Approach to postoperative respiratory distress Quiz: Ace Your Exams

A 74-year-old woman is being evaluated in the surgical unit for shortness of breath, productive cough, and fever for the past 12 hours. She underwent a partial large bowel resection 6 days ago to remove a necrotic bowel caused by ischemic colitis. She had a postoperative ileus and is now tolerating oral fluids. She has coronary artery disease with 2 coronary stents placed 2 years ago. She takes baby aspirin, pravastatin, and atenolol. Temperature is 38.3°C (100.9°F), blood pressure is 135/74 mmHg, pulse is 105/min, and respirations are 26/min. Pulse oximetry on room air is 90%. Cardiac examination is normal. Lung examination reveals decreased breath sounds in the right base with rhonchi. There is dullness to chest percussion in the right base. There is no jugular venous distention or peripheral edema. Abdominal examination is normal. The incision site is intact without redness or drainage. ABG reveals pH 7.33, Pa02 65 mmHg, and PaC02 46 mmHg. Leukocyte count is 15,000 /mm3. Which of the following findings would most likely be found on a chest X-ray?