Intended for healthcare professionals

Endgames Spot Diagnosis

An easily mistaken pulmonary opacity

BMJ 2017; 356 doi: (Published 23 March 2017) Cite this as: BMJ 2017;356:j1188
  1. Timothy Shao Ern Tan, foundation year 1 doctor,
  2. Omar Abdulla, specialty registrar in radiology
  1. Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
  1. Correspondence to T S E Tan: timothy.tan.shao.ern{at}

A 54 year old male smoker of 20 pack years presented with a six week history of fever, anorexia, worsening cough, and dyspnoea. He had previously undergone coronary artery bypass grafting. A chest radiograph showed previous sternotomy, borderline cardiomegaly, pulmonary oedema, right lower zone consolidation, and a right mid zone oval density (fig 1). What is the diagnosis for this oval density?

Fig 1

Chest radiograph

Short answer

Encysted pleural fluid in the right oblique fissure.


Apart from the right sided encysted pleural fluid, fig 1 also shows left subpulmonic and right lamellar effusions. Overall, the radiological findings suggest congestive heart failure with coexisting right lobar pneumonia caused by Mycoplasma pneumoniae (organism confirmed on laboratory testing).

On …

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