AP projection. Background chronic lung changes with widespread bullae noted. There is improvement noted with increased aeration in the lower zones bilaterally. Scattered nodules seen previously appear to be stable. Ongoing inflammatory reaction.

O O O B I I I I I I I I E B I I I I I I I I I I I I I E B I I I I


heart size is enlarged allowing for a slight patient rotation. Upper lobe blood vessel diversion noted, congestive changes noted at the right base, the tips of the pacing wires insitu.

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PA erect study. Comparison made with previous chest x-ray 11/09/2017. Normal heart size and mediastinum. Right mid zone atelectasis at the fifth and sixth posterior rib is similar to previous appearances. Pleural thickening and mild cystic changes are seen in the right apex have changed little since an old film from 2016. No signs of infection. No pleural effusion. Partial fusing of the right anterior second third ribs noted. No other significant bone abnormality.

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Both lung fields are showing increased vascular markings with mild bi vessel bronchiectatic changes seen. No focal active lung lesion seen.

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Cardiomegaly with congestive changes, no evidence of pulmonary oedema. There is bibasal plate like atelectasis. There is a single lead PPM in situ.

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atelectasis cardiomegaly interstitial_shadowing object


Increased consolidation in the left upper zone compared with the previous CXR 2 months ago. There is also increased opacification in the left lower zone with an associated underlying collapse. Bilateral pleural and hilar calcifications noted. The lungs are hyper expanded. Longstanding interstitial shadowing at the right CP angle.

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The heart and lungs are normal in appearance. No change in the previously demonstrated soft tissue appearances in the aortopulmonary window.

B I I I I I I I E B I I I I I I I I I I I


AP erect. The cardiac shadow is enlarged with congestive features and possible pneumonic infiltrates left lower lung. Increased BMI. Degenerative changes of the dorsal spine.

O O O B I I I I I I I I I I I I I I I I I E B I E


There is a mild thoracic scoliosis concave to the left. An abnormal contour to the right heart border is shown on previous films to be due to a fixed hiatus hernia. There is a new moderate to large left sided pleural effusion extending into the mid zone. The patient has been shown on previous films to have pleural calcification which would be suggestive of previous asbestos exposure. In the light of this and the previously diagnosed bronchiectasis, malignant or infective causes for the pleural effusion should be investigated. Urgent referral to a chest physician for further investigation is suggested. Referral to the Lung Cancer MDT / Tracker is advised. Glenfield Hospital ext. 2415 For GP Patients a referral proforma is enclosed

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Dual chamber pacemaker seen in place. Prominent cardiac shadow, with widening of the carina. Rt. basal atelectases seen, with shallow Rt. CP angle. Engorged hila, with exaggerated BV markings. No major consolidation. Unremarkable Lt. CP angle.

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Sternotomy noted. The heart is enlarged. There are small pleural effusions with some central pulmonary venous congestion in keeping with heart failure.

B I I I E B I I I E B I I I I I I I I I I I


Heart is markedly enlarged. There is slight pulmonary congestion. No major collapse or consolidation seen. There is no pleural effusion.

cardiomegaly consolidation interstitial_shadowing normal


AP. There is a left basal pleural effusion with pulmonary venous congestion. Appearances are of LVF/fluid overload.


Drains are out. Cardiomegaly with CCF of the second degree and bilateral small pleural effusions. RIJV line in a good position. Midline sternotomy noted.

O O O O O B I I I I I I I I I I I I I I I I I I


Diffuse ground-glass opacification and pulmonary venous congestion noted. No free gas under the diaphragm. Features suggest cardiac failure.


AP erect. Rotated to the left. Cardiomegaly with pulmonary venous congestion.


Compared with the previous chest x-ray from January this year the mass at the upper pole of the left hilum appears smaller. However there is now some increased shadowing in the left upper zone and some fibrosis and loss of volume. Some of this may be post radiotherapy change. The right lung remains clear.

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Mobile supine chest radiograph. The heart is enlarged with upper lobe blood diversion. There is a suspicion of some increased shadowing adjacent to the aortic knuckle on the left side and possibly in the left mid zone, these may be artefactual as these are projected over the anterior end of the rib.Follow up examination in full inspiration may be helpful further assessment. The right lung appears clear.

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The right sided pleural effusion hasnt changed. There is no evidence of pneumothorax. There is moderate CCF and minimal pleural effusion on the left. Dual lead PPM in situ noted.

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aortic_calcification bulla cardiomegaly emphysema object

Chest x-ray. Left ICD insitu, the leads are appropriately positioned. Sternal clips and cardiac wires are noted. There is perhaps mild cardiomegaly. Background COPD with likely left basal bulla but no focal active lung lesion. There is a linear artefact at the right lung apex.

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The lungs are hyperinflated with coarse lung markings in keeping with emphysema. In the right upper zone laterally, there is an area of opacification with lucent areas which may represent focal bronchial dilatation. This is likely chronic, however, no previous CXR for comparison. In the right mid zone there is a focal dense opacification laterally adjacent to the 3rd rib? calcification. Biapical pleural thickening. The heart size is normal. No destructive bone lesion. I note referral to the sarcoma MDT.

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The heart size is normal. There is bibasal atelectasis with blunting of the costophrenic angles. there is a little peripheral shadowing in the right upper zone. I note from a previous CT in 2013 that she was though to have a generalised interstitial lung disease, predominantly basal. This appearance would be consistent with that. The calcified goitre is also noted. I do not think there is any specific evidence of active infection.

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There is a small left apical pneumothorax (30mms). There is possibly a small amount of pleural effusion in the left CP angle. There is no mediastinal shift. There is an air fluid level below the aortic arch suggestive of dilated oesophagus or oesophageal diverticulum. ICD in situ. Midline sternotomy and CABG noted. The findings were discussed with SHO on ward 28 and repeat CXR in the morning of Wednesday 16th in PA and left lateral projection is recommended.

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abnormal_non_clinically_important normal object other pleural_effusion pneumothorax recommendation


CXR's from 24, 25, 26 July are reported. There is a right sided pneumothorax in adhesions with moderate pleural effusions. There are bilateral multiple pulmonary nodules and large mediastinal mass on the right. Right sided chest drain in situ. On the following xrays the chest drain was changed. Otherwise stable findings.

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Left sided drain has been removed. There is persistent hydropneumothorax with short air/fluid levels in the mid zone and basal collapse/consolidation. Right lung remains clear. There is little if any change since the previous film.

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atelectasis comparison normal object pleural_effusion pneumothorax


AP semi erect. ET tube, RIJ line and NG tube noted. There is bibasal collapse/consolidation. lungs are mildly congested.

atelectasis consolidation object paratracheal_hilar_enlargement


Bilateral significant congestion noted. Mild right pleural effusion. The central pulmonary arteries are minimally widened. The heart is moderately enlarged. The overall picture is in keeping with heart failure. In comparison with the previous chest xrays moderate progression noted.

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The chest drain has been removed. There is only minimal apical pneumothorax on the right. Bilateral minimal pleural effusions are seen. There are congestive changes of the 1st degree. There is a borderline sized heart. Midline sternotomy and MVR noted.

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comparison interstitial_shadowing normal object pleural_effusion pneumothorax


Cardiomegaly with CCF of the second degree and small pleural effusion on the left. There is retrocardiac consolidation possibly due to pneumonia. Repeat CXR after appropriate treatment is suggested.

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Heart appears mildly enlarged with mild pulmonary congestion. There is consolidation of the right base with a small pleural effusion consistent with active infection.

B I I I I I I I E B I I I I I I I I I I I I I I


There is a small right pleural effusion present. Right paratracheal soft tissue mass noted. Heart size is normal. Old fracture of T12 vertebral body is noted. Please see subsequent CTPA report dated 17/01/16.

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Cardiomegaly with moderate ccf. Left basal consolidation with small pleural effusion is seen. Repeat CXR after appropriate treatment is suggested.


Series of chest radiographs from 29/4/16 to 24/5/16. ET tube, left internal jugular line and left sided chest drains in situ on the initial radiograph with opacification of the left lung, although the left pleural mass has reolved. Theres are removed over the subsequent radiographs. On the final radiograph there is persistent left sided pleural thickening with a small amount of air at the site of previous LVRS. The heart size is normal.

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abnormal_non_clinically_important comparison consolidation normal object other pleural_abnormality


Series of chest xrays dated 15.12.2015 to 26.1.2016. Cardiomegaly with congestive changes and signs of pulmonary hypertension. There has been progression of bilateral small pleural effusions.

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AP erect. No previous films available for comparison. Small pleural effusions bilaterally suggesting heart failure. Some collapse/consolidation noted in both lung bases which is most likely related to the heart failure but an infection is also a possibility. Dorsal spondylosis. Degenerative changes demonstrated in the right shoulder joint.

O O O B I I I I I E B I I I I I I I I I E B I I I I I I I I I I I I I I I I I I I I I I I I I I


AP projection. Tricuspid tube, NG tube and left IJ line are noted and are correctly sited. There is evidence of pulmonary venous congestion. There is collapse/consolidation left lower lobe. There is a left basal pleural effusion which appears loculated. Small amount of loculated air is seen in the left mid zone. Previous left-sided chest intervention noted.

O O O B I I I I I I I I I I I I I I I I I I I E B I I I I I I I E B I I I I I I I I I E B I I I I I I I I I I I


portable ap Pacemaker noted. The lungs are congested with bilateral small effusions suggesting failure.


No change in the elevated right hemidiaphragm with basal atelectasis and right paramediastinal mass as demonstrated on CT on 30/04/2015. Left sided mastectomy noted.No obvious acute lesion on the CXR.

B I I I I I I I I I I I I I I I I I I I I I I I I I I I I I


Stable cardiomegaly. Mild pulmonary venous congestion. Small right pleural effusion and blunting of left costophrenic angle. There is mild left basal atelectasis. Features suggest mild degree of heart failure.

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Supine film. Even allowing for projection the heart is enlarged. The lungs appear congested. No frank pulmonary oedema.

cardiomegaly consolidation normal technical_issue


AP erect. RIJ line and 2 right-sided drains and NG tube in situ. NG tube is coiled in the fundus of the stomach. There is mediastinal shift to the right with a moderate pneumothorax and collapse/consolidation in the underlying lung. There is a little surgical emphysema overlying the right chest. Left lung appears clear.

O O O B I I I I I I I I I I I I I I I I I I I I I I I I I I E B I I I I I I I I I I I I I I I I I I I I I I

atelectasis consolidation mediastinum_displaced normal object pneumothorax subcutaneous_emphysema


Heart size at the upper limit of normal. The aorta is unfolded. Upper lobe blood vessel diversion noted. The right hilum appears prominent, no previous CXR available for comparison to see whether this is due to the vascular component, old or new. The lungs appear clear. No evidence of definite pleural lesion seen on the available radiograph. There is however small ill defined shadowing at the left base with slight elevation of the left hemidiaphragm, this could either be due to resolving infection or PE.

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ICD noted in site. Poor inspiratory effort. There appears to be some mild pulmonary venous congestion. No significant effusions.


AP erect. Comparison is made with the previous radiograph from 1.6.2015. Suboptimal film. The patient is rotated. There is a large left sided pleural effusion with underlying collapse/consolidation. Multiple sclerotic bony metastases.

O O O B I I I I I I I I I I I I I E B I I I E B I I I E B I I I


Chest. Abdominal pacing, the lead is projected over the right ventricle. AP supine projection, the heart size is probably normal. No focal active lung lesion, the corticated bony opacity in the left upper zone is probably related to the the left scapula. Mild double thoraco lumbar scoliosis. No pneumothorax.

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normal object scoliosis undefined_sentence


The heart size is within normal limits. Previous right thoracotomy noted, I note from previous reports that the patient has had an oesophagectomy. There is a 4 x 3.5 cm area of shadowing in the right lower zone adjacent to the minor fissure. This could be due to infection or possibly encysted fluid but in view of the history the possibility of metastatic disease would also have to be considered. The lungs are otherwise clear. A repeat chest x-ray in one month following treatment for infection is recommended.

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abnormal_non_clinically_important consolidation normal object possible_diagnosis recommendation


AP erect. Lungs are hyperinflated with features of COPD. There is pulmonary venous imbalance with pulmonary congestion and small bilateral pleural effusions consistent with LVF. Pericardial calcification is noted as before.

O O O B I I I I I I I I I I I E B I I I I I I I I I I I I I I


Surgical clips projected over the right hemithorax and right axilla. No focal lung lesion. The heart size is within normal limits. On review the previous 2 chest x-rays the right scapula appears slightly sclerotic and expanded when compared to the left scapula. This may be due to projection/overlying soft tissue or previous radiotherapy. Appearances are stable since 22/06/2015.

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I note this patient passed away on 9.4.15. These images had been reported in retrospect as part of backlog reporting. AP projection. There is collapse/ consolidation of the left lower lobe. There is evidence of pulmonary venous congestion. There is a moderate sized left basal pleural effusion. This shows interval worsening when comparison is made with the previous examination dated 25.3.15. There is blunting of the right costophrenic angle suggesting a small amount of right basal pleural fluid. Some thickening/fluid is seen in the horizontal fissure. There is right upper lobe upper lobe collapse which is long standing.

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There is a S shaped thoraco lumbar scoliosis with associated degenerative change. There is an unusual soft tissue appearance to the lower neck, does the patient have a goitre or adenopathy?. Alternatively appearance could be a clothing or hair artefact. There is some linear atelectasis in the left mid to lower zone but the appearances at the lung base are otherwise now within normal limits.

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Comparison is made with the previous CXR of 26.8.15. History of breast malignancy noted. Left mastectomy and axillary dissection noted, surgical clip in left axilla. No pneumothorax. The moderate left pleural effusion persists. There is new obscuration of the left hemidiaphragm and left heart border in keeping with underlying left lower lobe collapse. Known middle lobe lesion demonstrated on the previous CT is not demonstrated.

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The heart is enlarged with pulmonary congestion as before. No significant change.


There is bilateral small pleural effusions more pronounced on the left side. There is pleural calcification along the left lateral chest wall. Lungs appear congested. The heart is enlarged. Combined appearances are consistent with heart failure. There is a calcified oval lesion in the region of the left hilum measuring about 2 cm in diameter. This is apparent on previous images and has not changed in size.

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There is cardiomegaly with bilateral pleural effusions in keeping with heart failure.


The heart is enlarged with prominent pulmonary arteries and pulmonary congestion. No pleural fluid. There has been a little improvement since the previous film.

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Bibasal effusion with consolidation. Pulmonary venous congestion noted. This is likely to be related to infection and failure. Right sided rib fractures.

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inadequate details. No clinical findings. No previous history. Previous history of acute LVF. AP erect. Gross cardiomegaly. Pulmonary venous congestion and effusions worse on the right. No change on all xrays since Jan 2015.

O O O O O O O O O O O O O O O O O O O O O O O B I I I I I E B I I I


Mild cardiomegaly. Both lung fields are showing increased vascular markings. No focal active lung lesion seen.


Multiple x-rays have been reviewed since 1/8/15. Indwelling catheter noted on the left. There has been marked improvement in the left pleural effusion especially on comparison with the previous film. There is an expansile soft tissue lesion laterally on the right. There remains left basal consolidation.

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Evidence of cardiac surgery noted. Heart appears mildly enlarged. There is minimal left pleural reaction. Lungs are otherwise clear. Marked degenerative changes noted in the left shoulder joint.

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(17.05.2006) No signs of pleural effusion seen. There is probably doubtful minimal blunting of the right costophrenic angle. Right apical pleural thickening with a deviation of the trachea towards the right side. The increased density seen over the right breast is mostly due to breast surgery or underlying inplant. Left lung appears clear.

O O O O O O O B I I I I I I I E B I I I I I I I I I I I I I I I E B I I I I I I I I I I I I I I I I I I E


Bilateral lower zone linear atelectatic bands could be post-infective /post-inflammatory in nature.Multiple lytic lesions as before. Right sided pleural effusion/thickening noted.Right sided calcified granulomas noted. Suggest repeat if clinically indicated.

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Chest. The previously noted left basal consolidation has significant improved. There is residual atelectasis in the left lung base (mild cylindrical bronchiectasis with mucous plugging on recent CT). Rest of the lungs are clear. Please note that is persistent 36 mm ground glass opacity in the right upper lobe with a small central solid component measuring 5-6 mm. The appearances are highly suggestive of adenocarcinoma insitu (AIS) or minimally invasive adenocarcinoma (MIS). Above was discussed in the ILD MDT on 23/7/2015. Referral to the Lung Cancer MDT / Tracker is advised. Glenfield Hospital ext. 2415 For GP Patients a referral proforma is enclosed

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ap. As on the previous image, there is collapse consolidation in the right lung. An underlying tumour is possible. Suggest CT. Fracture of right neck of humerus as before. Pacemaker in position. Referral to the Lung Cancer MDT / Tracker is advised. Glenfield Hospital ext. 2415 For GP Patients a referral proforma is enclosed

O O B I I I I I I I I I I I I I E B I I I I I E B I E B I I I I I I I I I I E B I I I E B I I I I I I I I I

atelectasis comparison consolidation object parenchymal_lesion recommendation rib_lesion


Pulmonary congestion , collapse consolidation left lower lung with effusion.


There is a large right tension hydropneumothorax with mediastinal shift to the left and flaring of the rib spaces. MIld opacification in the left mid zone suggestive of consolidation. Subsequent imaging demonstrates treatment with chest drain.

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comparison consolidation mediastinum_displaced object pleural_effusion pneumothorax


Bibasal effusions noted.Pulmonary venous congestion noted. Cannot comment on the heart and mediastinum as AP view.


AP erect there is persistent cystic lesion in the left lower zone with patchy lung changes which are quite extensive and peripheral. The appearance has improved slightly since June 2015.

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AP film. There is elevation of the left hemidiaphragm. There is scarring in both lung apices presumably from old TB. The lungs are otherwise clear. There is widening of the superior mediastinum and deviation of the trachea to the right side. This is likely vascular but a repeat PA chest X-ray is reccomended to rule out sinister pathology.

O O O B I I I I I I I I I I I E B I I I I I I I I I I I I E B I I I I E B I I I I I I I I I I I I I I I I I I I I E


AP projection. Right IJ line, tracheostomy tube and NG tube are noted and are correctly sited. There is evidence of pulmonary venous congestion. Atelectasis is seen in the region of the right lower zone.

O O O B I I I I I I I I I I I I I I I I I I I E B I I I I I I I E B


Patchy/dense calcified lesion with pseudo-cavity both upper lung with paratracheal/hilar lymphadenopathy, suggestive of TB. Referral to the TB service is advised. Glenfield Hospital ext. 3766 For GP patients a referral proforma is enclosed

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AP erect rotated poor inspiratory film. There is pulmonary venous congestion noted. This finding may be related to the poor inspiration and AP chest x-ray would be more helpful. No major consolidation.

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There is cardiomeagly with single lead permanent pacemaker seen with early congestive changes seen.


Bilateral apical pleural thickening noted with fibrotic changes seen in the right upper zone. No focal active lung lesion seen. No change compared to previous xray 25.9.12 although fibrosis in the right zone appears to be new.

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Previous chest radiograph from 21/2/2006 was reviewed. There is bilateral apical scarring. A cavitating opacity is seen in the right lower zone measuring approximately 16 mm in diameter. Rest of the lungs and pleural spaces are clear. The heart is not enlarged. Appearances may be secondary to infectious aetiology including mycobacterial infection or neoplastic lesion. Staging CT scan for further assessment is recommended. Referral to the TB service is advised. Glenfield Hospital ext. 3766 For GP patients a referral proforma is enclosed

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Soft tissue opacity in the mediastinum is noted. Difficult to separate this from the cardiac shadow. No previous examination for comparison. Some opacity seen in the right base. Suggest lateral projections of further assessment. Lung otherwise clear.

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comparison consolidation mediastinum_widened normal recommendation


Series of chest xrays from 9.2.2016 to 22.2.2016. Recent resection of the left lung is noted. There is no evidence of pneumothorax. Small residual pleural effusion on the left associated with mild elevation of the left hemidiaphragm. No new changes in the right lung. The heart is not enlarged.

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AP radiograph. Blunting of the left costophrenic angle consistent with consolidation or effusion. Widening of the upper mediastinum consistent with retrosternal extension of the thyroid. Heart size is normal. Please see subsequent CT report.

O O O O B I I I I I I I I I I I I I I I I E B I I I I I I I I I I I


AP erect. Comparison is made with the previous chest xray from 23/11/14. Suboptimal film. The patient is rotated. The lungs look congested. No major collapse or consolidation. No sizeable pleural effusions.

O O O B I I I I I I I I I I I I I I E B I I I E B I I I E B I


Moderate cardiomegaly. Mild pulmonary venous congestion. No pleural effusions. Appearances are mild heart failure. No significant consolidation.


The cardiac shadow appeared minimally enlarged without obvious congestive features or pneumonic infiltrate. Calcified aortic knuckle. Slight elevation of the right hemi-diaphragm. Scoliosis of the dorsal spine with degenerative changes.

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Series of chest x-rays dated 14/10/2015-18/10/2015. Post operative films following right lobectomy. Right chest drain in situ. There is a large pneumothorax with almost complete collapse of the remaining right lung. The last chest x-ray shows almost complete white-out of the right hemithorax. There is also evidence of pleural effusion. The left lung is unremarkable.

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comparison normal object pleural_effusion pneumothorax


XR Chest. Comparison is made with the previous chest x-ray from 01/11/14. The patient is rotated. There is right-sided pneumothorax. The underlying lung is collapsed. A recent right 8th rib fracture noted. The left lung and the left CP angle are clear. The heart size is normal. Urgent surgical referral is advised.

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atelectasis comparison normal pneumothorax recommendation rib_fracture technical_issue


Relevant imaging dating back to 18.02.2015 reviewed. There is a right sided central line with the tip situated at the SVC. There is volume loss in the right lung with pleural thickening with right upper zone scarring and traction bronchiectasis. No major collapse or new consolidative change. The left lung is clear.

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Chest. When compared to the prior chest x-ray on 7/11/2015, there has been no significant change in the small right basal pleural effusion. However atelectasis at the right lung base is new, additional consolidation cannot be excluded. The left lung is clear. Mitral ring is noted. Mild thoracic scoliosis.

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atelectasis comparison consolidation normal object other pleural_effusion possible_diagnosis scoliosis


Right lung lower zone collapse/consolidation with right basal pleural effusion and inter-fissural fluid. Subsequent CT scan of the chest, abdomen and pelvis performed on 12/03/2015 has demonstrated metastatic disease with necrotic mediastinal adenopathy, bone and soft tissue deposits.

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Left-sided drain has been removed. There is a large hydropneumothorax on the left with overlying surgical emphysema and basal collapse/consolidation. There is significant mediastinal shift to the left indicating the collapse. Right lung is unchanged.

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The right upper lobe is opaque.There is a likely left lower lobe retrocardiac metastasis. Free intraperitoneal gas noted.


Previous CXRs and CT thorax (4/08/2015 & 27/01/2015 reviewed). Known anterior mediastinal soft tissue. The heart is of normal size. The paraaortic shadowing remains unchanged. The lung fields are clear, no effusion.

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Opacified right mid/lower lung with obscured CP angle/hemidiaphragm, known lung Ca., now with collapse consolidation mid lower lung with possible effusion. Prominence of the left hilar with streaky/linear shadow left lower lung.

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Elevated left hemidiaphragm. Both lung fields are showing increased vascular markings but no focal active lung lesion seen. No change compared to previous xray of 2/7/14.

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portable ap. Compared with previous, there is more congestion in keeping with failure. Probable new left clavicle fracture.


Cardiomegaly with CCF of the second degree and bilateral pleural effusions. There are several patchy opacities seen in both lungs, the largest is 20mms in the right upper lobe. I note this was not present on previous CXR and sinister cause needs to be ruled out. CT of the chest and abdomen is recommended. Referral to the Lung Cancer MDT / Tracker is advised. Glenfield Hospital ext. 2415 For GP Patients a referral proforma is enclosed

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12 x 8.5 cm right paramediastinal consolidation noted.Bibasal pleural effusions noted.Degenerative changes in the shoulder joints noted. This could be infective or neoplastic in nature. Suggest repeat post-treatment.

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atelectasis consolidation pleural_effusion scoliosis

No previous film available for comparison. A right convex scoliosis of the dorsal spine with deformed thoracic cage, widening of the mediastinum with probably enlarged cardiac shadow but no congestive features. Increase rt. lower lung marking and hazy left mid/lower zone with less distinct lower cardiac margin/ hemidiaphragm, possible infection or composite shadow, correlation with the clinical finding advise.

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No previous films available for comparison. Heart size is at the upper limit of normal. There is an enlarged thyroid causing deviation and some compression of the trachea. Left drain noted. There is right basal atelectasis/scarring. Lungs are otherwise clear. HIatus hernia noted.

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atelectasis comparison hernia mediastinum_displaced normal object possible_diagnosis


Comparison is made with the previous images. There is a rounded density projected over the right side of the heart suggesting a mass. Remaining lungs are otherwise clear. Dilated oesophagus is again noted. CT scan is recommended. Referral to the Lung Cancer MDT / Tracker is advised. Glenfield Hospital ext. 2415 For GP Patients a referral proforma is enclosed

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abnormal_non_clinically_important comparison normal other parenchymal_lesion recommendation


Cardiomegaly with CCF of the second degree. Lung fields clear.


Comparison is made with the previous radiographs. The heart size is normal. The lungs are hyperinflated. Although less dense there continues to be bilateral are symmetrical perihilar mid zone opacification although there is a decrease in the surrounding nodularity and likely bronchial dilation with mucous plugging distally. There remains chronic right apical scarring. There are no pleural effusions. Given the symmetry of the changes does the patient have breast implants? As atypical infection must be considered I would suggest a CT thorax for further evaluation if there is no history of implants.

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There is evidence of a longstanding severe osteoporotic wedge fracture of the body of T8. There is generalised osteoporosis associated with a kyphosis. There is no other feature of note. CT ratio 13/24. No active focal lung lesion seen. Previous surgery noted.

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abnormal_non_clinically_important cardiomegaly comparison normal other rib_lesion scoliosis


There is advanced centrilobular and paraseptal emphysema with heterogeneous distribution. There is right apical loculated pneumothorax. Resection of the right upper lobectomy of the right upper lobe noted. Endobronchial valves in segmental bronchi of the right upper lobe are seen. There is moderate bronchiectasis. There is only very subtle herniation of the lung with a bulla lobe into the second intercostal space on the right anteriorly. Otherwise no evidence of lung herniation. No evidence of significant mediastinal lymphadenopathy. Midline sternotomy and CABG noted. Visualised upper abdominal and retroperitoneal organs appear unremarkable on this scan in arterial phase. There ae several wedge fractures of vertebral bodies the mid thoracic spine. Gas bubbles without fluid collection or inflammation noted in the posterior chest wall on he right posteriorly to the scapula, I note this is probably in the site of previous thoracotomy. Impression. There is severe pulmonary emphysema. LVRs and EBV noted on the right. Very subtle lung herniation on the right (better seen on sagittal reconstructions).

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There is a moderate sized loculated hydropneumothorax anteriorly extending to the lung base. Increased pleural density suggest previous talc pleurodesis, however in view of the intermittent pleural thickening and enhancement, appearance is suggestive of metastatic pleural disease/collection. There is worsening multifocal peribronchial consolidation in the residual right lung may represent infection In addition, the patchy peripheral ground-glass opacities cysts/bullae in the left lung there is also loss when compared to the previous CT. Several small solid and sub-solid pulmonary nodules some with early subtle cavitation are concerning for progressive lung metastasis. No significant mediastinal or hilar lymphadenopathy. Subtle increased density within the sternum cortex as seen on the previous CT is suspicious of bone metastasis. Series, following the chest drain on 12 December 2016, and the left-sided pleural collection completely resolved and subsequently reoccurred.

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Hyperinflated lung fields in keeping with COPD with multiple right-sided rib fractures and a right clavicle fracture, unchanged compared to previous x-ray of 22 November 2015. Small retrocardiac density suggestive of possible hiatus hernia. No significant pleural effusion seen. Mild bibasal bronchiectatic changes seen.

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There is no acute pulmonary embolism. The main pulmonary trunk is not dilated and measures 2.9 cm in diameter. There is no straightening or paradoxical bowing of the interventricular septum. Moderate calcification of the left anterior descending and circumflex coronary arteries. The aortic valve calcification is noted. No pericardial effusion. The ascending aorta is mildly dilated and measures 4 cm in diameter. There is no mediastinal or hilar lymphadenopathy. There is bilateral ground-glass opacification involving the dependent aspects of both upper lobes, middle lobe and both lower lobes. There is traction bronchiectasis most prominent at the bases with honeycombing at the lung bases. Patchy areas of mild mucous plugging in both lower lobes. No sparing of the costophrenic angle. Multiple gallstones and a thin-walled gallbladder. Focal calcification are seen in the spleen. Rest of the imaged upper abdominal viscera, within limitation of an arterial phase scan appears unremarkable. No focal osseous lesion.

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There is a right upper lobar cavity surrounded by scarring. In the cavity there appears to be a rounded lesion that has progressed in size and is suggestive of a fungus ball. Lungs are otherwise clear. The heart is not enlarged. CT of the chest fo further assessment is recommended.

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Metallic artefacts noted. Bibasal opacification noted with small right effusion noted. Pulmonary venous congestion noted. Features are suggestive of failure and superadded infection should be excluded.

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No previous chest radiographs available for comparison. There is bilateral apical lung fibrosis consistent with old TB with hyperinflation of the remaining lung with bulla formation. There is a small additional right pneumothorax likely to be the cause of current severe difficulty in breathing.

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No contrast extravasation or evidence of great vessel trauma. No pericardial effusion. Normal cardiac configuration. No signifiant coronary artery or valvular calcification. No pneumothorax. No pleural effusion or haemothorax. Mild paraseptal emphysema. Bilateral mild lower lobe bronchiectasis. Bilateral basal atelectasis. A 3 mm subpleural nodule in the left lower lobe is likely inflammatory. No other lung parenchymal or endobronchial mass lesion. Multiple bilateral old healed rib fractures. There is angulation of the manubriosternal joint with mild increase in the joint space anteriorly. No associated haematoma or fat stranding. No manubriosternal dislocation. No other acute fracture. No mediastinal, hilar or axillary lymphadenopathy. Small hiatus hernia. Multiple gallstones in a thin-walled gallbladder. Partially imaged left kidney shows cortical cyst. Rest of the upper abdminal viscera within the limitation of an unenhanced scan appears unremarkable.

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Comparison made with the previous chest radiographs from August 2016. Interval films reviewed. Mobile AP erect chest x-ray performed. The right internal jugular line has its tip in the SVC. There remains a PPM in situ. The heart appears enlarged with prominent pulmonary vascularity in keeping with heart failure. There is bilateral basal atelectasis. The lungs are otherwise clear.

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atelectasis cardiomegaly comparison interstitial_shadowing normal object upper_lobe_blood_diversion


At the level of the MPA (32 mm). The ascending aorta measures 30 mm and the descending thoracic aorta measures 24 mm. At the level of the hemidiaphragms, the descending thoracic aorta measures 23 mm, at the level of the renal arteries. The abdominal aorta measures 23 x 20 mm and just prior to the bifurcation 17-18 mm. No thoracic or abdominal aortic aneurysm, focal dissection or ulceration. There is severe background mixed centrilobular and panacinar emphysema with extensive mucus plugging with likely chronic left lower lobe collapse. Focal scarring in both lung apices but no focal consolidation. Normal pleura, mediastinum and pericardium. No pneumothorax. Conventional origin coronary arteries with no coronary artery calcification. The solid abdominal organs are unremarkable, no ascites/pneumoperitoneum or lymphadenopathy. Double thoracolumbar mild scoliosis with multiple thoracolumbar moderate vertebral collapse/fractures secondary to severe generalised osteopenia (steroid use for COPD). No obvious acute rib fracture, however, there are a few bilateral recent rib fractures (left 11th posterior rib) with callous formation.

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CT Abdomen. Small left basal pleural effusion and left basal atelectasis.Left paracardiac and anterior fat pad, lymph nodes and ill defined soft tissue mass as seen on CT chest. Mildly enlarged spleen measuring 13.7 cm (craino-caudal), probable mild hepatomegally. No splenunculus. There are small volume paraaortic and bilateral inguinal lymph nodes, all less than one cm. No concerning osseous lesion. Left hilar/perihilar mass and samll left basal effusion.

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No lung mass or consolidation noted to explain cause of hyponatraemia. Cardiomegaly. Left axillary artefact noted.


Panel the various moderate to loculated or pleural effusion with high density at content suggestive of haemothorax. There is a chest drain in a there is C2. Pound and compressive atelectasis of bilateral the right lower lobe noted. It is only minimal apical pneumothorax. There are several fractures of the lower ribs (8-11)on the right. Fragments of the ribs are dislocated to the pleural cavity. No evidence of active haemorrhage. Otherwise no evidence of new trauma. Healed sternal fracture. Wedge fractures of T8 and 12 vertebrae as seen on previous CT.

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Pacemaker and previous cardiac surgery noted. Soft tissue calcification in left arm and chest wall as before. Lungs otherwise appear clear.

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abnormal_non_clinically_important comparison normal object


CT Thorax/Abdo. There is a very large hiatus hernia containing the whole stomach, loops of the small bowel, parts of colon. body and tail of the pancreas and large part of the mesentery. The defects in the diaphragm is more than 5 cm wide. The mediastinal structures and basal parts of the lungs are compressed by the hernia anteriorly. Both main bronchi significantly narrowed. The right lower lobar bronchus is occluded by mucus impaction. There are compressive atelectasis of the right lower lobe, parts of the right middle lobe and the almost follow left lower lobe. There is aberrant right subclavian artery. There are several calcified mesenteric lymph nodes. The intra-abdominal the visualised upper abdominal organs appear unremarkable on this noncontrast scan. There are no destructive bony lesions.

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abnormal_non_clinically_important atelectasis hernia normal


On the most recent examination;. Images compared with previous. There is cardiomegaly. Median sternotomy wires and valve replacement noted. There is bilateral apical scarring and chronic background changes. The lungs and pleural spaces are otherwise clear of any confluent consolidation or collapse. No evidence of pneumothorax. Reported by [REDACTED] (Locum Reporting Radiographer).

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apical_fibrosis cardiomegaly comparison normal object other


No pulmonary emboli identified. The main pulmonary artery is normal in calibre. No features of right heart strain. There is small retrosternal haematoma related to the recent surgery. Linear atelectasis in the left upper lobe adjacent to the recent CABG noted. Bilateral small pleural effusion with compression atelectasis of adjacent lungs noted.Otherwise no focal parenchymal lung abnormality. No significant mediastinal, hilar or axillary lymphadenopathy. Allowing for the phase of scanning, no significant abnormality of the imaged upper abdomen. Non united sternotomy and recent CABG noted. No focal bone lesion.

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CT Thorax &. Note made of previous CT 25/03/2010. Multiple areas of patchy airspace opacification in the right lung, predominantly in the lower lobe. Moderate right sided pleural effusion noted. Bilateral patchy pleural thickening noted. Small calcified granulomas in the left upper lobe. There is an irregular 4.7 x 4.7 x 4.0 cm, enhancing lesion in the superolateral aspect of the left kidney. The right kidney appears normal. Multiple calcific gallstones, but the gallbladder wall is thin and there is no pericholecystic fluid. The liver, spleen, pancreas, and both adrenals appear normal. The imaged small and large bowel appears normal. Degenerative changes in the spine, with mild lumbar scoliosis concave to the right. No bony lesion.

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The lungs are congested and there is evidence of upper lobe pulmonary venous blood diversion. No consolidation. The heart is enlarged (CTR 14.5/26.6). Normal hilar and mediastinal contours. Features are consistent with cardiac failure.

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cardiomegaly consolidation object pleural_effusion

Satisfactory position of ET. NG tube is coiled back in the stomach. There is widespread, diffuse air space opacification in both lung fields. There are some ground-glass changes as well in both upper lobes. There is anterior posterior gradient of changes. Besides consolidtion and ground glass there are smooth septal lines seen mainly in upper long lobes. There is minimal paraseptal emphysema in upper lung lobes. Airways are patent. There is only trace of pleural effusion on both sides. Small volume mediastinal lymph nodes noted, not significant by size criteria. The main pulmonary artery is of normal calibre. No pericardial effusion. The cardiac configuration appears normal. The partially imaged upper abdomen is unremarkable. No destructive bone lesion. A small haemangioma noted in the T10 vertebral body.

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XR Chest 21-07-2017,. Comparison made with previous CT 03/06/2017. Non-contrast CT. Multiple spiculated soft tissue lesions have increased in size and number. The irregular left-sided nodular pleural thickening has increased since the previous study. Small left sided pleural effusion is present. Severe bilateral centrilobular emphysema. No pericardial effusion. Thoracic aortic aneurysm noted. Metastasis in the right lobe of the liver as previously described. The remaining imaged upper abdominal organs appear normal. Multiple mixed sclerotic/lytic lesions demonstrated in the thoracic spine.

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There is a extensive consolidation the right lower lobe in the site of the wedge resection a with fluid collection containing multiple gas bubbles. Patches of consolidation and ground-glass opacities are also seen in the right upper lobe and some ground glass opacities are seen in the left upper lobe. There is a loculated small pleural effusion with pleural thickening on the right. There is a single pulmonary nodule seen in the left lower lobe with maximum diameter 13 mm. Multiple reactive mediastinal nodes noted. The visualised upper abdominal and retroperitoneal organs appear unremarkable. No destructive bony lesions.

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Hyperinflated lung fields in keeping with COPD with no change in the chronic shadowing and right hilar density compared to previous x-ray of 20/10/2016. There is associated loss of volume on the right side. No change in the small right basal pneumothorax compared to previous x-ray.

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single lead pacemaker insitu. Heart is enlarged. Lung shows changes of venous congestion. No active lung lesion seen.


CT Thorax &. The scan is mostly in the arterial phase of scan due to cardiac incompetency. There is air space opacification in the middle lobe, lingula, right and left lower lobes. There is partial collpase of both lingula and middle lobe. There is scarring in the apicoposterior segment of the left upper lobe, suggestive of previous TB exposure. There is severe centrilobular emphysematous changes, predominantly in the upper lobes with bronchiectasis. Several calcified granulomas noted bilaterally. Mediastinal lymphadenopathy largest measuring 1.4cm in paratracheal lesion. Small right sided pleural effusion. There is cardiomegaly is gross dilatation of both atria with dilatation of the pulmonary trunk and arteries. There is large volume reflux of contrast to the IVC and hepatic veins suggestive of tricuspid regurgitation. Large sliding hiatus hernia with the majority of the stomach in the thoracic cavity. There is a 0.6cm hyperenhancement in segment 8 of the liver, which is non-specific. No evidence of background liver cirrhosis. The spleen, pancreas, both adrenal glands and kidneys are unremarkable. Trace of pericholecystic fluid. The imaged bowel are unremarkable. No focal bone lesion. There is thoracic kyphosis. Inferior endplate depression of T11 vertebral body.

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Comparison to previous. There is again cardiomegaly and upper lobe venous imbalance. Persisting left basal pleural effusion/thickening no overt pulmonary oedema. No subdiaphragmatic free gas pneumothorax. Appearances consistent with failure. There is increased mid to lower zone air space opacification and compared to previous study. Persisting cardiomegaly and upper lobe venous imbalance and perihilar congestive changes. Left-sided PICC line demonstrated. No evidence of subdiaphragmatic free gas or pneumothorax. Appearances are consistent with acute infection or background of cardiac failure. Post treatment follow-up is recommended to ensure resolution.

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atelectasis cardiomegaly hernia mediastinum_widened

There is adequate opacification of the pulmonary vasculature with no acute PE. The main pulmonary artery is of normal calibre with no acute right heart strain. There is a large nonobstructed hiatus hernia with adjacent lower lobe atelectasis as well as basal ground-glass dependent changes. There is minimal basal bronchiectasis. There is no interstitial lung disease. There is a benign air filled cyst in the left upper lobe. There are renal cysts. The bones are generally osteopenic with multilevel wedge fractures and abnormal bony texture consistent with the known diagnosis of myeloma.

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Images compared with previous. There is cardiomegaly. Median sternotomy wires noted. There is upper lobe venous diversion, congestive changes and small bilateral pleural effusions suggestive of a degree of cardiac decompensation. Band of atelectasis within the left midzone is unchanged from previous. Reported by [REDACTED] (Locum Reporting Radiographer).

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Reported with chest radiograph dated 28/7/17. No pulmonary embolus. No evidence of right heart strain. There is a 4.2 x 3.1cm right hila/lower lobe soft tissue mass. The right lower lobe bronchus runs through the mass. No evidence of mediastinal invasion. There is a further 3.2 x 2.9cm thick walled cavity in the right upper lobe. No other lung nodule. No pleural effusion. Subcarinal and right hila lymphadenopathy. Mild centrilobular emphysema. Images of the upper abdomen are unremarkable. Possible nodularity left adrenal gland, however on axial images this is less apparent, assess at completion staging. No destructive bone lesion.

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Mild dorsal scoliosis with cardiomegaly and early congestive changes seen in both lung fields in keeping with heart failure. Follow-up x-ray is suggested after treatment.

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cardiomegaly possible_diagnosis recommendation scoliosis


There is no evidence of pulmonary embolism, pulmonary hypertension or right ventricular strain. Mild calcification in all three coronary vessels noted. Both atria are mildly dilated. There is no significant mediastinal lymphadenopathy. There is a large hiatus hernia. There is right upper lobar consolidation noted. Tree in bud nodules are seen throughout both lungs, maixmum in the right lower lobe. Mild cylindrical bronchiectasis are seen in both the lungs, most prominent in the right middle lobe associated with volume loss and fibrosis. There is a small chronic atelectasis with some bronchiectasis in the lingula. The visualised upper abdominal and retroperitoneal organs appear unremarkable on this scan in arterial phase. Wedge fractures of first degree of T8, T10 and T12 vertebrae. No destructive bony lesions.

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There is no central, lobar or segmental pulmonary embolus. There is bibasal atelectasis. No pneumothorax, major areas of collapse or consolidation. The left ventricle and atrium are enlarged. Coronary artery calcification is noted. There is mild interlobular septal thickening which predominates in the upper lobes. Features suggest a degree of cardiac impairment. The partially imaged upper abdominal viscera are unremarkable for the phase of scan. Incidental haemangioma within the T11 vertebral body. No concerning bone lesions.

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Reported with multiple prior chest radiographs. Comparison is made with CT of 23/6/16. Suture material from lingula resection. No pulmonary embolus. The pulmonary artery is larger than the aorta, the right ventricle appears dilated, suggestive of pulmonary hypertension. The heart is enlarged. There is bronchiectasis. There is apical predominants lung cysts on a background of fibrosis, with widespread ground glass opacity. There is a trace right pleural effusion and small left pleural effusion. The cysts, bronchiectasis and fibrosis are grossly unchanged from previous and are likely related to previous TB, but there is new pleural effusions and ground glass opacity. This could represent further infection or heart failure. The left brachiocephalic vein is narrow and there is significant collateral flow via jugular, chest wall and spinal veins. Normal upper abdominal viscera. Tricuspid regurgitation noted. No bone lesion.

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There is loss of volume in the right upper lobe with scarring and traction bronchiectasis with regional air trapping. There is further scarring with traction bronchiectasis in the lower lobe, again with air trapping. There are further small areas of air trapping. There is no generalised bronchiectasis or interstitial lung disease. There are mild dependent changes on a background of respiratory motion artefact. There are retained secretions within the trachea. There are partially small volume calcified mediastinal and hilar lymph nodes. There is a multinodular thyroid which is causing no tracheal compression. There is no destructive bony lesion.

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Partial collapse of the left lung is noted secondary to the left hilar mass lesion. Cavity in the left apex is also identified with pleural effusion. Appearances have worsen from the last examination. Right lung is still clear.

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Comparison is made with previous examination of February 2017. Hyperinflated lungs with flattened hemidiaphragms noted. Calcfied retrosternal goitre. Known cardiomegaly (CTR = 0.58). Both lung fields are otherwise clear.

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CT Chest/Abdo.Consultant review on 22/08/2017. No significant discrepancy with report.Small area of ground-glass opacification posteriorly in the left upper lobe of the lung is most likely inflammatory in nature. Small hiatus hernia. The calculi mentioned in the common hepatic duct in the original report, is actually in the cystic duct. Colonic diverticulosis, most marked in the sigmoid colon. Complex mass lesion in the upper pole of the left kidney, appearances concerning for malignancy.

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Comparison is made to the previous chest film from 11/3/2009. AP erect film. There is chronic opacification of the left hemithorax with volume loss and mediastinal shift to the left. Multiple small nodules are seen in the right upper zone. Appearances are unchanged since the previous film. Degenerative changes are noted at both glenohumeral joints.

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AP erect film. Bilateral lower lobe pleural effusions present with areas of consolidation. Left sided pleural effusion has advanced since previous imaging 22/04/2017. Heart size difficult to assess. Prominent vascular markings. Presentation consistent with oedema secondary to heart failure.

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Hyperinflated lungs with flattened hemidiaphragms noted as previously. Small central hiatus hernia. Heart size is normal. Volume loss and fibrotic change at the left apex is most likely post-treatment change. Remainder of the lung fields are clear. No change compared with previous examination of May 2017.

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Dual-chamber pacemaker noted in situ. The heart remains grossly enlarged. Increased vascular markings with appearances unchanged as compared to the previous film from January 2015. No definite focal consolidation. The pleural spaces are clear.

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cardiomegaly comparison interstitial_shadowing normal object


Grossly dilated bowel loops noted in the visualised portion of the abdomen. Chronic lung changes with left-sided pleural calcification and thickening. Bilateral atelectasis. No definitive acute collapse or consolidation.

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Chest. PA projection. Right-sided chest drain seen previously has been removed. Impression of small locules of air within the pleural space in the right upper zone similar to the earlier study. Small amount of right-sided tissue emphysema. Healed/healing right-sided rib fractures with pleural opacity globally in the right hemithorax. Air fluid level noted in the right middle zone. Stable appearances compared with the earlier exam.

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Both lung fields are clear. No focal active lung lesion seen. Heart size within normal limits. No change in the retrosternal thyroid displacing the trachea to the left side. the large hiatus hernia has increased compared to previous x-ray of 09/10/2013.

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comparison hernia mediastinum_displaced normal


CT Thorax &. Mild cylindrical bronchiectasis with mosaic attenuation and several subtle tree in bud nodules seen predominantly in the upper lung lobes. Otherwise no evidence of focal lung lesions. Subtle subpleural ground glass opaicties and reticulation are seen in both lungs with dorsal and basal predominance. Three subpleural cyst noted in the right lower lobe. Bilateral calcified pleural plaques predominantly on the diaphragm. Multiple non significant mediastinal lymph nodes noted. Mild calcification in all three coronary vessels is seen , the maximum calcification is in the anterior anterior segments of the LAD. There is severe calcification in the mitral valve and moderate calcification in the aortic valve. Small pleural effusion is on the right, minimal pleural effusion on the left. Very small cyst is noted in the left lobe of the liver, otherwise no evidence of focal liver lesions. The gallbladder, the pancreas, liver and spleen, both kidneys and the right adrenal appear unremarkable. There is a lobulated lesion in the left adrenal with maximum diameter of 25 mm. Advanced spondylotic changes in advanced atherosclerotic changes of the abdominal aorta noted. Advanced spondylotic changes of the lumbar spine seen. There is a wedge fracture of the first degree of L1 vertebra. No destructive bony lesions.

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Please refer to chest x-ray report. No bony lesion or fracture seen. OA changes present. Right lung abnormality noted. No previous imaging for comparison. There is partial collapse of the right upper lobe with an elevated abnormal right hilum. There is mediastinal widening and tracheal deviation in keeping with mass/ lymphadenopathy. There is volume loss of the right lung. Heart size normal. Overall appearances are consistent with lung cancer. Referral to the Lung Cancer MDT advised please email [REDACTED]. 3110. (lc).

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CT Chest/Abdo. Comparison with previous CTs dated 29/1/16 and 18/5/16. NG tube in situ with tip in the stomach. There is segmental consolidation in the middle lobe with patchy opacification in the lingula. There are subtle areas of ground glass in the left upper lobe. There are multiple tree in bud nodules seen in maily lower lobes. There is mucus impaction in the airways in lower lobes. Atelectasis at the right base. No pleural effusion. No mediastinal, hila or axillary lymphadenopathy. The spleen measures 11.8cm in AP dimension (previously 15cm). No focal splenic lesion. The liver, pancreas, both kidneys and adrenals are unremarkable. Scattered simgoid diverticulae. Unremarkable small bowel appearances. No free fluid. No abdominal collection. Old right 4-7th rib fractures. Old left 4th rib fracture. Degenerative disease at L5/S1. No destructive bone lesion.

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Images compared with previous. Heart and mediastinal contours are within normal limits. The lungs are hyperinflated with coarsened bronchovascular marking, There is increased patchy opacification within the right midzone. Appearances are consistent with supra-added infective processes. A repeat chest radiograph in 6-8 weeks folowing appropriate treatment is recommended to ensure complete resolution. Reported by [REDACTED] (Locum Reporting Radiographer).

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comparison consolidation hyperexpanded_lungs normal other possible_diagnosis recommendation


Good opacification of the pulmonary arteries with no pulmonary emboli seen. The pulmonary trunk remains normal in calibre at 2.91 cm. There is no straightening intraventricular septum. There is severe bilateral bullous centrilobular emphysema, with large bullae particularly in the posterior segment of both the lower lobes. Mild bronchial wall thickening and dilatation is also noted. There may be an element of nonspecific mild fibrosis but certainly the emphysema is the most dominant feature. No concerning lung nodule. No significant mediastinal or hilar lymphadenopathy. There are moderate diffuse calcific plaques in the proximal/mid LAD and circumflex and probable mild plaques in the proximal RCA, has a cardiac origin for his chest pain been excluded.?. Given phase of contrast, upper abdominal viscera are unremarkable. Degenerative changes. No destructive bony lesion.

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bronchial_wall_thickening bulla emphysema normal


Previous CT scan from 19/01/2017 was reviewed. Unenhanced scan. Left sided fractures of 5th - 10th ribs with medial indentation of the posterior fracture fragments. Small left pleural effusion. Previously seen pnumothorax has resolved. Mild atelectasis in the left lower lobw and in the lingula anteriorly. Mild scarring at the left apex. There is a 4 mm calcified granuloma in the middle lobe. Soft tissue lesion measuring 1 cm in the right upper lobe with irregular outline is unchanged. Subpleural soft tissue lesion withsurrounding ground glass opacification at the right apex with air-bronchograms, measuring approximately 3.3 cm. There is some associated subpleural scarring. This has not significantly changed compared to the previous scan. There is a focus of calcification within this opacity. Mild reticular changes in the right lower lobe with associated mild bronchiectasis. Multiple other small calcificed granulomas in rest of the lungs. Main pulmaonry trunk is not dilated. Thoracic aorta is of normal calibre with moderate atheromatous calcification. Severe calcification of LAD and right and mild calcification of the circumflex coronary arteries. No signifcant valvular calcifcation. No pericardial effusion. Small mediastinal lymphnodes are not significant by size criteria. Within limitation of an unenhanced scan, umaged upper abdominal viscera appears unremarkable.

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Hyperinflated lung fields in keeping with COPD with fibrotic changes seen in the left upper X and upper zone and right mid zone with bilateral bronchiectatic changes seen. No change compared to previous x-ray of 17/01/2017 but there is increased density noted in the left lower zone which could be secondary to associated infection. Follow-up x-ray is suggested after treatment.

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There is mild cardiomegaly. Reticular interstitial changes noted in both lungs particularly in the upper zones. There is blunting of the costophrenic angles suggestive of bilateral small pleural effusions. Combined appearances are suggestive of heart failure. There is marked calcification of the aortic arch and left subclavian vein.

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There is moderate loculated pleural effusion on the right with multiple gas bubbles suggestive of presence of septae. Compression atelectasis of the dorsal parts of the right lower lobe. There is a small subpleural consolidation seen in the left lower lobe. Multiple tree in bud nodules noted in the left lower lobe and several tree in bud nodules also in the right lower lobe. Mild cylindrical bronchiectasis noted. There is no significant mediastinal lymphadenopathy. The main pulmonary artery has usual calibre. There is dilatation of the ascending aorta up to 39 mm. Surgical emphysema noted lower right chest wall in site of previously inserted chest drain. The visualised upper abdominal and retroperitoneal organs on this scan in arterial phase appear unremarkable. There are no destructive bony lesions.

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Mild cardiomegaly with old healed fracture of the eighth rib noted on the right side with increased vascular markings seen in both lung fields and a possible opacity noted in the left upper zone which is most likely composite shadowing. Please see the follow-up CT report.

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Imaging is affected by respiratory motion artefact. Both kidneys demonstrate cortical atrophy suggestive of scarring. There is calcification at the lower pole of the right kidney and upper and lower pole of the left kidney involving the calyces suggestive of calculus. There is a calculus in the right proximal ureter measuring 7 mm in maximum length with mild proximal hydronephrosis. No left ureteric calculus is noted. There is no significant perinephric stranding. Simple cortical cyst noted in association with both kidneys. CBD is dilated measuring up to 9 mm. No CBD or gallstone is noted and no intrahepatic biliary dilatation is identified. Pancreatic atrophy is likely due to patient's age. Normal appearances of the spleen, liver and adrenal glands demonstrated. There is a large calcified uterine fibroid measuring 9 x 7.5 x 11 centimetres in maximum dimensions, mildly displacing the urinary bladder towards the right side. Calcification of the infrarenal abdominal aorta noted. No aneurysm identified. Mild diverticular disease noted in association with the sigmoid colon. There is otherwise no significant small or large bowel dilatation. No free fluid or intraperitoneal gas identified. No omental or mesenteric disease noted. There is a small hiatus hernia present. Patchy ground-glass shadowing is noted at both lung bases, more prominent on the left side. Is there any clinical suggestion of aspiration?. No lytic bone lesion demonstrated. Degenerative changes note within the visualised spine.

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Cardiomegaly is noted with congested lungs. Slightly widened superior mediastinum likely vascular. No acute lung pathology. Retrocardiac shadow likely large hiatus hernia.

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cardiomegaly consolidation hernia mediastinum_widened normal possible_diagnosis


THIS REPORT HAS BEEN CHANGED. Multiple chest radiographs reported together. The most recent of which performed 09/06/2018. There are small bilateral pleural effusions and atelectasis, worse on the right, appearances have improved since the previous chest radiograph. There is a ill-defined (approx 2.9/3.4 cm) mass which appears calcific in nature seen in the left upper zone adjacent to the aortic knuckle. It appears largely unchanged since previous recent imaging however a CT thorax may be recomended for further evaluation. The heart is enlarged with a left sided pacemaker is in situ. Empty placeholder value or index. The left lung lesion is benign and does not require CT assessment. I note Mr Smith has had CT scan in Kettering for his aortic dissection.

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Extraosseous soft tissue shadowing noted adjacent to the outer angle of the second rib in the supraclavicular region. Multiple healed fractures noted on the right along the anterior fourth and fifth ribs. The heart is not enlarged. Increase sclerosis is noted along the lateral end of the left clavicle. This is partly imaged on the CT scan. The appearances are of an established area of bone sclerosis.

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XR Chest 08-07-2018, CT Chest/Abdo.Comparison with previous CT 30 October 2017. Large right pleural effusion with severe bilateral bullous emphysematous disease. Partial right lower and middle lobe collapse, with atelectatic changes in the left lower lobe. No enlarged mediastinal or hilar lymph nodes. No PE. Triple-vessel coronary artery calcification. New hypoattenuating lesions in the periphery of the right liver, segment VI. Biliary stent in situ with dilated intrahepatic ducts but no pneumobilia. The remaining solid abdominal organs are normal in appearance. The unprepared large and small bowel is unremarkable. No enlarged abdominal or pelvic lymph nodes. No perforation, obstruction or free fluid in the abdomen or pelvis. Repaired infrarenal abdominal aortic aneurysm and aortocaval fistula. The inferior vena cava is occluded at the level of the aneurysm (L2). Degenerative changes in the spine but no destructive bone lesion.

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Left-sided pacemaker in situ. No postprocedural pneumothorax. Increased density noted at the right tracheobronchial angle is again noted. Has right-sided aortic arch been confirmed to account for these appearances?.

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Comparison is made with previous chest radiograph dated 15/11/2018. Heart size cannot be accurately assessed on this AP projection. Calcification of the mitral annulus noted. Left mid/upper zone linear scarring. Both lung fields are otherwise clear.

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Multiple chest radiographs are reported together. The most recent dated 24/07/2018. The previous bilateral chest drains have been removed. no pneumothorax. Mild residual subcutaneous emphysema is seen in the left axilla. Lingular opacification and small left pleural effusion in keeping with postoperative changes of recent bulectomy and lingulectomy. Right mid zone atelectasis similar to previous.

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atelectasis comparison consolidation normal object pleural_effusion subcutaneous_emphysema


Comparison is made with the previous examination dated 23/05/2017. Volume loss to the left hemithorax with scarring in the upper zone and lung base in keeping with a previous upper lobectomy. The lungs are clear of any acute collapse or consolidation. The cardiomediastinal contours are within normal limits. No destructive bone lesion identified.

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Comparison made with Chest Xray dated 13/11/2009 and CT Chest dated 20/07/2018. Evidence of right lung volume loss due to previous lobectomy and cystic bronchiectasis. There may be superimposed infection. Patchy consolidation left lower zone in keeping with likely mucus plugging.

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Left-sided pacemaker/kidney in situ. No lungs and pleural space appear clear. Heart size is minimally enlarged. There is a small calcific density overlying the left mid clavicle of unknown aetiology, if there is any concern and dedicated views of the clavicle are recommended in the first instance. Empty placeholder value or index.

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cardiomegaly normal object other recommendation rib_lesion


There are no pulmonary emboli. There is a right hilar mass which is splaying the right upper and lower lobar arteries. This is confluent with the consolidation extending from it into the right upper lobe. The solid component measures 5.3 x 5 cm (coronal and sagittal planes).Hilar mass measures 3.5 x 3 cm. Rest of the lungs are clear. No pleural effusions. Given the lack of enhancement, simple renal cysts. There are numerous low attenuation lesions within the liver. A variegated bone attenuation but no bone destruction.

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There is right basal scarring/atelectasis, which is longstanding; remaining lungs are clear. Normal heart size. There has been previous surgical excision of the right sixth rib.

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Comparison made to CXR dated 12/04/2006. There is new large right hilar opacity extending to right middle lobe with volume loss and mild pleural effusion. Appearance suggest right middle lobe collapse with or without consolidation and concerning for central obstructing lesion. No focal lesion demonstrated within left lung. The descending aorta is tortuous and probably ectatic. Further characterisation of the lesion recommended with CT chest and abdomen. Referral to the Lung Cancer MDT advised please email [REDACTED]. 3110. (lc).

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Comparison is made to previous study dated 1 August 18. Hyperinflated lungs. Left perihilar haziness and some volume loss and apical pleural thickening is seen previously. No focal new lung lesion of concern.

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Serial review of chest x-rays from 04/10/2018 to 10/10/2018. AP mobile semi-erect chest radiograph, rotated film with overlying ECG artefact. Intra-aortic balloon pump in situ. The tip of the right jugular line is in the cavoatrial junction. Right mid and lower zone diffuse opacification may represent a combination of pleural effusion with underlying collapse. There is no gross mediastinal shift. Congestive changes are seen in the remaining aerated lung zones. The heart is enlarged.

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cardiomegaly comparison consolidation interstitial_shadowing normal object pleural_effusion


IV beta blocker or sublingual GTN was not administered due to persistent hypotension. No coronary artery calcific plaques. There is moderate LMS ostial stenosis. LAD, diagonal branches, small circumflex, RCA, PDA and PLV. No obstructive coronary artery disease. Normal cardiac morphology. AVR with likely interposition graft, there is minor shelving in the proximal ascending aorta. No obvious AVR leaflet vegetations/filling defects seen. Mild interlobular septal thickening at both bases suggest pulmonary oedema. The subpleural ground-glass opacity/consolidation anteriorly in the middle lobe and posteriorly in the right lower lobe may represent atypical infection or resolving alveolar pulmonary oedema. Tiny bilateral pleural effusions present. Simple cyst in the right lobe of the liver measures 2.1 cm. may represent atypical infection. Reticular interstitial opacities in both the mid and lower zones are highly suggestive of pulmonary oedema. No pleural effusion. AVR and sternal wires noted.

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Diffuse tree in bud nodularity particularly in the left lower lobe and to a lesser extent in the upper lobes is consistent with small airway disease/infection. Probable mild patchy consolidation in the left lung base posteriorly. No diffuse "free stranding" bronchiectasis, however there is mild bilateral perihilar bronchitis (bronchial wall thickening). No significant mediastinal/hilar lymphadenopathy. Previous CABG noted. Limited images of the upper abdomen are unremarkable. Moderate degenerative anterior osteophytes in the mid and lower thoracic spine. The left lower lobe abnormality is obvious on chest x-ray, please consider follow-up chest x-ray in 2-3 months following the appropriate treatment.

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Comparison made with chest x-ray dated 15 December 2014. Supine projection. There has been a significant progression of the sclerotic deposits noted to the left posterior 3rd, 4th ,5th posterior ribs. In keeping with previous prostate cancer. There is a blunting of the left costophrenic angle with a small pleural effusion/pleural thickening. There is a band of linear atelectasis noted in the left lower lung zone. The lungs appear otherwise clear.

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No evidence of pulmonary embolism. There is good opacification of the pulmonary arterial vasculature. The pulmonary trunk is normal in calibre. No CT features of right heart strain. There are bilateral moderate pleural effusion associated with passive collapse of bilateral lower lobes predominantly on left side. There is solitary thin walled bulla within right upper lobe. No size significant focal lung nodules noted. No pneumothorax. There is cardiomegaly with small pericardial effusion. No mediastinal or hilar lymphadenopathy. Partially imaged intra-abdominal organs appear normal. No destructive bone lesions demonstrated. Moderate degenerative changes of the spine demonstrated.

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THIS REPORT HAS BEEN CHANGED. CT Chest/Abdo. CT confirms a large mediastinal mass encasing and almost occluding the SVC and the left brachiocephalic vein. There are extensive anterior abdominal wall and chest wall collaterals. The right main pulmonary artery is also encased and narrowed but not occluded. The mass measures are maximum 10.6 x 11.5 cm, is inseparable from the right hilar/mediastinal nodes. Left preaortic lymphadenopathy measures 1.3 cm in short axis. 2R node measures 1 cm in short axis and a right supraclavicular lymph node measures 1.5 cm in short axis (is probably challenging to biopsy). The mass is associated with interlobular septal thickening with perivascular infiltration in the right upper and middle lobes, is highly suggestive of lymphangitis. The 2.8 cm nodule in the right lower lobe is likely to represent the primary. As previously known, there is moderate to large right-sided pleural effusion. Nodularity in the left upper lobe is more likely to represent lung parenchymal sarcoidosis, is essentially unchanged since the previous CT. Enlarged right adrenal measures 2.9 cm (previously 2.8 cm), is highly concerning for adrenal metastasis. Rest of the solid abdominal organs are unremarkable. Round 1.4 cm left inguinal lymph node is concerning for nodal metastatic disease. Distended right common femoral vein with suggestion of filling defect is suspicious of DVT, however CT is not confirmatory, please consider ultrasound Doppler scan. Permeative bone appearance of the left anterior pubic ramus is concerning for bone metastasis. Dr [REDACTED], Consultant VAscular Radiologist. Asked to review scan with view to SVC stent. As above, CT confirms a large mediastinal mass encasing and almost occluding the SVC and the left brachiocephalic vein. Referring SHO Dr [REDACTED] states pt has no signs of SVCO. As pt has had no treatment for this mass, if a stent is placed and then treatment is commenced there is high risk of migration of stent into the heart.

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Volume loss in the right hemithorax in keeping with previous LVRS. The lungs are hyperinflated with dense changes. No acute lung pathology identified. Heart size is normal. No significant interval change since previous imaging.

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Right basal drain in situ. The right pleural fluid collection is smaller. There has been no re-expansion of the right lung which remains completely collapsed. A moderate left pleural effusion is noted.

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Comparison made with previous radiograph dated November 2017. Increased pulmonary congestion with upper lobe diversion and trace of fluid in the horizontal fissure, in association with cardiomegaly. This is suggestive of stage I congestive cardiac failure.

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There is persistent small right-sided pleural effusion which is probably loculated. The mildly enhancing pleura is thickened, measures maximum 1.4-1.5 cm. The pleural collection is probably associated with some rounded atelectasis, there is significant loss of right lower lobe lung volume. Background mild mixed centrilobular and paraseptal bullous emphysema with upper lobe predominance, no focal consolidation. No significantly enlarged mediastinal or hilar lymph nodes, the largest subcarinal node measures 1.1 cm in short axis. Mild to moderate calcific atheroma is noted in the LMS extending to the proximal LAD and circumflex. Normal pericardium. Multiple surgical clips are noted along the gastro-oesophageal junction and greater curvature of the stomach - please correlate with surgical notes. Diffuse pancreatic fatty infiltration, otherwise the limited images of the upper abdomen are unremarkable. Moderate degenerative anterior osteophytes are noted throughout the thoracic spine.

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CT Chest/Abdo. The tip of the ETT, NGT and the bladder catheter are appropriately positioned. The tip of the left chest drain is at the left lung apex and left mid zone posteriorly, the tip of left jugular CVC is in the proximal left brachiocephalic vein. The ECMO line has been removed. Moderate septated right-sided pneumothorax is anterior, there is a very small loculated left anterior pneumothorax or possible bulla. Multiple bilateral low density/cavitating lung lesions are again noted, the largest in the left lower lobe measures 10.9 cm (axial diameter) and 21 cm in the craniocaudal diameter. Bilateral parenchymal scarring is noted. No significant mediastinal, axillary or hilar lymphadenopathy. The abdominal organs are unremarkable, no abdominal/pelvic lymphadenopathy or ascites. There has been no significant interval change since 5 September 2018. Bilateral loculated collections as described on CT.

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cavitating_lung_lesion comparison interstitial_shadowing object other pneumothorax


The heart size is normal. Chronic changes in both the upper zones in keeping with previous sarcoid. I am not convinced of any new abnormality as compared to the previous study from twenty-first of 05/2017.

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Several chest x-rays have been reviewed. The latest from 4/12/18 shows that the right chest drain has been removed. There is tiny residual right apical pneumothorax with a little right sided subcutaneous emphysema and right upper zone scarring/atelectasis and small bilateral pleural effusions. No change since previous.

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The heart is significantly enlarged with sternal wires, AVR and left-sided pacemaker in situ. Calcification of the mitral annulus noted. There is extensive perihilar airspace opacification with suggestion of small bilateral pleural effusions. Appearances are in keeping with heart failure. Baruch Videan. RA67103. Reporting Radiographer.

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Multiple examinations reviewed, most recent reported. Suboptimal AP erect rotated projection with suboptimal inspiration and medical device artefact obscuring the right hemithorax. Within limitations. There is persisting bilateral pulmonary oedema. Overt cardiomegaly and bilateral congestive changes. Bilateral pleural effusions also noted. There is some increased right perihilar air space opacification which given the clinical history could be attributed to a degree of aspiration pneumonia.

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AP semi-erect projection. The heart does not appear enlarged given the AP projection. There is blunting of the costophrenic angles suggestive of bilateral small pleural effusions. There is pulmonary venous congestion. Combined appearances are consistent with fluid overload. No gross consolidation or collapse.

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Left pacemaker noted with cardiomegaly, upper lobe venous diversion and mild Bibasal air space shadowing, which could represent congestion due to cardiac decompensation. Bulky central vasculature suggest pulmonary hypertension. Remaining lungs are clear. No pleural effusion.

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Enlarged cardiac shadow with congestive features , pneumonic infiltrate with possible effusion rt.


AP film. The thoracic aorta is ectatic. There is evidence of pulmonary venous congestion. No active lung lesion seen.


Chest. As on the previous film, there is or almost complete whiteout of the right lung with some aeration of the right upper lobe. The trachea is mildly deviated to the right, the partial whiteout is likely due to combination of collapse and pleural effusion. Recent CT suggests rt loculated effusion and large cavity in the right upper lobe and suspicious low density in the right upper lobe. With the given clinical history, necrotising pneumonia with abscess and empyema is most likely. Malignancy however, remains a possibility.

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