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Curious CXR.

Graham Pluck¹, Max Friedman¹, Henrietta McGrath²

¹Emergency Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.

Emergency Medicine Journal : EMJ

|July 20, 2019

Summary

This summary is machine-generated.

An elderly man presented with symptoms suggestive of intracranial bleeding but was diagnosed with pneumonia. This case highlights the importance of considering common infections in the elderly, even with atypical presentations.

Keywords:

bacterial chest geriatrics infectious diseases pneumonia/infections x-ray

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Area of Science:

Geriatric Medicine
Pulmonology
Emergency Medicine

Background:

A 98-year-old male with a history of atrial fibrillation on warfarin presented with headache, nausea, malaise, and unsteadiness.
Initial suspicion was intracranial bleeding, prompting referral to the Emergency Department (ED).

Observation:

Vital signs revealed hypertension (BP 210/104) and mild hypoxia (SpO2 95% on air).
Physical examination noted bilateral crepitations and somnolence, with a Glasgow Coma Scale (GCS) of 14.
Cranial CT scan was unremarkable; however, chest X-ray (CXR) indicated significant findings.

Findings:

The chest X-ray revealed acute consolidation, indicative of pneumonia.
Despite initial concerns for a neurological event, the diagnosis shifted to a pulmonary cause.

Implications:

This case underscores the need for a broad differential diagnosis in elderly patients presenting with non-specific symptoms.
Prompt recognition and management of pneumonia are crucial, even when neurological conditions are suspected.
Atypical presentations of common infections like pneumonia in the elderly warrant thorough investigation beyond initial suspicions.