Examine this patient's chest.



· Sudden onset of breathlessness.

· History of cough.

· History of asthma, TB, lung cancer.


· Trachea deviated to the affected side.

· Movements decreased on the affected side.

· Percussion note dull on the affected side.

· Breath sounds diminished on the affected side.

Proceed as follows:

Tell the examiner that you would like to look for tar staining (tobacco smoking), clubbing and cachexia (bronchogenic carcinoma, see

pp 274-6).


This patient has a collapsed lung (lesion); you would like to exclude malignancy (aetiology). He is breathless at rest (functional



What are the causes of lung collapse?

These include:

· Bronchogenic carcinoma.

· Mucus plugs (asthma, allergic bronchopulmonary aspergillosis; BMJ1982; 285: 552).

· Extrinsic compression from hilar adenopathy (e.g. primary TB).

· Tuberculosis (Brock's syndrome).

· Other intrabronchial tumours including bronchial adenoma.

What are the chest radiograph findings of collapse of the right middle lobe?

The loss of definition of the right heart border reflects collapse (or consolidation) affecting the right middle lc}he

What is Brock's syndrome?

It is collapse due to compression of the right middle lobe bronchus by an enlarged lymph node.

Sir Russell C. Brock (1903-1980) graduated from Guy's Hospital and was surgeon at Guy's and Brompton Hospitals. His interests included both

thoracic and cardiac surgery. He was the President of the Royal College of Surgeons, 1963-1966.