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Background
Radiograph of the chest is a common investigation, often performed as screening for respiratory and non-respiratory conditions. Most of the time, abnormalities are not found in chest radiographs in the absence of respiratory symptoms. However, in a few patients, it can be a useful investigative tool to pick up abnormalities that are asymptomatic. The abnormality may be localised to the neck (paratracheal) or chest (lungs, pleura or bones) and may be diffuse or localised. We present a case of a patient who presented with respiratory symptoms and underwent a chest radiograph, which showed an abnormality.
Case presentation
A 60-year-old man, a non-smoker, was referred to us for evaluation of an abnormal chest radiograph. The radiograph had been performed 2 months prior during a bout of fever and cough. At the time, he had no history of chest pain or haemoptysis. He had received oral antibiotics after which his fever and cough subsided. As the radiograph had shown an abnormality, he was asked to go to a specialist centre. When he came to the outpatient department of our hospital, he had no symptoms. He had no history of chronic cough, neck swelling, dysphagia, regurgitation of food, coughing after eating, weight loss or change in voice. He denied any history suggestive of tuberculosis, pneumothorax or connective tissue disease. On examination, he was afebrile with stable vital signs. He had no pallor and no significant peripheral lymphadenopathy. On examination, the trachea was deviated to the left. There was no swelling in the neck at rest or after Valsalva manoeuvre. Examination of the chest, abdomen, cardiovascular and nervous system was unremarkable.
Investigations
Blood examination revealed normal haemoglobin (13.8 g/dL) and leucocyte counts (8700/mm3 ). The patient's blood chemistry including sodium (144 mg/dL), potassium (4.7 mg/dL), urea (27 mg/dL), creatinine (1.0 mg/dL), calcium (9.1 mg/dL), phosphate (3.3 mg/dL), bilirubin (0.4 mg/dL), serum glutamic-oxaloacetic transaminase (29 U/L) and glutamic pyruvic aminotransaminase (34 U/L), alkaline phosphatase (271 U/L), total protein (7.0 g/dL) and albumin was unremarkable. He was carrying the radiograph of the chest along with him ( figure 1 ), which showed a tubular air pocket adjacent to the trachea, on the right side ( figure 1 ). The air pocket was cylindrical in shape and had distinct...