SET T0025 -
Emergency Department. All CXRs.

Relevant observations:

• Shadowing behind the left side of the heart.
• Left hilum is lower than the right hilum.

Impression:

 Collapse of the left lower lobe. (The left lower lobe shadowing is confirmed on the lateral CXR shown here).

Basic steps when evaluating a lateral CXR?

See : The Chest X-Ray : A Survival Guide : Pages 14-31

Observations:

• Extensive shadowing behind the left side of the heart.
• Loss of the silhouette of most of the left dome of the diaphragm
• The left hilum is in a normal position.
• The left hilum may well be enlarged.

Impression:

1. Consolidation in the left lower lobe.
2. No evidence of lobar collapse on this CXR ( contrast this with the appearance in Case 1 ).
3. The suspicion of left hilar enlargement (even if it had been an isolated finding) warrants further investigation.

Observations:

• Good inspiration.
• Lungs unremarkable.
• The heart appears enlarged ( applying the cardio-thoracic ratio guideline)

Impression:

Cardiac enlargement. No other abnormal finding.

Diagnosing cardiac enlargement on a CXR - validity? Pitfalls?

See : The Chest X-Ray : A Survival Guide : Pages 148-149

Observations:

• The AP projection will magnify the heart and thus invalidates (as a single AP CXR) any assessment of possible cardiomegaly.
• Bilateral pleural effusions.
• Parenchymal shadowing in both lower zones.

Impression: the most likely explanation for these appearances is left heart failure.

Left ventricular failure - diagnostic features on a CXR?

See : The Chest X-Ray : A Survival Guide : Pages 158-159