Endgames Picture Quiz

An abnormal chest radiograph

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6592 (Published 13 November 2014) Cite this as: BMJ 2014;349:g6592
  1. Avinash Aujayeb, specialist respiratory registrar1,
  2. Mark Weatherhead, consultant in respiratory medicine1
  1. 1Department of Respiratory Medicine, Wansbeck General Hospital, Ashington NE63 9JJ, UK
  1. Correspondence to: A Aujayeb aujayeb{at}doctors.net.uk

A 55 year old man presented to the emergency department with syncope after laughing. His full examination was documented as normal, and no abnormalities were seen in his electrocardiograph or routine blood tests. Blood pressure when lying and standing was normal. However, his chest radiograph and the results of computed tomography were abnormal (figs 1 and 2).

Fig 1 Chest radiograph

Fig 2 Computed tomogram of the chest

He had never smoked, had no occupational dust exposure, and had no pets such as birds or cats. He had noticed some exertional dyspnoea and a mild cough over the past few months, but no haemoptysis. In addition, he had no weight loss or night sweats.


  • 1. What does the chest radiograph show?

  • 2. What does the computed tomogram show?

  • 3. What are the differential diagnoses?

  • 4. What further investigations and management would you plan?


1. What does the chest radiograph show?

Short answer

There is marked deviation of the trachea to the right, with a homogeneous opacity in the upper mediastinum.

Long answer

The radiograph shows marked …

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