This patient unfortunately has suffered a comminuted, displaced fractured clavicle, a fractured scapula, and there is a fracture fragment inferior to the humeral head (red arrows). When you get the lateral view (see blow), you also note a posterior dislocation with humeral head fracture. The posterior dislocation is suggested on the AP view by the "lightbulb sign" (blue arrow), and by the "rim sign" (green line, medial border of the humeral head is > 6 mm from the anterior glenoid rim).
Remember, a fracture of the scapula is a significant injury and can portend serious intrathoracic and other concomitant traumatic injuries. CT imaging of the thorax is recommended to evaluate for further injury.
For more information on radiographic findings of the shoulder, check this out.
A 32 year old male with a history of HIV, noncompliant with his medications, presents to the ED with a fever, hypoxia, and a cough. CXR is shown below. Given his clinical/medical history, what does this most likely represent, and what lab value might help confirm your diagnosis? What other clinical entity might a CXR like this represent? What is the first line treatment, and what are the indications for steroid therapy in this patient?