A breathless woman with asthma

doi:10.1136/bmj.b4008

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Robert H Thomas, specialist registrar in radiology,
Christopher Burke, specialist registrar in radiology,
David Howlett, consultant radiologist

¹Eastbourne District General Hospital, Eastbourne BN21 2UD

Correspondence to: R H Thomas roberththomas{at}gmail.com

A 36 year old housewife presented to the accident and emergency department because of increasing breathlessness, wheeze, and productive cough over the past two weeks. She had a history of asthma, which was well controlled with inhalers, but had no other history of note and was a non-smoker.

On examination, she was dyspnoeic but afebrile, with a prolonged expiratory wheeze at the left base.

Posteroanterior chest radiography was performed as part of her initial investigations (fig 1⇓).

Fig 1 Posteroanterior chest radiograph

Questions

1 What radiological abnormality is present?
2 What is the most likely cause considering her history?
3 How would you treat her?

Answers

Short answers

1 The chest radiograph shows a triangular shadow of soft tissue density behind the heart in the left lower zone. It also shows a loss of clarity in the adjacent descending thoracic aorta and the left hemidiaphragm in its medial portion, with depression of the left hilum. These features are consistent with left lower lobe collapse.
2 In a patient of this age with known asthma, the most likely cause is mucous plugging and bronchiole obstruction. In older patients or smokers, the most common cause of lobar collapse is a stenosing lesion secondary to bronchogenic carcinoma.
3 The patient should …