What do these x rays indicate?

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Posted on Mon, 14 Sep 2015 in Lung and Chest disorders
Question: Hi after a large right sided pleural effusion/pnemonia and type 1 respiratory failure is a raised right hemidiaphragm likely due to damage to the lung?
doctor
Answered by Dr. Kaushal Bhavsar 53 minutes later
Brief Answer:
Yes,possibility of lung damage is more.

Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
I have gone through the x rays you have attached.
Possibility of underlying lung damage is more.
And in this, infection is more likely. So better to get done aspiration of pleural fluid and microscopic examination, culture examination to identify the causative organism. On the basis of this antibiotics are given.
You may need intercostal drainage tube for fasten recovery.
So better to consult pulmonologist and get done intercostal tube insertion.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 10 hours later
Hi thank you for your answer. Could you tell me if the xray from the 13.06.14 I have uploaded show a pleural effusion? I did get the effusion drained and was given antibiotics but I now have eventration of right hemidiaphragm, I assume because there is lung damage.
doctor
Answered by Dr. Kaushal Bhavsar 1 hour later
Brief Answer:
Yes,X ray dated 13-6-14 is having pleural effusion.

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
Chest x ray dated 13-06-14 is having right sided CPA (Costo Phrenic Angle) bunting with higher right sided diaphragm. So possibility of sub pulmonic effusion. In this kind of effusion, fluid collects between under surface of lung and diaphragm.
But in chest x ray dated 14-6-14, you are having increasing pleural effusion.
So please let me know
1. Do you have any recent x ray?
2. Pleural fluid aspiration done after x ray dated 13-06-14 or after chest x ray dated 14-6-14?
3. At present what symptoms you have?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 22 minutes later
Dear Doctor Bhavsar,
I unfortunately do not have a recent xray, I am just trying to get an understanding of what happened with my lungs. I have uploaded two ct images from 13.06.14 and a chest xray from the 15.06.14 which shows the chest drain in situ, due to a blockage ( of a gungy substance)in the chest tube no further fluid was drained so the fluid that is there was not drained further from the xray dated 15.06.14, I was sedated and mechanically ventilated at this point. I have uploaded a further xray from the 17.06.14 which is when I was extubated as I had type 1 respiratory failure due to pleural effusion/pneumonia as you rightly suggested. If possible and if you would be so kind, looking at the xrays and ct scan images do you think the reason for my right sided elevation is potentially due to lung damage? Current diagnosis states Eventration of right hemi diaphragm with normal diaphragmatic function on lung physiology, normal CT thorax. No bronchial neoplasms and diaphragm shows complete normal movemnet up to three intercostal spaces on deep inspiration and expiration.
doctor
Answered by Dr. Kaushal Bhavsar 19 minutes later
Brief Answer:
Yes, eventration is due to lung damage.

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
I have gone through the CT images and new x rays.
You are having very severe, sudden onset massive pleural effusion. And intercostal drainage is the only option.
After healing, diaphragm eventration is likely.
But no need to worry for this because your function of diaphragm is normal.
Please let me know
1. What kind of treatment you had after discharge? I mean antibiotics, anti tubercular drugs?
2. Had doctors ruled out tuberculosis?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 15 minutes later
I was on mechanical ventilation for 4 days with high dose intravenous antibiotics given for 10 days in total, no further antibiotics all cultures tested negative for all bacteria etc including tuberculosis. My lung has never been able to breath as deeply since this happened and I was still having pain for 8 weeks after discharge and given anti inflammatory. I get out of breath if I walk and talk at the same time, bend over or lift, my breathing is more difficult when humidity rises.
doctor
Answered by Dr. Kaushal Bhavsar 2 hours later
Brief Answer:
Possibility of post infectious bronchitis is more.

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
By your history, description and current symptoms, possibility of post infectious bronchitis is more.
Severe bacterial infection actually causes inflammatory changes in lung.
And in some patients, this can stay long and cause bronchitis.
So please let me know
1. Have you ever undergone PFT (Pulmonary Function Test)?
2. If you had PFT than what is your latest PFT report? Was it normal?
3. Are you smoker at present or in past?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 40 minutes later
I have had sniff test and other test breathing into machines, I have also had sputum and mucus cultures, no infection. I have had physiotherapist teach me exercise to clear mucus from my lungs as I cough and clear mucus much more now.
On the 12th I went t hospital as I was getting pain with my breathing and short of breath, I had chest xray which I have uploaded (day before first xray I have showed you) they said lower respiratory tract infection/pleurisy as xray showed atelectasis and consolidation in my lower right lobe. I had no temperature, dry cough and my CRP levels were up, WBC was slightly raised.What I would like to know is on the 13th I suddenly developed excruciating pain, I could not breath at all as it was so painful, I could not lie down as it was much worse and I could not talk properly. My stomach muscles were tensing up as I was trying to breathe and pan relief was not really helping. Could this have been when i had the sudden onset of massive effusion, this occured about 5 hours before the xray on the 13th was taken?
doctor
Answered by Dr. Kaushal Bhavsar 5 hours later
Brief Answer:
Pleurisy might have started before 13-06-2014.

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
Honestly speaking, there is no fix time or specific period for development of massive pleural effusion and symptoms.
Symptoms starts after infection. So first to occur is symptom of chest pain, cough and breathlessness.
This causes reaction in the pleura and development of fluid in pleural cavity.
So you are not having massive pleural effusion before 13-06-14. You developed massive pleural effusion in one day.
Sudden development of this can cause respiratory failure. So you were ventilated and intercostal drainage was put.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 14628 Questions

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