A 50-year-old male smoker presented with three episodes of hemoptysis over one day, expelling 100-150 mL of blood-stained sputum each time. On examination, his left lung fields were dull to percussion and breath sounds were diminished. A chest x-ray showed a homogeneous opacity in the left upper, middle, and lower lung zones, with the left diaphragm and heart border not visible. Differential diagnoses included left lung collapse or fibrosis. A chest physician suspected central bronchogenic carcinoma as the cause of the collapse.
2. 50 yr male old came with c/o
Hemoptysis three episodes over 1 day
◦ Around 100-150 ml per episode
Blood stained sputum since morning
No h/o breathlessness.
Past h/o : not a known DM/HT/BA/PT
Personal h/o: known smoker 15 yrs
Contact h/o : no contact with TB
3. O/E conscious ,afebrile
no pallor/icterus/cyanosis/clubbing/LN/PE
VITALS - stable
RS: Tracheal shift to left
apical impulse at 5 ICS lat to mid
clavicular line.
VF,VR diminished Lt side lung fields
Dullness in same side on percussion
Lt side BS absent
Rt side NVBS heard.
4.
5. Chest x ray PA view
In full inspiration
Properly positioned
Adequate penetration
Soft tissue shadow normal
6. Trachea shifted to left
Homogenous opacity seen in lt upper/ mid/lower
lung zones
Lt diaphragm silhouetted
Lt heart border couldn’t be made out.
Lt side crowding of ribs+
Rt side hyperinflation+
12. CAUSES OF CENTRAL OBSTRUCTION
In children:
mucous plug,foreign body
<40 YRS :
mucous plug,F.body,endo broncial
tumour[lowgrade]
>40YRS:
bronchogenic ca.
13. Collapse reversed in 3 days.
Probably a mucous block which has been
coughed out.
CT shows bronchiectactic changes in left
lower zone.
FOB: no mass or block detected.
16. INDIRECT SIGNS:
local opacity
diphragmatic elevation
mediastinal shift
Approximation of ribs
overinflation of remainder lung
displacement of hila
absence of visibility of inter lobar A.