At this point, his pulmonary function tests revealed an obstructive defect that was not reversible with bronchodilator. His lung volumes were high with moderate gas trapping and some hyperinflation (elevated FRC). His FVC is low likely related to his previous lobectomy and the gas trapping. He was treated acutely with a five day course of oral steroids.
He improved with this and was not seen for six months. During those six months he had an additional course of oral steroids and two courses of oral antibiotics. He also developed symptoms of nausea and vomiting associated with retrosternal burning. He was treated empirically with ranitidine for presumed gastroesophageal reflux. He improved.
Two weeks later he then presented with increased shortness of breath. He did not look toxic, his oxygen saturation in room air was above 94% but he was slightly tachypneic and febrile.
A
chest x-ray was done. PRESENTED
BELOW
ENLARGE X-ray left,
X-ray right.
WHAT
IS YOUR INTERPRETATION OF THE CHEST X-RAY?
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