CXR abnormality (Fig. 39.1)?
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