Normal Chest X-Ray

Despite the ever-increasing number of new diagnostic imaging techniques available to today's clinician, the chest x-ray remains a simple, easy, inexpensive, and most informative examination. In some areas it has been replaced by more sensitive techniques; for example, sonography in the evaluation of pericardial effusions. Still, the chest roentgenogram provides invaluable information as part of the crucial first step in differential diagnosis and in following progression of disease. An appreciation of normal, abnormal, and normal variants in cardiovascular anatomy is essential. A systematic approach is presented that sequentially examines (1) heart size and shape, (2) pulmonary vasculature (lung fields and hilum), (3) aorta, and (4) thoracic cage.

This chest x-ray shows coal worker's lungs. There are diffuse, small, light areas on both sides (1 to 3 mm) in all parts of the lungs. Diseases that may result in an x-ray like this include: simple coal workers pneumoconiosis (CWP) - stage I, simple silicosis, miliary tuberculosis, histiocytosis X (eosinophilic granuloma), and other diffuse infiltrate pulmonary diseases.

This picture shows complicated coal workers pneumoconiosis. There are diffuse, small, light areas (3 to 5 mm) in all areas on both sides of the lungs. There are large light areas which run together with poorly defined borders in the upper areas on both sides of the lungs. Diseases which may explain these X-ray findings include complicated coal workers pneumoconiosis (CWP), silico-tuberculosis, disseminated tuberculosis, metastatic lung cancer, and other diffuse infiltrative pulmonary diseases.

Silicosis with progressive massive fibrosis. Image shows large, conglomerate nodules in both the middle and upper lung zones. Peripheral hyperlucency represents emphysematous lung tissue secondary to central migration of the large nodules. Also shown is evidence of volume loss in both upper lobes

The patient, a 31-year-old male. He complained of shortness of breath at rest and with exertion, dry cough, and cough with phlegm. Additional symptoms included fatigue, chest tightness, wheezing, and decreased ability to perform physical activity. The patient ’ s major occupation was the installation of new carpeting and the removal of old carpets, stripping and patching floors using cement and water, and scraping and cleaning floors. In the process of his work, he used adhesives and glues on floors. The patient mentioned that there was usually a substantial amount of talc present when installing new carpeting.

An abnormal Chest X-Ray showing a cancer in the patient ’ s right lung

Asbestosis

Clinical presentation: 66 year old man, who smokes 30 cigarettes a day and used to be an office manager for an insulation company

Chronic hypersensitivity pneumonitis: radiographic findings. Posteroanterior chest radiograph shows mild bilateral reticular pattern in the lower lung zones in a 58-year-old woman with symptoms of dyspnea over two.years