Left Lower Lobe Pneumonia (Retrocardiac)

The radiographs in this case may appear normal to a radiologist in training, especially on a tablet/phone! The lateral radiograph demonstrates an opacity over the posterior lower lobes. In a normal patient, the vertebral bodies should become more radiolucent from the mid thoracic spine to the lower thoracic spine. In this patient, the vertebral bodies appear as the same density or more dense as they approach the diaphragm. When dense appearing lower vertebral bodies are present, review the PA radiograph closer for any airspace consolidation. Since the right lower lobe appears clear, the consolidation is located behind the heart in the left lower lobe.

This child presented to the ER with abdominal pain and a history of asthma. Based on the order of a chest radiograph and an abdominal CT, the diagnosis of pneumonia wasn't high on the ER physician's list. Some of my favorite calls to make are on cases that are ordered for different reasons. This is where radiologists can really help a patient and an ordering physician who might be fishing!