Gordon had an elderly patient who presented via MAS sats 70%, diaphoretic, altered conscious state, HR 90. He had a hx of COPD, HT and CCF. No further hx.
Listening to his chest he had a few scattered crackles only.
CXR was not very helpful (see below)
Gordon did a lung US and echo which clarified the diagnosis of APO, R sided pleural effusion and cardiomyopathy.
Multiple coalescing B lines (vertical) seen anteriorly R and L.
Normal lung with horizontal A lines for comparison
R pleural effusion with collapsed lung.
dilated CM on PLAx
The patient had prompt and appropriate management for APO and responded well.
Bilateral multiple B lines anteriorly in a hypoxic patient is typically due to APO. However, other differentials could be:
1. bilateral pneumonia (would also have thickened pleural line)
2. pulmonary fibrosis (PHx and thickened pleural line)
3. ARDs (patchy, there will be skip areas, abnormal pleural line)
Cardiac US can also help with differentiation.