A 63-Year-Old Woman with a 4-Day History of Coughing

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)