Chest x-rays

 

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CLINICAL DETAILS:

Pulmonary mass suspected. Follow-up films recommended.

CHEST: The PA projection of the chest confirms the impression of a lobulated mass, in the left midzone . It is difficult to localise on the lateral projection: it possibly overlaps the hilar region.

Referral to the chest clinic is recommended for further investigation.

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CLINICAL DETAILS:

Previous TB. Persistent lymphocytosis

CHEST:

There is bilateral apical pleural thickening. Heart size is at the upper limit of normal but the mediastinal contour is normal. The lungs are clear.

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CLINICAL DETAILS:

? Pulmonary oedema. Resolving post

diuresis.

CHEST:

There is some septal and fissural thickening at the right lung base which appears to have developed since the previous film which may be related to pulmonary venous hypertension. There was no evidence of pulmonary oedema on this or the previous chest x-ray.

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CLINICAL DETAILS:

Post Hickman line insertion.

CHEST

There is left sided pleural effusion. The lungs are clear. Right Hickman line is present, the tip projecting over the superior vena cava. No pneumothorax is seen.

Sternotomy sutures and AVR are noted. The heart is slightly enlarged.

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CLINICAL DETAILS:

TB. Bilateral pleural effusions, left more than right.

CHEST:

There is a moderately large right-sided pleural effusion extending into the oblique fissure. A small right basal chest drain is noted. There is no obvious left-sided pleural fluid. The lungs appear clear.

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CLINICAL DETAILS:

Known metastatic breast carcinoma. Painful left ribs ? mets.

CHEST:

Left mastectomy noted. There is eventration of the left hemidiaphragm and linear atelectasis at the left base. The heart is noted to be displaced to the right. No definite pulmonary or bony metastatic deposits identified.

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CLINICAL DETAILS:

Chest infection?

CHEST:

There is cardiac enlargement and bilateral fine air-space shadowing and bilateral pleural effusion. Features are more suggestive of cardiac failure than infection.

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CLINICAL DETAILS:

Angina.

CHEST:

There is left lower lobe collapse with fibrosis and pleural thickening. There is hyperlucency of the left hemithorax secondary to compensatory hyperinflation of the left upper lobe. The right lung also appears hyperinflated. No new abnormality is detected. The heart is not enlarged.

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CLINICAL DETAILS:

Mycetoma

CHEST:

The mycetoma cavity remains dense. Chronic airspace shadowing is present in both lower zones. No new inflammatory focus is seen.

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CLINICAL DETAILS:

Aspergilloma infiltrate with sclerosant ? fibrosing alveolitis.

CHEST + LATERAL:

The opacity in the left mid zone remains unchanged, with a superior rim or air visible. The increased linear markings in both bases also remain unchanged. Heart size and mediastinal contour normal.

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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.

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CLINICAL DETAILS:

? right hilar lesions. Comparison is made with the previous chest radiograph.

CHEST:

The heart size and mediastinal contours are normal. A mass is seen projected over the right hilum. Lateral film, this is seen to be placed posteriorly. Measures approximately 6 x 3cm in size. No other lung lesion is seen. The bones appear normal.

CONCLUSION:

This is likely to represent a pulmonary lung neoplasm, and referral for bronchoscopy and chest CT is recommended.

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CLINICAL DETAILS:

Smoker. Weight loss and haemoptysis.

CHEST:

There is a relatively ill-defined opacity measuring approximately 4 x 2cm in the posterolateral aspect of the left upper lobe which is associated with a band of subsegmental atelectasis. There is impression of added soft tissue in the left aortopulmonary window and left hilum which is also suspicious on the lateral view. Compared with the previous radiograph of 25.04.95, the opacity has increased in size and previously the band of atelectasis is not present. The remainder of the lungs and pleural spaces are clear. The lungs are hyperinflated, consistent with COAD. Degenerative changes affect the mid thoracic spine, there is also loss of height of T12 and L1 which was not visualised previously due to the area being coned from the radiograph.

INTERPRETATION:

The left upper zone opacity and added soft tissue at the left hilum is suspicious for a bronchogenic carcinoma, and a CT scan is recommended to further evaluate the left upper lobe and left hilum. Background changes of COAD.

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CLINICAL DETAILS: -

Chronic cough. Non smoker.

CHEST + LATERAL:

There is a right hilar,lower hilar mass. Evaluation required.

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CLINICAL DETAILS:

Post CABG. Left pleural effusion, exudate. Low albumin (22), raised ESR (80), AFT 60. Histology, MC&S of effusion normal. ? Malignancy. ? TB.

CHEST:

Stenotomy wires and CABG clips noted. There is a moderate size left pleural effusion.

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CLINICAL DETAILS 

Cough. Past history of bullectomy.

CHEST:

There is gross bullous change involving both apices and right mid zone with flattened hemidiaphragms consistent with bullous chronic airflow limitation.

 

Heart size and mediastinal contour normal.No focal lung infection identified.

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CLINICAL DETAILS:

Fall. Smoker. Paranoid delusions. ?Bronchogenic carcinoma. ?Mediastinal mass on previous film.

CHEST + LATERAL:

There is a right upper paramediastinal density. On the lateral film I cannot identify any discrete mass, but I am concerned by the indentation of the anterior aspect of the trachea, just above the bifurcation. I suggest this patient has a contrast-enhanced CT chest examination further to investigate the possibility of a right-sided hilar mass.

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CLINICAL DETAILS:

Rightpleural effusion with blood stained fluid. Pre bronchoscopy with biopsy.

CHEST:

The hydropneumothorax remains on the right side and is possibly a little improved. The left lung remains clear.

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CLINICAL DETAILS:

A Right sided pleural effusion. Post pleural biopsy. Aspiration.

CHEST:

The right pleural effusion is possible slightly increased and a small right apical pneumothorax persists. There is some worsening of the collapse/consolidation affecting the right middle and lower lobe. However, the right basal upper lobe consolidation has improved. The left lung and pleural spaces are clear.

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CLINICAL DETAILS:

Right pleural effusion. Post op 

CHEST + LATERAL:

There is a right pleural effusion. No active lung lesion identified. No hilar or mediastinal adenopathy seen.

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CLINICAL DETAILS:

Asymptomatic. Opacities on CT. ?Change.

CHEST + LATERAL:

A suboptimal inspiration has been achieved which probably accounts for the increased bronchovascular markings in both lower zones. The previously noted soft tissue opacities are again seen and there may be one further opacity projected over the anterior end of the left fifth rib and adjacent fourth/fifth interspace. The CT chest scan performed within the last fortnight will of course provide a more accurate assessment of the progression of these pulmonary opacities.

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CLINICAL DETAILS:

Weight loss - one stone in past year. Vague chest pain. No cough. Smokes 60 per day.

CHEST:

A rounded opacity of soft tissue density measuring approximately 3cm in diameter is projected over the left mid zone. It has a spiculated outer-margin. This is poorly visualised on the lateral view but is probably located in the apical segment of the left lower lobe.

No other focal lung lesion is seen. Mild apical pleural thickening is noted. No evidence of pleural effusion.

Heart size and mediastinal contour are normal. Degenerative changes are noted in the thoracic spine, but no other bony abnormalities identified.

COMMENT:

The appearances of the spiculated mass in the mid zone are highly suspicious for bronchogenic carcinoma.

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CLINICAL DETAILS:

Green sputum. Ex-smoker. COAD. Neoplasm left lower lobe. For assessment please.

CHEST:

There is an area of increased density projected over the lower left perihilar region. It appears to be posterior to the hilum in the lateral view. There is linear atelectasis in the right base. A hazy shadow above this could represent some consolidation.

There is mild cardiomegaly. Pleural spaces appear clear.

COMMENT:

Further investigation of this left perihilar shadow is recommended.

 

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CLINICAL DETAILS:

Right upper lobe consolidation for follow-up.

CHEST:

There is a large irregular opacity at the right apex, there is some distortion of the right hilum. The remainder of the cardiomediastinal contour appears normal. The lungs are hyperinflated consistent with COAD. A small granuloma is again noted in the right mid zone and some linear scarring of the left base laterally.

INTERPRETATION:

The distortion of the right apex may be on the basis of previous TB infection, however, a neoplastic lesion cannot be excluded and a CT is recommended in the first instance to fully evaluate the right apical lesion.