An interesting chest radiograph

doi:10.1136/bmj.a1505

Published 24 September 2008, doi:10.1136/bmj.a1505
Cite this as: BMJ 2008;337:a1505

Endgames

Picture quiz

An interesting chest radiograph

Sylvia A O’Keeffe, specialist registrar, Andrew McGrath, specialist registrar, Graham Wilson, consultant radiologist

¹ Department of Radiology, St James’s Hospital, Dublin 8, Ireland

Correspondence to: S A O’Keeffe sylviaokeeffe@yahoo.co.uk

The first 150 words of the full text of this article appear below.

A 63 year old man presented with a two week history of shortnessof breath, fatigue, and cough. He had a 20 pack year ((numberof cigarettes smoked each day times number of years smoked)/20)smoking history and no appreciable occupational exposure todusts such as asbestos or coal. On examination his trachea wasslightly deviated to the left with slightly diminished breathsounds over the left lung.

1. What does the figure

show?

2. What is the luftsichel (airsickle) sign?

3. What disease processes can cause this finding?

4. What further investigations are needed?

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Fig 1 Patient’s posteroanterior radiograph (a) and lateral chest radiograph (b)

1. Posteroanterior and lateral chest radiographs show completecollapse of the left upper lobe.

2. In left upper lobe collapse,hyperinflation of the superiorsegment of the left lower lobeoccurs. This aerated segmentis lucent and shaped like a sickle;it outlines . . . [Full text of this article]