Chest Xray - Things you might miss

A 76 years old male patient admitted to the medical casualty ward with low-grade fever for 2 days with rhinitis and cough. He was on losartan for hypertension. His grandchild also has had similar symptoms a couple of days back.

On examination the lungs were clear.

WBC - 7.6, Hb 11.8, Plt 234, RBS 92, CRP 4.2



How will you manage the patient?

 Well, the upper respiratory tract infection will settle on its own. You might not have to do anything. If there is an epidemic of influenza you may use oseltamivir.

 Chest Xray shows some features of hyperinflation. So, take a history of smoking and other exposure. If the patient has exertional SOB you can manage as COPD.

 But, if you look carefully, chest Xray also shows a rib that's too white! What is it? That's due to sclerotic bone mets, probably from a prostate carcinoma.

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