SET T0040 -
GP Referrals -
Chest Radiographs

Large mass obscures the right border of the heart.

Possibilities:  tumour in the middle lobe that is encroaching on the mediastinum; or a mediastinal mass that is situated anteriorly and extends outwards and displaces, or involves, the middle lobe.

If this is an anterior mediastinal mass then the three most likely causes are: thymoma, or lymphoma, or teratoma.

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Subsequent histology: lymphoma.

Observations:

• An unfolded aorta (age related) explains the prominent aortic arch.
• Heart size within normal limits.
• Medistinum, hila, lungs, bones - all normal.

Summary: The cause of the chest pain is not shown. The CXR appearances are within normal limits for age.

Bilateral pleural effusions. Heart not obviously enlarged.

Several possible causes for the bilateral effusions. However, given the history, the likely explanation is left ventricular failure (LVF) as the cause of the effusions.

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Note: most patients who have CXR evidence of LVF invariably have evidence of cardiac enlargement on a standard PA CXR. One exception to this "rule" is the patient with a normal size heart who developes an acute myocardial infarction and then goes into LVF.

Cardiac enlargement as revealed/assessed on a PA chest radiograph  .  .  . See : The Chest X-Ray : A Survival Guide : Pages 148-149

Opaque left hemithorax. The mediastinum (and the trachea) is displaced to the left.

Diagnosis: major collapse of the left lung.

The likely cause - given the history - is an underlying obstruction to the left main bronchus. A bronchial carcinoma is a strong probability.