Differential Diagnosis

  • Airway obstruction
  • Hyperlucent lung
  • Pneumothorax
  • Unilateral emphysema

Diagnosis

No acute lung infiltrates; left lung hyperlucent postmastectomy.

Learnings/What to Look for

  • Common causes include:
    • Compensatory distention of adjacent lobe or lung
    • Contralateral increased density (eg, chest wall hemihypertrophy; pleural effusion)
    • Emphysema, bullous or diffuse; large bulla
    • Air trapping (eg, bronchial foreign body, stricture, mucus plug or neoplasm)
    • Pectoral muscle absence, congenital (eg, Poland syndrome) or surgical (mastectomy) or atrophy (eg, polio)
    • Pneumothorax
    • Scoliosis
    • Technical factors: positioning (eg, patient rotation); grid cutoff

 

Pearls for Urgent Care Management and Considerations for Transfer

  • Consult the history for prior surgery or infections
  • Assess the soft tissues to exclude mastectomy (as in this patient)
A 63-Year-Old Woman with a 4-Day History of Coughing
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