Chest x-rays

CLINICAL DETAILS:

Emphysema.

CHEST:

The heart size is normal and the lungs are clear.

CLINICAL DETAILS:

Ca lung. Change in bronchoscopy one week ago. Left-sided back pain.

CHEST

There is a dense consolidation distal to the central lesion at the right hilum. A right pleural effusion is also present. The widening of the superior mediastinum and old left-sided healed rib fractures are noted.

CLINICAL DETAILS:

Pre op for GA.

CHEST:

The lungs are hyperinflated and show coarsening of the bronchiovascular markings. There is additionally a soft tissue opacity on the left perihilar region which is associated with elevation of the left hemidiaphragm.

CLINICAL DETAILS:

Pre op for GA.

CHEST:

The lungs are hyperinflated and show coarsening of the bronchiovascular markings. There is additionally a soft tissue opacity on the left perihilar region which is associated with elevation of the left hemidiaphragm.

CLINICAL DETAILS:

Ca breast SOB. ? Cause

CHEST:

Permanent pacemaker in situ. Cardiomediastinal contour within normal limits. No pulmonary metastatic deposits identified.

CLINICAL DETAILS:

Previous carcinoid lung. Recent fever.

CHEST:

A rounded soft tissue mass overlying the right lung base adjacent to the right side of the cardiac silhouette has not changed significantly in appearance since the previous film. It measures approximately 3 cms in diameter. There does not appear to be any associated consolidation around this mass lesion.

An area of very poorly defined increased opacity is projected over the right upper zone, over the right clavicle. A small rounded lucency is seen within this area of increased opacity. I am not sure if these appearances are due to a composite opacity, or whether they represent intrapulmonary disease. A lordotic film would be useful to project this area clear of the overlying clavicle in order to assess it further.

COMMENT:

Carcinoid tumour right lung base. Possible area of parenchymal abnormality in the right upper zone. Lordotic film advised.

CLINICAL DETAILS:

Dull left base. ? Cause.

CHEST:

No change is identified in comparison with the previous image of 18/9/97: there is tenting of the left hemidiaphragm indicating loss of volume at the left upper lobe. This is confirmed by the elevation of the left hilum.

The right lung remains clear. Again there is evidence of severe atheromatosis of the thoracic aorta with dilation of the lumen and extensive calcified plaques. The differential diagnosis would involve a Nelson test.

CLINICAL DETAILS:

Dull left base. ? Cause.

CHEST:

No change is identified in comparison with the previous image of 18/9/97: there is tenting of the left hemidiaphragm indicating loss of volume at the left upper lobe. This is confirmed by the elevation of the left hilum.

CLINICAL DETAILS:

Had haemoptysis, now settled. Smoker 12/day. Mild COPD. Previous infection slow to resolve.

CHEST + LATERAL:

The left hilum is prominent and increased in density suggesting a mass at the hilum. Perhaps a CT would be helfpul.

CLINICAL DETAILS:

Sarcoidosis. Epithelial sarcoma left wrist. Persistent cough ? sarcoid ? recurrence.

CHEST:

There is some increased shadowing in the left lower zone with loss of definition of the medial half of the left hemidiaphragm and some streaky increased shadowing noted posterior to the cardiac shadow. The left hilum is depressed. The lungs are otherwise clear.

Findings are in keeping with consolidation and volume loss in the left lower lobe. Despite the patients age this combination of findings always raises the possibility of an obstructing bronchial neoplasm. Endobronchial sarcoid left lower lobe infection should also be considered. Initial follow up with repeat PA and left lateral radiographs is recommended. Bronchoscopy and biopsy should be considered if abnormality persists.

CLINICAL DETAILS:

Sjogrens, breathlessness.

CHEST:

There is an irregular ill-defined soft tissue opacity projected in the left mid zone, adjacent to the anterior aspect of the left 5th rib. No matrix calcficiation is detected and this lesion appears to be solitary. The cardiomediastinal and hilar contours are within normal limits and the pleural spaces clear.

INTERPRETATION:

The appearances are highly suspicious for a primary bronchial neoplasm and urgent chest referral is indicated.

CLINICAL DETAILS:

Chest opacity. Right chest pain.

CHEST:

There is a mass adjacent to the right hilum and a second smaller area of increased density below the mass in the right lower zone. This could just be due to distal consolidation rather than a separate mass lesion. The left lung remains clear.

CLINICAL DETAILS:

Haemoptysis x 1wk. H/o prostate Ca ? tumour.

CHEST:

There is a mass at the right hilum which on the lateral view is shown to lie in the right middle lobe. Findings are more suggestive of primary lung carcinoma rather than a secondary deposit. Referral to a chest physician is advised.

CLINICAL DETAILS:

Ca breast. Mastectomy 1987. Now ?supra-clavicular fossa mass. Right-sided rib pain. ?Mets. Hip pain.

CHEST:

Right mastectomy noted. Heart size and mediastinal, contour are normal. The lungs are clear. The posterior aspect of the right 8th rib is not clearly seen suggesting possible destructive change. No other definite bony abnormality demonstrated although there is significant degenerative change of the thoracic spine.

CHEST + LATERAL(CXRL)

CLINICAL DETAILS:

Smoker, haemoptysis.

CHEST + LATERAL:

The left hilum is prominent and increased in density suggesting a mass at the hilum. Perhaps a CT would be helfpul. No further focal lesions are identified. The lungs are hyperinflated. There is flattening of both hemidiaphragms suggesting underlying COAD. Heart and mediastinal contour are normal.

CLINICAL DETAILS:

Pain in right sternoclavicular joint. ? Mets.

CHEST:

The cardiomediastinal silhouette is normal. The lungs are clear. There is no evidence of any aggressive process affecting the right sternoclavicular joint.

CLINICAL DETAILS:

Tumour of bladder. ? metastasis on CT scan.

CHEST + LATERAL

There is some streaky increased opacity projected over the left lower zone through the left side of the cardiac silhouette consistent with some consolidation as seen on the recent CT scan. No other abnormality is seen. Heart size is within normal limits.

CLINICAL DETAILS:

Stage 1 seminoma.

CHEST:

The pleural spaces and lung fields are clear. No abnormality of the hilar shadows, cardiac shadow or mediastinum seen.

CLINICAL DETAILS

Pulmonary TB on treatment. Lung abscess. ? resolution.

CHEST + LATERAL:

There is a shadowing in the right apex cavity.

CONCLUSION:

The appearances are consistent with a resolving infective process.

CLINICAL DETAILS:

IDDM. Chest pain and SOB.

CHEST:

There is a 4.5 cm cavitating lesion in the apical segment of the right lower lobe with an air fluid level within it and suspicion of an opacity within the cavity on a background of fine nodulation through both upper and mid zones, more marked on the right. There is no hilar enlargement. Pulmonary vasculature is normal and heart is of normal size. This is most likely to represent an abscess and it could well represent a mycetoma.

CLINICAL DETAILS:

Chronic cough. Half cup grey sputum per day, haemoptysis. Smoker. Old TB.

CHEST:

If there is clinical suspicion of an aspergilloma, then HRCT through the left upper lobe opacity would be helpful.

CLINICAL DETAILS:

Mycetoma. Old TB ? change.

CHEST:

There is volume loss and fibrotic change and apical pleural thickening on the left. Two rounded opacities are noted projecting over the left upper zone with suggestion of surrounding lucency. This is highly suggestive of mycetoma formation.

The left costophrenic angle has been coned from the film. The remainder of the lungs and pleural spaces appear clear.

COMMENT:

There are no features to suggest active disease.

CLINICAL DETAILS:

Haemoptysis.

CHEST:

There is a cavitating mass in the left mid. In addition, there is dense consolidation of the left lower lobe and impression of a left pleural effusion. The right lung and pleural space remain essentially clear.

INTERPRETATION

The cavitating lesion in the left mid zone is of uncertain aetiology, the differential would include an abscess and in an immunosuppressed patient, fungal infections need to be considered. Further evaluation in the first instance with chest CT is recommended.

CLINICAL DETAILS: Emphysema. CHEST: The heart size is normal and the lungs are clear.	CLINICAL DETAILS: Ca lung. Change in bronchoscopy one week ago. Left-sided back pain. CHEST There is a dense consolidation distal to the central lesion at the right hilum. A right pleural effusion is also present. The widening of the superior mediastinum and old left-sided healed rib fractures are noted.	CLINICAL DETAILS: Pre op for GA. CHEST: The lungs are hyperinflated and show coarsening of the bronchiovascular markings. There is additionally a soft tissue opacity on the left perihilar region which is associated with elevation of the left hemidiaphragm.
CLINICAL DETAILS: Pre op for GA. CHEST: The lungs are hyperinflated and show coarsening of the bronchiovascular markings. There is additionally a soft tissue opacity on the left perihilar region which is associated with elevation of the left hemidiaphragm.	CLINICAL DETAILS: Ca breast SOB. ? Cause CHEST: Permanent pacemaker in situ. Cardiomediastinal contour within normal limits. No pulmonary metastatic deposits identified.	CLINICAL DETAILS: Previous carcinoid lung. Recent fever. CHEST: A rounded soft tissue mass overlying the right lung base adjacent to the right side of the cardiac silhouette has not changed significantly in appearance since the previous film. It measures approximately 3 cms in diameter. There does not appear to be any associated consolidation around this mass lesion. An area of very poorly defined increased opacity is projected over the right upper zone, over the right clavicle. A small rounded lucency is seen within this area of increased opacity. I am not sure if these appearances are due to a composite opacity, or whether they represent intrapulmonary disease. A lordotic film would be useful to project this area clear of the overlying clavicle in order to assess it further. COMMENT: Carcinoid tumour right lung base. Possible area of parenchymal abnormality in the right upper zone. Lordotic film advised.
CLINICAL DETAILS: Dull left base. ? Cause. CHEST: No change is identified in comparison with the previous image of 18/9/97: there is tenting of the left hemidiaphragm indicating loss of volume at the left upper lobe. This is confirmed by the elevation of the left hilum. The right lung remains clear. Again there is evidence of severe atheromatosis of the thoracic aorta with dilation of the lumen and extensive calcified plaques. The differential diagnosis would involve a Nelson test.	CLINICAL DETAILS: Dull left base. ? Cause. CHEST: No change is identified in comparison with the previous image of 18/9/97: there is tenting of the left hemidiaphragm indicating loss of volume at the left upper lobe. This is confirmed by the elevation of the left hilum.	CLINICAL DETAILS: Had haemoptysis, now settled. Smoker 12/day. Mild COPD. Previous infection slow to resolve. CHEST + LATERAL: The left hilum is prominent and increased in density suggesting a mass at the hilum. Perhaps a CT would be helfpul.
CLINICAL DETAILS: Sarcoidosis. Epithelial sarcoma left wrist. Persistent cough ? sarcoid ? recurrence. CHEST: There is some increased shadowing in the left lower zone with loss of definition of the medial half of the left hemidiaphragm and some streaky increased shadowing noted posterior to the cardiac shadow. The left hilum is depressed. The lungs are otherwise clear. Findings are in keeping with consolidation and volume loss in the left lower lobe. Despite the patients age this combination of findings always raises the possibility of an obstructing bronchial neoplasm. Endobronchial sarcoid left lower lobe infection should also be considered. Initial follow up with repeat PA and left lateral radiographs is recommended. Bronchoscopy and biopsy should be considered if abnormality persists.	CLINICAL DETAILS: Sjogrens, breathlessness. CHEST: There is an irregular ill-defined soft tissue opacity projected in the left mid zone, adjacent to the anterior aspect of the left 5th rib. No matrix calcficiation is detected and this lesion appears to be solitary. The cardiomediastinal and hilar contours are within normal limits and the pleural spaces clear. INTERPRETATION: The appearances are highly suspicious for a primary bronchial neoplasm and urgent chest referral is indicated.	CLINICAL DETAILS: Chest opacity. Right chest pain. CHEST: There is a mass adjacent to the right hilum and a second smaller area of increased density below the mass in the right lower zone. This could just be due to distal consolidation rather than a separate mass lesion. The left lung remains clear.
CLINICAL DETAILS: Haemoptysis x 1wk. H/o prostate Ca ? tumour. CHEST: There is a mass at the right hilum which on the lateral view is shown to lie in the right middle lobe. Findings are more suggestive of primary lung carcinoma rather than a secondary deposit. Referral to a chest physician is advised.	CLINICAL DETAILS: Ca breast. Mastectomy 1987. Now ?supra-clavicular fossa mass. Right-sided rib pain. ?Mets. Hip pain. CHEST: Right mastectomy noted. Heart size and mediastinal, contour are normal. The lungs are clear. The posterior aspect of the right 8th rib is not clearly seen suggesting possible destructive change. No other definite bony abnormality demonstrated although there is significant degenerative change of the thoracic spine.	CHEST + LATERAL(CXRL) CLINICAL DETAILS: Smoker, haemoptysis. CHEST + LATERAL: The left hilum is prominent and increased in density suggesting a mass at the hilum. Perhaps a CT would be helfpul. No further focal lesions are identified. The lungs are hyperinflated. There is flattening of both hemidiaphragms suggesting underlying COAD. Heart and mediastinal contour are normal.
	CLINICAL DETAILS: Pain in right sternoclavicular joint. ? Mets. CHEST: The cardiomediastinal silhouette is normal. The lungs are clear. There is no evidence of any aggressive process affecting the right sternoclavicular joint.	CLINICAL DETAILS: Tumour of bladder. ? metastasis on CT scan. CHEST + LATERAL There is some streaky increased opacity projected over the left lower zone through the left side of the cardiac silhouette consistent with some consolidation as seen on the recent CT scan. No other abnormality is seen. Heart size is within normal limits.
CLINICAL DETAILS: Stage 1 seminoma. CHEST: The pleural spaces and lung fields are clear. No abnormality of the hilar shadows, cardiac shadow or mediastinum seen.	CLINICAL DETAILS Pulmonary TB on treatment. Lung abscess. ? resolution. CHEST + LATERAL: There is a shadowing in the right apex cavity. CONCLUSION: The appearances are consistent with a resolving infective process.	CLINICAL DETAILS: IDDM. Chest pain and SOB. CHEST: There is a 4.5 cm cavitating lesion in the apical segment of the right lower lobe with an air fluid level within it and suspicion of an opacity within the cavity on a background of fine nodulation through both upper and mid zones, more marked on the right. There is no hilar enlargement. Pulmonary vasculature is normal and heart is of normal size. This is most likely to represent an abscess and it could well represent a mycetoma.
CLINICAL DETAILS: Chronic cough. Half cup grey sputum per day, haemoptysis. Smoker. Old TB. CHEST: If there is clinical suspicion of an aspergilloma, then HRCT through the left upper lobe opacity would be helpful.	CLINICAL DETAILS: Mycetoma. Old TB ? change. CHEST: There is volume loss and fibrotic change and apical pleural thickening on the left. Two rounded opacities are noted projecting over the left upper zone with suggestion of surrounding lucency. This is highly suggestive of mycetoma formation. The left costophrenic angle has been coned from the film. The remainder of the lungs and pleural spaces appear clear. COMMENT: There are no features to suggest active disease.	CLINICAL DETAILS: Haemoptysis. CHEST: There is a cavitating mass in the left mid. In addition, there is dense consolidation of the left lower lobe and impression of a left pleural effusion. The right lung and pleural space remain essentially clear. INTERPRETATION The cavitating lesion in the left mid zone is of uncertain aetiology, the differential would include an abscess and in an immunosuppressed patient, fungal infections need to be considered. Further evaluation in the first instance with chest CT is recommended.