Wednesday, 22 July 2015

xrayoftheweek 29: can you find an abnormality on this chest x-ray?

Can you find an abnormality on this week's #xrayoftheweek?

Did you find the abnormality? This patient has a history of adrenal insufficiency, and if you take a look at the review areas, you will see rounded calcification bilaterally, projected just lateral to the vertebral column. This is adrenal calcification, with secondary Addison's disease.

Most cases of Addison's disease do not have adrenal calcification, with previous haemorrhage (causes include trauma and sepsis due to a variety of bacteria: Waterhouse-Friedrichsen syndrome) and tuberculosis being the main causes of subsequent calcification. This CT shows the adrenal change clearly:

Learning point: review areas on chest x-rays include soft tissues of neck and axillae, behind the heart, and under the diaphragms.

#FOAMed #FOAMrad 

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