The CXR shows a left pleural mass. It is usually possible to differentiate this from lung parenchymal masses abutting the pleura which tend to be relatively round with the angle between the mass and the chest wall being acute (unlike here where the angle is obtuse - Fig. 88.2). The CT Thorax (Fig. 88.3) shows that the mass is of fat density confirming the presence of a pleural lipoma, which is benign.
Case 89. This patient is asymptomatic. The CXR is shown (Fig. 89.1).
CASE 89 SWYER-JAMES-MACLEOD'S SYNDROME
The CXR shows typical findings of Swyer-James-MacLeod's Syndrome on the left. The two hallmarks of this condition are unilateral hyperlucency and hypoplastic pulmonary artery. This rare syndrome usually occurs following viral bronchiolitis in childhood. Pneumothorax and bronchiectasis are known complications.
CASE 90 MALPOSITIONED PULMONARY ARTERY CATHETER (PAC)
The most glaring abnormality is that the PAC has migrated too far distally. The potential complications include knotting of the catheter, perforation of the pulmonary artery, and pulmonary artery aneurysms. The ideal position of the tip of the catheter is just 2-3 cm from the midline (Fig. 90.2) on either side. The first clue to distal migration of the PAC is usually a dampening of the pulmonary artery waveform, which must be monitored on a real-time basis.
Case 91. This patient gave a history of being involved in a motor vehicle accident resulting in a crush injury to his torso. He is admitted now for vague abdominal pain. His CXR is shown (Fig. 91.1).
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