Asbestosis

The patient presented for an unrelated reason, yet his chest XR was quite interesting.
Multiple pleural plaques were noted, likely related to previous asbestos exposure. The patient was employed as pipe fitter for many years prior to 1975.

Considering the abnormal chest XR, underlying malignancy (related or unrelated to asbestos exposure) could not be ruled out. PET scan was performed and no evidence of malignancy was noted.

The patient was complaining on chest discomfort and dry cough likely attributed to asbestosis.

The patient with locally advanced squamous cell carcinoma of the esophagus developed tracheoesophageal fistula. The patient was a poor candidate for surgical treatment. Combined chemo and radiation therapy was attempted.
Two overlapping tracheal stents were placed for tracheoesophageal fistula (see image above).

The patient in her 70’s underwent right pneumonectomy (lung resection) for cancer. Subsequently she developed a right bronchopleural fistula – communication between the lung (bronchus) and the pleural space.

The patient presented with coughing, fever and chest pain in the post-operative period. Several surgeries including fistula closure with a muscle flap have been attempted. Despite aggressive treatment the fistula persisted.

Age over 60years, right pneumonectomy and subsequent radiation/chemotherapy are all the risk factors for the development of a bronchopleural fistula.

56 year old female with a history of morbid obesity and obstructive sleep apnea, presented with a progressively worsening shortness of breath. Arterial blood gas showed evidence of hypoventilation and CO2 retention. Eventually, the patient had to be intubated for respiratory failure. Echocardiography revealed evidence of right ventricular failure and pulmonary hypertension due to chronic hypoventilation and hypoxemia. The Chest XR above demonstrates low lung volumes and a significant amount of subcutaneous tissue.

Lung Cancer on the Chest XR

The patient presented to his PCP complaining of shortness of breath and cough. Chest XR revealed large left-sided lung mass. CT guided mass biopsy confirmed the diagnosis of poorly differentiated adenocarcinoma. Oncology service was consulted.

An elderly female presented to our ER with shortness of breath and cough. Her CT Chest is above. She carries a diagnosis of sarcoidosis that has accelerated in the last few months and is less receptive to steroids. She was treated with steroids and antibioics and discharged to home.

Bronchiectasis due to Cystic Fibrosis

29 year old male with a history of Cystic Fibrosis presented with fever, chills, productive cough and hemoptysis. His chest XR revealed bilateral pulmonary consolidations. The patient was started on IV antibiotics including Meropenem and Tobramycin.

Cystic Fibrosis is an autosomal recessive disease secondary to a defect in a cystic fibrosis transmembrane conductance regulator protein (CFTR). The clinical manifestations are primarily due to the production of thick, viscous secretions in the lungs, pancreas, liver, intestines and reproductive tract.

Pulmonary manifestations often include obstructive lung disease with chronic bronchitis and bronchiectasis (see image above with arrows pointing to the bronchiectasis). The colonization with Pseudomonas Aeruginosa is very common in these patients.

Other manifestations of Cystic Fibrosis may include:
Exocrine pancreas insufficiency leading to malabsorption
Focal biliary cirrhosis
Infertility

64 year old female presented with shortness of breath ang cough. Her Chest XR revealed evidence of pneumonia. The patient had a CT angio chest wich showed calcified clot in her pulmonary artery due to chronic venous thromboembolism. The patient also had a severe pulmonary hypertension and cor pulmonale.

68 year old patient with a previous history of heavy smoking presented with worsening shortness of breath. CT chest revealed bullous emphysema and pneumothorax.