A 32-year-old female nonsmoker is admitted with a 5-wk history of intermittent hemoptysis. She denies any sputum production, fever, or repeated infections. There is no history of contact with TB. On physical examination, the patient is afebrile; she has dullness on percussion and decreased breath sounds in the LLL zone posteriorly. CV exam is normal. PPD is 4-mm induration. Bronchoscopy shows a polypoid lesion paially obstructing the left lower lobe orifice. This lesion bled easily during the procedure. Bronchial washings are negative for malignancy and the biopsy is pending. Chest x-ray is shown below.What is the radiological diagnosis?
High-Yield Explanation
This x-ray shows a classical "sail sign," i.e., a double density seen in the retrocardiac area. This opacity has a homogeneous pattern with no air bronchograms. The left cardiac silhouette is clear. This is left lower lobe collapse/atelectasis. The presence of a polypoid lesion obstructing the left lower lobe orifice is the cause of the left lower lobe atelectasis seen on the x-ray. The absence of air bronchograms is evidence against pneumonia, and failure to see the visceral pleural line with a collapsed lung rules out pneumothorax. There is no evidence of pleural disease and no pleural effusion is seen.