60 year old male with a history of homelessness, latent tuberculosis, and methamphetamine abuse. The patient was admitted to the hospital for shortness of breath and leg edema. A urine drug test on admission was positive for methamphetamine.

Chest radiograph (right) shows an enlarged cardiac silhouette, for which a differential of cardiomegaly or pericardial effusion was provided. Subsequent echocardiogram confirmed this was cardiomegaly with a low ejection fraction. The pulmonary vascular markings on the chest x-ray are also prominent, compatible with congestion from heart failure. The patient has a normal past chest radiograph (left) that provides an easy comparison for these findings.

  • @APVoidEnglish
    1•1 year ago

    Just curious, how far apart in time is the comparison radiograph?

    • @SpectatorOPMEnglish
      2•1 year ago

      I didn’t actually save that information, and this is from many years ago now. I guess within 5 years between the two x-rays since, aside from the dramatic changes in the heart and lung markings, the bones and soft tissues look unchanged. Most people, homeless or not, tend to move and end up in different hospital systems past that point. My notes say he was seen at another hospital for these symptoms, so this is the first time in our system we saw him with that brand new heart size.