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Special Feature
July 20, 2009

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:Department of Internal Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, India.



Arch Surg. 2009;144(7):693-694. doi:10.1001/archsurg.2009.106-a

A 48-year-old patient presented with sudden-onset, severe respiratory distress for 3 to 4 days. This was associated with chest pain. The patient was also complaining of vomiting for 1 day. The patient had no history of any respiratory disease and his medical history was unremarkable. There was no history of any fever, cough, or expectoration. The patient had been assaulted while taking part in a procession 4 months earlier. However, he had no complaints before this illness. Chest radiographs (posteroanterior [Figure 1] and left lateral [Figure 2]) were done at the emergency department.

Figure 1. 
Posteroanterior chest radiograph on hospital admission.

Posteroanterior chest radiograph on hospital admission.

Figure 2. 
Left lateral chest radiograph.

Left lateral chest radiograph.

What Is the Diagnosis?

A. Hydropnemothorax

B. Multiple lung abscess

C. Tubercular pyopneumothorax

D. Diaphragmatic hernia with intestinal obstruction

E. Staph pneumonia with pneumatocele