An 85-year-old male was admitted with a rapid increase in his shortness of breath, and blood-stained frothy sputum. His dyspnoea started just before going to sleep and, within a few hours, he became increasingly breathless. His past medical history included atrial fibrillation (on warfarin), aortic valve replacement (porcine), previous infective endocarditis, gout, hypothyroidism and hypertension. His medications on admission were warfarin alternating between 5 and 6 mg once daily (q.d.), furosemide 120 mg once monthly and 80 mg q.d., levothyroxine 50 μg q.d., allopurinol 400 mg q.d., candesartan 16 mg q.d., digoxin 125 μg q.d.
On examination, the patient was in respiratory distress with a arterial oxygen saturation (Sa,O2) of 96% on 8 L of oxygen and a respiratory rate of 28 breaths·min−1 but was normotensive and afebrile. On auscultation he had diffuse bilateral crackles with raised jugular vein pressure. A chest radiograph (fig. 1) and chest computed tomography (CT) scan (fig. 2) were performed.
Task 1
How would you interpret this chest radiograph?
Answer 1
There has been a previous sternotomy. There …