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Roentgenogram of the Month |

Right Apical Opacification on a Chest Radiograph and Chest Pain*

Jonathan Spratt; Sylvia Worthy; Andrew Grainger; Stephen Bourke
Author and Funding Information

*From the Departments of Respiratory Medicine (Dr. Bourke) and Radiology (Drs. Spratt and Worthy), Royal Victoria Infirmary, Newcastle-on-Tyne; the Department of Radiology (Dr. Grainger), Freeman Hospital, Newcastle-on-Tyne, UK.

Correspondence to: Jonathan Spratt, FRCS, FRCR, Department of Radiology, University Hospital of North Durham, North Rd, Durham DH1 5TW, UK; e-mail: jonathan.spratt@medix-uk.com



Chest. 2003;124(3):1143-1144. doi:10.1378/chest.124.3.1143
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Extract

A 55-year-old man presented to the hospital on several occasions with “atypical” chest pain sometimes consistent with angina, with normal ECG findings and cardiac enzyme levels. The only risk factor for ischemic heart disease was smoking 10 to 20 cigarettes a day. His medical history included hematuria, with normal IV urogram and cystoscopic findings. He was unable to perform an exercise test due to severe diffuse “arthritis” (previous radiographic confirmation of lumbar and cervical osteoarthritis), and results of a subsequent dipyridamole myocardial perfusion scan suggested mild ischemic heart disease. He was started on treatment with aspirin, atenolol, and glyceryl trinitrate spray. A chest radiograph (Fig 1 ) was performed that revealed a new hazy opacity in the right upper zone, and referral to a chest physician was made. Subsequent bronchoscopy did not show any endobronchial lesion, and test findings of BAL fluid for cytology, bacteria, mycobacteria, fungi, viruses, and Pneumocystis carinii were negative. CT of the thorax showed no evidence of a lung mass, and he was assumed to have had a transient area of infective consolidation. However, another chest radiograph revealed persistent unchanged right-upper-zone opacification.

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