A 75 year old female is admitted with new left sided weakness and atrial fibrillation (AF). A clinical diagnosis of stroke is made. CT head shows no acute haemorrhage and warfarin is subsequently started for AF. The patient remains bed bound. Five days later the patients condition worsens with dyspnoea and hypoxia. CXR reveals consolidation in the right mid and lower zones.
What is the most likely diagnosis?
Aspiration pneumonia | |
Pulmonary infarction | |
Pulmonary oedema | |
Pulmonary alveolar proteinosis | |
Pulmonary haemorrhage secondary to anticoagulation |
The history of stroke and subsequent immobility (supine in bed) raise suspicion of aspiration pneumonia and pulmonary embolism. The patient is anticoagulated making PE less likely and the CXR appearances are against this also. Aspiration pneumonia in recumbent patients commonly affects the posterior segments of the upper lobe and superior segments of the lower lobes.