Patient ID: OH#__TOH 1086797-6_______ Date of Study: _Nov 15, 2008; 21:20______
Type of Study: _CXR____________________________________________________
1. Clinical Indication: __90 yo male admitted from Retirement Home with sudden SOB,
increased cough x 1 month with purulent sputum and trace hemoptysis.
O/E: Chest – decreased air entry, RML dull, bibasilar crackles present, egophany present
ECG: ECG: NSR at 80, Normal axis, normal intervals, no ischemic changes
2. Picture:
2. Describe the radiological findings:
There is consolidation in the right middle lobe and mid left lung in keeping with
pneumonia. Some air bronchograms are present. There is good inspiration with 7 ribs
seen anteriorly. There is no air under the diaphragm or pleural effusions. The heart is
within normal size limits (<50%) of the width of the chest cavity. There appears to be
some flattening of the left hemidiaphragm, which may suggest COPD. The trachea
appears slightly deviated to the right, however it is likely due to the fact that the patient is
slightly rotated to the right as visualized by the clavicles which are not equidistant. There
is no evidence of a tension pneumothorax. No other new findings are seen.
3. Provide possible diagnosis(es):
Community Acquired Pneumonia, Aspiration, _
4. What would you recommend next for this patient?
_Since the patient is presenting to the ER, I would start a course of IV antibiotic therapy
(respiratory fluroquinalone) for 10 days, and bridge to oral antibiotics when patient starts
improving. If a sputum culture is obtained, narrow the antibiotics once culture
sensitivities are returned by the lab.
5. Is the use of this test/procedure appropriate?
_Yes, is quick, efficient, little harm to the pt, and easy to interpret.__________________
6. Is(are) there any alternate test(s)?
Sputum gram stain: purulent should be > 25 PMNs/lpf.
Sputum culture
Blood cultures before antibiotics
SaO2 or PaO2
Other laboratory evaluation: CBC with differential, electrolytes, BUN/Cr,
glucose, LFTs
7. How would you explain to the patient about the possible risks and benefits of this test?
RISKS: X-rays are a form of electromagnetic radiation that pass through the body. Due
to their high energy nature, they can damage cells in the body. This can lead to an
increased risk of developing cancer. This risk is fairly low, but is cumulative with each
X-ray a person receives.
BENEFITS: The benefit of the X-ray is that it will quickly provide a picture of what is
happening in the lungs and help to confirm a suspected pneumonia. It is non-invasive,
causes little discomfort for the patient, and if the patient is immobile can be administered
at the bedside (portable - although not ideal).
8. What is the cost of this test?
The cost of a CXR is approximately $50-80, not including the cost of interpretation by a
radiologist or physician. (Source: www.enlmedical.com). (Note: It was very difficult to
find the actual cost of an x ray, although various databases and sources were searched
including CIHI, e-medicine, Uptodate, etc.) _