A 70-year-old man with a history of emphysema and progressive dyspnea is admitted with mild hemoptysis. On exam, he is afebrile; he has a left-sided chest wall scar from a previous thoracotomy with decreased breath sounds in the left lung field. There are wheezes and rhonchi heard in the right lung field. The CXR is shown in . Based on the CXR and clinical history, the most likely diagnosis is
This chest x-ray shows opacification of the left lung field with surgical rib changes and clips seen near the left main stem secondary to a left pneumonectomy. Multiple nodular opacities of varying sizes are seen in the right lung field. These changes are characteristic of metastatic disease. With the history of a left-sided thoracotomy and chest radiograph changes consistent with a pneumonectomy, the rightsided lesions are most likely metastatic lung cancer. There is no clinical evidence of a mucus plug with atelectasis, although the roentgenographic picture of a homogeneous density without air bronchogram with an ipsilateral mediastinal shift is typical of lung atelectasis. The history does not suppo other choices.
Left lung atelectasis with mucus plug
Metastatic lung disease from lung primary
Multiple pulmonary infarcts
Septic emboli
Respiratory system