This is the chest x-ray for Ray Alderton from scenario SIC001US

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Clinical Picture

  • 42-year-old man presenting with 2 day history of coryza and non-productive cough.
  • Stable renal transplant, no recent issues. No chest pain, no fever, no shortness of breath and no signs of sepsis. Daughter recently experienced similar symptoms.
  • Looks well, normal vital signs, normal physical examination. 

Findings

  • Technical factors
    • Rotation – Normal
    • Inspiration – Adequate
    • Picture – Adequate
    • Exposure – Adequate
  • A-E Assessment
    • Airway – Trachea central
    • Breathing – Clear lung fields
    • Circulation – Normal heart size and border
    • Diaphragm – No abnormalities, no free air
    • Everything else – No abnormalities

Summary 

  • This is a normal chest x-ray

Differential diagnosis

  • Appreciating there was a limited amount of information available, there was no significant concern in the patient history to suggest a sinister cause of cough. Though Ray had a renal transplant, he had no issues with it and the history was highly suggestive of a viral cause. Whilst it may be reasonable to inform Ray’s normal team of the situation, the most likely cause of the cough in this case was a viral respiratory tract infection.

Management

  • Reassurance
  • Symptomatic treatment of a viral infection

Further reading

 

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