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The misleading pre-operative chest radiograph

Department of Radiology, Bristol Royal Infirmary, Bristol BS2 8HW

This excerpt was created in the absence of an abstract.

A 66-year-old man presented to the Accident and Emergency Department with pain in the right hip and difficulty in weight bearing after falling in the street that morning. He smoked about 15 cigarettes a day and had a wheeze which was relieved by Salbutamol. No other relevant history was elicited, apart from a vague story of ill defined upper chest pain in the past.

On examination he was observed to walk with a limp. His right hip was externally rotated, with limitation of movement because of pain. His right lower limb was 2 cm shorter than the left. Radiographs of the pelvis and chest and an apical view are shown in Figs 1 and 2 and frontal tomography of the chest was subsequently performed (Fig. 3).

What are the abnormalities demonstrated? What differential diagnosis should be considered and what might skeletal scintigraphy reveal?

A bone scintigram was performed a few days after admission to hospital. The right femoral head was imaged to assess vascularity (Fig. 4).

^* Current address: X-ray Department, Kwara State Specialist Hospital, PMB 1452, Sobi-Ilorin, Kwara State, Nigeria.

Received for publication September 1, 1987. Revision received June 1, 1988.