Presentation
Increasing shortness of breath. On home oxygen.
Patient Data
The lungs are hyperexpanded. Obscuration of the right heart border. Prominent main pulmonary trunk, suggestive of pulmonary arterial hypertension.
Comparison with chest x-ray 5 years earlier demonstrates a pectus excavatum on the lateral projection. The lungs are also hyperexpanded,
Case Discussion
Lung hyperinflation or hyperexpansion can be normal, especially in young patients who take a large breath in for an inspiratory chest radiograph or can reflect COPD. The latter is the cause in this case due to a history of heavy smoking and a clinical diagnosis.
Pectus excavatum is a great mimicker of right middle lobe collapse or consolidation. The shift of the heart to the left and horizontally oriented ribs are good clues, and a lateral projection will confirm the diagnosis.