Inhalation Anthrax Chest X-ray
The classic appearance of inhalation anthrax on a chest x-ray is mediastinal widening with clear lungs. However, some patients do present with the additional finding of (hemorrhagic) pleural effusion. The differential diagnosis of mediastinal widening includes normal variant (fat or tortuous vessel), aneurysm, or a soft tissue mass (primary neoplasm or enlarged lymph nodes). A CT scan with contrast is ideally situated for analysis of the widened mediastinum, having the ability to distinguish between nonvascular and vascular lesions and can often provide a specific diagnosis. The appearance of a widen mediastinum in a patient with fever, myalgias, or dyspnea should suggest the diagnosis of inhalation anthrax.
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