SET T0039 -
GP Referrals -
Chest Radiographs

Unimportant - an unfolded aorta. This accounts for the density projected over the left side of the heart. Also, note that a normal azygo-oesophageal line is well shown.

Important shadow - but subtle: a faint area of increased shadowing / an increased density is evident in the right lung . . . below the dome of the diaphragm. A subtle shadow - but if you do not look . . . you will not see.

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See the CT section. It confirms that there is a shadow at the base of the right lung. An area of pneumonia.

• Discrete calcifications - mainly in the left lung. Likely explanation . . . chicken pox as an adult in the past.
• Right midzone (RMZ) density . . . suspect a bronchial carcinoma.  
• Some shadowing to the left side of the trachea . . . unimportant and part of the manubrium on this slightly rotated CXR.

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See the CT section. RMZ lesion - the NG appearance confirmed. Lung calcifications well shown (history of chickenpox in her 30's).

A soft tissue shadow is visible in relation to the lateral aspect of the left 7th rib.

Possible rib destruction. The latter possibility is difficult to assess without a windowing facility on this Test Yourself site.

Nevertheless, the soft tissue shadow is there to be detected and that particular site needs further investigation.

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See the CT section. The rib destruction is confirmed. (Eventual diagnosis: the rare condition of Histiocytosis X).

Observations:

• Sternal sutures from previous CABG.
• Some old scars at the apex of the right lung.
• The important abnormality: the widened superior mediastinum with narrowing of the trachea. Suspect mediastinal tumour / nodes as the cause.