100 Chest X-rays: Reported and Annotated JUST LIKE THIS
Can you report the X-ray and put in place a management plan?
Turning over the page reveals a full on-image colour annotated X-ray, along with the report, detailing everything you should be expected to see on the X-ray.
Full Report Covering Every Detail Of The X-Ray You Need To Know
Penetration: Adequate – vertebral bodies just visible behind heart
Inspiration: Adequate – 8 anterior ribs visible
Rotation: Not rotated
The upper trachea is central. The lower trachea is displaced to the right by the aortic arch.
There is heterogeneous air space opacification in the right upper zone. This has a relatively well defined inferior margin, which is likely to represent the horizontal fissure. There is a focal area of increased opacification in the right upper zone, which may represent focal consolidation or an underlying mass. The remainder of the lungs are clear. The lungs are not hyperinflated.
The pleural spaces are clear.
Normal pulmonary vascularity.
The heart is not enlarged.
The heart borders are clear.
There is unfolding of the thoracic aorta, which displaces the lower trachea to the right.
The mediastinum is central, not widened, with clear borders. There is a welldefined density projected over the lower mediastinum, which is in keeping with a hiatus hernia.
Normal size, shape, and position of both hila.
DIAPHRAGM + DELICATES
Normal appearance and position of hemidiaphragms.
The imaged skeleton is intact with no fractures or destructive bony lesions visible.
The visible soft tissues are unremarkable.
EXTRAS + REVIEW AREAS
ECG electrodes in situ.
No vascular lines, tubes or surgical clips.
Lung Apices: Heterogeneous right apical consolidation. Normal left apex
Behind Heart: There is a retrocardiac density, which represents a hiatus hernia
Costophrenic Angles: Normal
Below the Diaphragm: Normal
Fully Annotated X-Ray, With On Image, Colour Labeling For Unbeatable Clarity
SUMMARY, INVESTIGATIONS & MANAGEMENT
This X-ray demonstrates heterogeneous right upper zone consolidation in keeping with pneumonia. The consolidation has a relatively abrupt inferior margin in keeping with the horizontal fissure, indicating this is right upper lobe pneumonia. A focal opacity in this region may represent focal consolidation or a mass. Incidentally, there is also a hiatus hernia.
Initial blood tests may include FBC, U/Es, blood cultures, and CRP. A sputum culture may also be taken. The patient should be treated with appropriate antibiotics for community-acquired pneumonia, and a follow-up chest X-ray performed in 4-6 weeks to ensure resolution. The antibiotics may be oral or intravenous depending on the severity of pneumonia (CURB-65).
If the focal opacity in the right upper zone does not resolve then a CT of the chest and abdomen with IV contrast would be appropriate to assess for a lung tumour. It would also be useful to review previous imaging and case notes to see if there was an abnormality at this site before.
President, Students Section, Royal Society Medicine
BSc in Medical Imaging, Year 4 Medical Student, University of Leeds
Catherine Elizabeth Lovegrove
BSc (Hons.), Final Year Medical Student, King’s College London
Medical Student, University of Birmingham
Final year medical student at KCL
Fourth year medical student, St George’s University
Fourth Year Medical Student, University of Leeds
Junior Doctor, Great Ormond Street Hospital, UK