Chest X-ray ward round

Case 2:

65-year-old ex smoker presents with a 6-week history of increasing SOB and cough

Chest CXR (Click to enlarge)

Questions:

What does the X-ray show?

What is the diagnosis and differentials?

Cancer: most often squamous cell carcinoma (primary or metastasis)
Autoimmune (granuloma from GPA or RA)
Vascular (septic pulmonary emboli)
Infection: TB, aspergillus, pneumococcal pneumonia, klebsiella, staph aureus pneumonia

What is the management?

Notes:

Sputum culture was negative for TB, sputum cytology showed no malignant cells

Aspergillus IgE was positive

Discussed at lung MDT: Cancer

This patient was not fit for bronchoscopy but improved with prolonged course of antibiotics