A 50 yr old female underwent an operation under ga for fracture rt olecranon.In the immediate postoperative period she started having respiratory distress and falling spo2.On examination bp was160/100,pulse96/min,regular,respiratory rate 46/min,afebrile,no pallor,jvp normal.auscultation revealed bl coarse crepts,more in the basal regions.On investigation tlc21400,n88,lft-wnl,rft-wnl,urine showed6-7 pus cells/hpf.Her chest xray revealed dense consolidation rul and streaky opacities lul.She had no cardiac or pulmonary ailment in the past.She was managed with niv,o2,antibiotics and diuretics. she was relieved within a few hours and the opacities in the chest xray disappeared in the same day. our diagnosis was fluid overload acute heart failure.However what appears confusing is the upper lobe distribution of the opacities,
If you observe carefully the initial xray was taken in the supine position.[ap view].In supine position there is equalization of blood flow in all the lung zones and the effect of gravity is abolished.This gave us the false impression of bacterial consolidation.The raised tlc was probably due to uti where urine c/s showed rich growth of Ecoli.