SET T0035 -
GP Referrals -
Chest radiographs

• Shadowing in left upper zone (LUZ).
• Enlarged and dense left hilum.
• Bones intact.

Diagnosis: LUZ bronchial carcinoma with left hilar lymphadenopathy.

• Mass in - or overlying - the RUZ that is displacing the trachea to the left. This mass is entirely consistent - ie because of the latter feature - with a thyroid mass. 
• Discrete, large, well defined opacities in both lungs.
• Note that one opacity has a very sharp horizontal inferior border . . . ergo it abuts the horizontal fissure and thus it is situated in the right upper lobe.
• Bones normal.

Diagnosis: Thyroid mass (ie carcinoma) with multiple pulmonary metastases.

The lack of a windowing facility for these "Test Yourslf " cases is a disadvantage. But we can make several observations in relation to this CXR. As follows:

• Discrete density projected over the left side of the heart.
• Possibly an additional density projected over the right border of the heart.
• Density at the cardiac apex - probably a large fat pad.

Comment: The main concern is the discrete density projected over the left side of the heart. CT evaluation is required.

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Follow up: see the attached CT section. Lung density confirmed (elsewhere, the lungs were normal).

Histology: a carcinoid tumour.

Normal appearances. The lungs are clear.