Right apical shadowing has, if anything, reduced slightly since the previous film dated 9/7/07. There is residual scarring and a little apical pleural thickening. Appearances are otherwise unchanged. Large volume lungs noted.

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Poor inspiratory effort. There is an indistinct right heart border suggesting right middle lobe collapse. The right hemidiaphragm is not clearly seen suggesting right lower lobe pathology. There is a small right sided pleural effusion. Although appearances may be infective a malignancy cannot be excluded and therefore CT is appropriate. There is a calcified nodule at left upper zone that may be old. Left lung is otherwise clear.

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A difficult film to interpret. There is a marked thoracic kyphosis. The heart appears enlarged even allowing for the projection. Mild pulmonary venous congestion and a probable small left pleural effusion.

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AP portable erect. There has been previous surgery. There is possibly some surgical emphysema on the left side of the neck. No pneumothorax seen. Raised left diaphragm. Linear collapse in the left mid zone. There is pleural calcification with pleural plaques on the right side.

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


Cardiomegaly but otherwise normal mediastinum. The lungs are generally clear although there is some soft tissue opacification at the lung apices, clinical correlation is required and it is likely this is just due to apical pleural scarring. If clinical concern is high a follow up chest radiograph in 6-8 weeks is advisable. No other specific adverse feature of note.

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apical_fibrosis cardiomegaly consolidation normal recommendation


There is expansion of the neck of the right 7th rib projected over the right hilar shadow. This has not changed since 2003 and is at the site of a posterior rib fracture in 1998. CTR 16/30, the heart is enlarged. There is some aortic arch calcification. No major collapse or consolidation.

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


Normal bowel gas pattern. There is line running from the left groin presumably a central venous line. A further line runs from the mediastinum probably an NG tube. Likely patchy air space changes at the lung bases. No free gas identified. The liver is at the upper limit of normal size, spleen is enlarged. Moderate degenerative change of the spine.

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


Even allowing for the projection there is marked cardiomegaly. There is evidence of a calcified ventricular aneurysm. An intracardiac defibrillator is noted in situ. Compared to the previous film from 30.11.07 there is volume loss in the right hemithorax with air space change in the right mid and lower zones and a small reactive pleural effusion.

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AP semi erect. The heart is grossly enlarged. There is aortic calcification and tortuosity. The lungs appear congested but there is no major collapse or consolidation. There is some pleural shadowing at the left costophrenic region. ..

O O O O B I I I I E B 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


AP erect. There is complete opacification of the left hemithorax which could be due to pleural fluid/consolidation. The right lung appears clear. Right hip: The right ilium is not seen in its entirety on this radiograph. There is heavy vascular calcification evident. No significant OA. No definite fracture identified. If the pain persists then an MRI is recommended. -

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

consolidation normal pleural_effusion recommendation


AP semi erect portable. Rotated film which I think accounts for the rather lateral position of the right sided internal jugular line this overlies the lateral aspect of the right side of the superior mediastinum, is blood flowing freely from this ? Diaphragmatic calcification noted. There is perihilar consolidation consistent with ARDS or pulmonary oedema which worse when comparison is made with the previous examination of 26th December.

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The mediastinum is widened with marked added soft tissue along the right mediastinal border. This would be inkeeping with stomach pull up related to oseophageal surgery if this has occurred in the past. If this is not the case this likely represents a mediastinal mass/lymph nodes. Sternal wires are noted. No major collapse or consolidation there is deformity of the left posterior 9th rib. No previous imaging is available on our system. Discussed with requesting FY 1 who informs me this man has not had a previous oesophagectomy and pull up. Without this history the mediastinal widening could be due to a mediastinal mass or lymphadenopathy although initially I would recommend reviewing old films given this patient is not particularly unwell at this time to see whether these changes are chronic. Ultimately CT would clarify.

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Valve replacement noted. The left chest drain has been removed. There are bilateral pleural effusions, more on the left compared with the right. There is increased interstitial shadowing, most marked in the right upper lobe. Subcutaneous surgical emphysema which is resolving is noted in the left lateral thoracic wall. Calcified mediastinal lymph nodes are also present. The cause of the increased interstitial shadowing is unclear. A CT thorax is advised to further characterise the abnormality.

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Chest and Abdomen There is evidence of pulmonary venous congestion. There are small bilateral pleural effusions. There is an impression of a soft tissue mass seen within the upper abdomen displacing transverse colon to the left. There is some vascular calcification. I cannot identify however any upper aortic dilatation on the ultrasound scan pictures performed on 4th January 2008.

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Mild tortuosity of the aorta with calcification of the arch otherwise normal mediastinum. Rib fractures on the right posteriorly are difficult to date but are probably old unless there are acute symptoms related to these. No pneumothorax. Lungs clear.

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There is elevation of the left hemidiaphragm which is most likely due to the underlying gastric distension. There is suboptimal inspiration with subsequent crowding of the vessels. Even allowing for this there is the impression of some soft tissue nodules in the upper zones. The posterior ribs are abnormal with patchy lucencies but no bone expansion. This could be due to marrow infiltration such as myeloma.

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There is enlargement of the cardiac shadow with multiple fluid levels due to hydro-pneumopericardium. There is more fluid in the pericardial sac compared to 18.2.08. --

B 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


AP supine. There is very extensive bony metastatic disease. There is a mass in the left upper zone of the lung which is presumably an extra pleural mass associated with a rib metastases. There is a moderate sized left pleural effusion. There is a soft tissue mass in the right axilla arising from one of the rib metastases. There is a further presumed extra-pleural soft tissue mass projected over the right mid zone. There has been disease progression since the previous film. Pelvis: There is extensive mixed lytic/sclerotic metastastic disease throughout the entire pelvis and proximal femora. There has been internal fixation of bilateral proximal femoral fracture position of metalwork as shown. Urinary catheter in situ. Left femur: There is extensive lytic change throughout the femur with a pathological fracture of the mid diaphysis. This has been internally fixed with two large plates. Position as shown. -

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Day 4 post CABG. Elevated right diaphragm. The lungs essentially clear otherwise. There is a prominence to the right side of the mediastinum as on the previous film. On this occasion there is a suggestion of an air fluid level but I suspect this is artefactual. Almost certainly he will have follow up films and this can be re-evaluated at that stage.

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


AP erect portable. Confluent opacity left hemi thorax likely a combination of large pleural effusion and compensatory lung collapse. The mediastinum is not particularly shifted. Large mass related to right inferior hilum. Clips in the right axillae. No major right lung lesion. The ribs are unremarkable.

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


AP erect. There are minor basal changes more marked on the left side. No free gas seen. There is a large amount of gas in a central viscus. Large rectal tube past up into distended loop of sigmoid.

O O O 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 I I E O O O O O


There is moderately extensive air space consolidation in the right upper zone - probably in the anterior segment of the right upper lobe. This is consistent with an infective or pneumonic process in the first instance and a follow up examination after suitable treatment is recommended. There is mild cardiomegaly and there is pulmonary venous hypertension suggesting a degree of mild heart failure.

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Heart is not enlarged. Minor scarring in left upper zone and right lower zone. Not much change compared to the x-ray of 10.3.2008. Suggest referral to chest physician for further examination. --

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apical_fibrosis comparison normal recommendation


Prior sternotomy. Heart size normal. Several nodular calcifications are projected over the cardiac apex of uncertain etiology. The lungs are clear.

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AP film. Tortuous unfolded thoracic aorta with cardiomegaly present. Pulmonary venous congestion present with left pleural effusion evident.


AP semi erect. There is a large superior mediastinal mass on both sides of the trachea which is not deviated significantly. There are calcifications within the mass and this was present on previous films. This is most likely to represent a retrosternal goitre. The heart is possibly a little enlarged most certainly it appears smaller than on the previous film of 30/1/08. There is now widespread fine nodular shadowing throughout both lungs. Other causes of fine nodular shadowing such as miliary tuberculosis or metastases seems much less likely in this clinical context. ..

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Heart is not enlarged. Evidence of left sided pulmonary tuberculosis with extensive left upper lobe calcification and a large plaque of apical and mid zone pleural thickening. There is less marked lower lobe calcification. There is marked volume loss in the left lung with mediastinal shift. Right lung appears clear. Without earlier studies for direct comparison it is always impossible to exclude the possibility of reactivation of the underlying pulmonary TB. When comparison is made with the previous report dated 24.6.2002 although it is difficult to be certain I think it is unlikely there has been significant change. Authorised by [REDACTED] absence of reporting Radiologist. --

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Portable erect AP. Despite the projection the heart appears enlarged. Prominent vessels indicates pulmonary venous hypertension and there are interstitial and minor air space opacities in the lungs mainly towards the bases likely interstitial oedema from LVF. The lung features are relatively mild. No focal collapse or consolidation to indicate infection. Prominent aortic vascular calcification. Osteopenic bones with no destructive bone lesion.

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


There are no previous films at this institution for comparison. I note that the patient being looked after by Oncology. The left hemidiaphragm is higher than the right there is what appears to be a left hilar mass with some linear change extending from the hilum. There is also a probable left pleural effusion and left lower lobe volume loss or consolidation. Some previous history would be useful but I suspect that there is an underlying neoplasm which is known about, if not then a CT of the chest is recommended.

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: Overall appearances slightly improved compared to film of 7/7/08. There is a small pleural effusion in the left costophrenic angle with some linear atelectasis medially in the left lower lobe and a minor area of focal air space change in the left lower zone. There is a right thoracotomy with significant displacement of the distal posterolateral segments of the right 6th and 7th ribs. There is added soft tissue around the more medially displaced segment of the right 5th rib. There is also a lamellar pleural effusion in the right lower zone with minor atelectasis in the right lower lobe.

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Enlarged cardiac graft CTR 18:32. Sternal wires and calcified aorta. Prominent vessels indicates mild pulmonary venous hypertension but no frank interstitial or alveolar oedema. No collapse or consolidation. Right costophrenic angle just clipped from edge of film.

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Heart upper limit of normal with cardiothoracic ratio of 17/32. Left mid zone opacity in keeping with the known rib metastasis, there is a 31mm x 24mm opacity at the left hilum ? lymphnode. There is pleural thickening of the right lower zone and blunting of the left costophrenic angle. here are possible nodules at the left lower zone ? lung mets. A hiatus hernia noted behind the heart.

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Presumed NG tube with tip beyond lower extent of film (way below diaphragm). Gas over right upper quadrant is probably small bowel anterior to the liver as this was not seen on 18/8/2008. Consolidation is evident within the medial segments of the left lower lobe with little collapse. This is perhaps more pronounced than on 18.8.08. Minor atelectasis at both lung bases. Old left mid rib fracture. Tracheostomy satisfactory. No pneumothorax.

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Unchanged appearances with chronically depressed left hilum and left pleural opacity related to lung torsion. Prominent costal cartilages anteriorly of the mid/lower right ribs as before. Fine bore left sided central line tip overlying SVC. No new feature.

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There are no films from outside sources. Previous rib resection right mid zone with apical pleural thickening and some fibrotic looking changes towards the right apex and elevation of the horizontal fissure on the right. No left lung or right basal inflammatory changes are seen. In view of the previous history it is difficult to exclude progressive pathology at the right apex.

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(AP Supine): There is volume loss in the left hemithorax with likely a degree of collapse of the left lower lobe, given the increased density behind the heart. Left chest drain tip lies at the level of the left hemidiaphragm. The right chest drain lies within the mid zone with the tip adjacent to the mediastinum, this should probably be withdrawn slightly. The right subclavian CVP line tip lies within the SVC. The patient remain intubated. The right lung is clear. ---

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

atelectasis normal object recommendation volume_loss


I do not have any previous plain films for comparison. There is a para-mediastinal mass in the upper half of the right lung. There are also soft tissue masses in the chest wall, associated with destruction of the right 7th and 8th ribs, and the left 7th and 8th ribs. I note that the patient has subsequently died. AP erect

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Overall appearances are largely unchanged from 07.10.08. Pericardial calcification is noted and there is also some probable peripheral pleural thickening. The changes in the lung fields could be old and fibrotic. --

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There is soft tissue overlying the left lung base making interpretation difficult. Even allowing for this there is the impression of a rounded density behind the heart which contains a rim of air superiorly. There is no gas seen below the left hemidiaphragm. Appearances are suggestive of an incarcerated hiatus hernia. Lungs are clear. No significant pleural effusion.

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AP. No major lung lesion. No free abdominal gas is visible. Deviation of the trachea is likely to be due to a goitre. Abdomen: No evidence of intestinal obstruction. Heavy vascular calcification is present. Calcification running across the midline in the pelvis may be a crossover graft. --

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


AP film with increased cardiac diameters and vessel prominence with basal effusions that look congestive.


Cardiomegaly with vessel prominence that looks more congestive than inflammatory. ..


Compared to 29.08.08, the heart remains enlarged. There is volume loss in the left lower lobe with possibly underlying elevated diaphragm, due to collapse of the left lower lobe. Congestive changes in the lungs persists. A repeat advised after treatment. ---

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cardiomegaly comparison consolidation hemidiaphragm_elevated recommendation volume_loss


Rotated PA film. Aortic arch calcification identified. Otherwise normal cardiac outline. No collapse or consolidation. No focal lung abnormality identified.Right humeral fracture noted. -

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consolidation object pleural_effusion pneumoperitoneum pneumothorax volume_loss

There remains right sided pneumothorax as well as an underlying right sided effusion and consolidation. There is still air above the liver in keeping with pneumoperitoneum.

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comparison consolidation pleural_effusion pneumoperitoneum pneumothorax


No apparent pneumothorax, but there is a little gas around the left cardiac border. There is increased interstitial shadowing in the lung fields. ---

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Previously noted right apical shadowing is still present and has not progressed. This is likely chronic. There is some right basal atelectasis. There is a retrocardiac shadow as previous which could represent a thoracic aortic aneurysm, hiatus hernia or soft tissue mass. A CT scan would clarify the findings. --

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The heart is enlarged. There are congestive changes in the lungs with blunting of the left costophrenic angle, which may be due to inflammatory changes in the left lower lobe. Follow up advised. ---

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is the soft tissue mass in the superior mediastinum on the right pushing the trachea to the left. Lung show background features of COPD. No major collapse or consolidation. No hilar adenopathy.

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aortic_calcification bulla cardiomegaly scoliosis

Transverse diameter of cardiac shadow 16cms. Heart is enlarged. There is large thin wall bullae in the right apical region, and minor scarring in right upper zone, and in both lower zones. No evidence of acute collapse or consolidation seen. If there is clinical suspicion of TB, suggest referral to a chest physician for further investigations. -

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


Large volume lungs with pleural thickening in the lower zones, and scarring in the apical region. There could be emphysematous bulla or cavity in the apical regions on both sides. Suggest a CT scan. -

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Normal heart size. There are rib fractures postero-laterally on the right side extending from ribs 4 through to 8 some of which are healed with callus formation some of which are ununited. There are ring opacities in the right lower zone together with some parallel lines visible more medially on the right side, in addition there is some linear atelectasis in the left lower zone and again some parallel lines. These appearances raise the possibility of underlying bronchiectasis. There are also some reticular opacities in the left apical region suggesting previous granulomatous disease. In the absence of previous films if no such abnormality has been documented I would suggest obtaining respiratory opinion. --

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NGT and right internal jugular central line in situ. There is marked elevation of the right hemidiaphragm and right basal atelectasis with possible early consolidation around the right hilum. No free subdiaphragmatic air. AXR: Large soft tissue mass within the right side of the abdomen which I understand is grossly enlarged native right kidney. Colon and small bowel deviated to the left side of the abdomen. No evidence of bowel obstruction or perforation. Surgical clips noted in LIF in keeping with recent transplant. Multiple phleboliths noted in the pelvis.

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atelectasis consolidation hemidiaphragm_elevated normal object


Portable AP erect chest film. Tracheostomy tube noted in situ. Surgical clips are present secondary to recent laryngectomy. Triangular increased density in the retro cardiac region indicates left lower lobe collapse. There is some bowel with gas in it to the right of the mediastinal contour. This could represent bowel related to a pull up for the laryngopharyngectomy. Remainder of the lungs and pleural are clear.

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consolidation hernia normal object possible_diagnosis volume_loss


atelectasis cardiomegaly consolidation dextrocardia object subcutaneous_emphysema volume_loss

Mediastinal silhouette is enlarged. the lungs show significant pulmonary congestion/plethora. Bilateral pig tail drains are in situ, presumably in the pleural space and there is no appreciable pleural fluid on this plain film. Some surgical emphysema is noted in the left chest wall.

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Fine linear change in the upper zones bilaterally similar to 30/9/2008 and likely chronic linear scarring. Other less marked changes are noted elsewhere in the lungs again as before. No acute collapse or consolidation. Enlarged heart, CTR 13:24, some of the linear changes in the lungs could be prominent vessels related to pulmonary venous hypertension. -

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There is a small right basal chest drain in situ. There has been significant reduction in the size of the right sided pleural effusion. This has resulted in some tracheal deviation to the right presumably due to underlying pulmonary collapse. There is a small right apical pneumothorax. ..

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Comparison made with the previous film from 23.1.09. There is evidence of previous upper thoracic spinal surgery with posterior instrumentation as shown. There are extensive myelomatous deposits throughout the bony skeleton with deformity of the bony thoracic cage due to previous rib fractures. Compared to previous films the overall appearances are unchanged. There is the impression of a soft tissue density mass behind the heart which is in part due to some collapse of the medial aspect of the left lower lobe. There is also some ectasia of the descending thoracic aorta. I have reviewed the previous CT dated 15.1.09. There is added soft tissue lying between the descending thoracic aorta and the left atrium. The nature of this is uncertain but it appears contiguous with the displaced the oesophagus. Are there any relevant symptoms?

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atelectasis cardiomegaly object paratracheal_hilar_enlargement

Median sternotomy sutures and epicardial pacing wires are noted. There is slight cardiomegaly with a CTR of 13.3 24.5. There is residual dilatation of the proximal ascending aorta consistent with post sternotic dilatation. Compared to the pre operative film from 16.2.09 the main pulmonary artery is noted to be enlarged. The reason for this is uncertain. The pulmonary vasculature is normal. No focal lung lesion. No pleural abnormality.

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Elevated right hemidiaphragm has developed since 17.2.2009. There is underlying atelectasis. An odd lucent well defined structure is seen just above this hemidiaphragm which could be a small amount of pleural air or air just underneath the hemidiaphragm. Likely small right effusion. No major collapse or consolidation. Bones are osteopenic. If this patient is recently post op this could explain the findings. This radiograph is a few days old now and a further film is recommended to see resolution of these changes. I imagine by the lack of radiology that the patient is not particularly unwell.

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atelectasis cardiomegaly consolidation mediastinum_widened object

There is scarring in left upper zone and ill-defined opacity around the left hilum. -


Left side of the thorax is opaque with deformities in the ribs and calcification due to past surgery. There is pleural thickening and ill defined opacities in right lung which may be due to scarring. No major consolidation seen. --

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Vascular calcification is prominent, this can relate to diabetes or advanced atherosclerosis. No destructive bone lesion or clear evidence of osteomyelitis although plain films are relatively insensitive for this. There is possibly deformity of the proximal phalanx of the 4th toe but is only seen in 1 view, this could relate to a recent or past fracture, are there any symptoms related to this? No other significant abnormality.

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There is marked enlargement of the cardiac silhouette. There is evidence of pulmonary venous hypertension with peri-hilar congestion. Features suggest heart failure and are similar to the examination of May 08.

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No free subphrenic gas. Added soft tissue adjacent to the right heart border, containing an air fluid level is presumed in relation to the previous oesophagectomy / gastric pull through. The lungs are clear and the heart size is within normal limits. 6th right posterior rib resection is also noted.

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aortic_calcification cardiomegaly consolidation object pleural_effusion scoliosis

Patient deceased subsequent to film. The distal end of the NGT lies below the left hemidiaphragm. ETT in situ. The tips of the Rt IJV and left IJV CVCs lie in the SVC. There is cardiomegaly and features of cardiac failure with pulmonary oedema and pleural effusions. No pneumothorax.

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cardiomegaly consolidation normal object other pleural_effusion


Large right effusion is a little smaller than on 14/5/09. The vessels are prominent and there is patchy air space opacity in the left lung. With cardiac enlargement, this is all likely to relate to left ventricular failure possibly with addition infection. Abnormality of the right humeral head on the previous radiograph may relate to previous trauma. Suggest correlate with history and obtain further views if concerned.

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Previous median sternotomy. CTR 167/309, the heart is somewhat enlarged. There is an opacity lateral to the aortic knuckle. There is aortic arch calcification. This may represent an aortic arch aneurysm or a lesion in the left upper lobe. The rest of the lung fields and pleural spaces appear clear. NB In line with Improving Cancer Outcomes Guidelines, this patient is being booked for an urgent CT scan of the chest.

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Compared with yesterday only a tiny pneumothorax is evident measuring approximately 1cm at the apex. Right chest drain in situ. Small right and tiny left effusion again noted. Calcified mediastinal nodes. There is upper lobe venous diversion and general ground glass change suggesting a degree of overload/failure. Heart size normal.

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There is no previous chest imaging. The heart is not enlarged. There is abnormality medially within the right lung. Medially at the right base there is a 2cm x 1.7cm diameter lung nodule. Further lobulated soft tissue is projected over the lower right hilum but this is more difficult to quantify. I note from the indications that the patient is on haemodialysis. The cause of renal impairment is not indicated. The differential for the appearances is relatively wide. This could be due to metastatic disease in the chest if there is history of a previous primary. Appearances could also be due to primary lung pathology or adenopathy and vasculitis such as Wagner''s is not excluded. A CT thorax is advised to evaluate further.

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comparison normal other parenchymal_lesion possible_diagnosis recommendation


No previous chest xrays. There is still a right sided pleural effusion and some underlying pleural thickening. Perihilar vessels are prominent, and also some apical segment bronchi in the right lower lobe. ---

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Median sternotomy sutures, mediastinal vascular clips and epicardial pacing wires noted. There are small bilateral pleural effusions. There is fluid loculated laterally in the right horizontal fissure. A degree of central venous congestion is noted. No overt pulmonary oedema.

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Poor inspiration. The heart is enlarged. There is widening of the superior mediastinum, and there are multiple nodular shadowing in both lung fields. It is unclear whether this is secondary to heart failure or indeed they are mitotic lesions in the lungs. A CT scan is advised. ---

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Pacemaker wire in situ. Median sternotomy sutures. The heart is fractionally enlarged. There is a mass extending out over the superior aspect of the left hilum which I suspect is aneurysmal dilatation of the upper thoracic aorta. This is unchanged since the previous examination of 9.8.09. Lungs clear. Old right sided rib fractures noted. Authorised by [REDACTED] absence of reporting Radiologist.

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There are calcified nodes and calcification in the upper zone from past T.B. There is an ill defined shadow in the lateral basal segment of the right lower lobe with soft tissue element. Possibility of underlying malignant changes not entirely excluded. This may be assessed by bronchoscopy. There are features of COAD. CHEST

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There is now complete opacification of the right hemithorax when compared with the image from 16.9.09. In addition, there is some loss of volume in the right hemithorax, with some shift of the mediastinum to the right. The left lung is clear.

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CTR is 14.4:27.5cm. There is increased plethora in both lungs but no focal collapse or consolidation. Calcified aorta.


There is an abnormal shape to the mediastinum with a soft tissue bulge at the level of the right atrium, on the previous CT this is a distorted right AV groove which I suspect is related to pleural tethering. Superiorly there are coarse reticular opacities and pleural thickening which would suggest past TB, volume loss in right upper zone also. No definite free gas although gas below the left hemidiaphragm is extensive but probably confined to colon. Comparison with old radiographs is recommended, there are none found on our UHB systems.

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AP film. Despite the projection there appears to be genuine cardiomegaly. There is evidence of pulmonary venous hypertension and bilateral pleural effusions, larger on the left. Appearances are consistent with heart failure.

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Comparison is made with the previous chest xray dated 29th October 2009. Patchy opacification persists at the left base, however this is somewhat improved when compared to the previous film. There is blunting of both costophrenic angles suggesting very small bilateral pleural effusions. There is cardiomegaly with a CTR of 15/26. There is some prominence of the perihilar pulmonary vasculature suggesting a degree of venous congestion however there is no frank pulmonary oedema at present. Overall appearances however do suggest a degree of LVF, with superadded resolving infection at the left base.

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There is left lower lobe volume loss and consolidation. On the right side there is a more complex appearance the right hemi diaphragm has gas lucency beneath it and there is apparently added density seen which I think is bounded inferiorly by the transverse fissure which therefore could be due to loculated fluid. A repeat AP erect film is recommended with better visualisation of the bases. If possible a departmental film is advised.

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Median sternotomy wires noted in situ. Heart is enlarged. There is some pulmonary venous congestion, however no features of pulmonary oedema, no pleural effusion seen. No focal consolidation or collapse.

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cardiomegaly consolidation normal object


Compared to 15.09.09, the heart is enlarged. There is collapse/consolidation of the left lingular, and bilateral pleural effusions and also patchy atelectasis at the right base. There is also some patchy shadowing in the apex on the right side, may be composite. Follow up advised, preferably bronchoscopy to assess the left lingular bronchus. ----

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abnormal_non_clinically_important atelectasis cardiomegaly consolidation pleural_effusion recommendation


Heart size at the upper limit of normal. There is a retrocardiac hiatus hernia. The lungs and pleural spaces are otherwise clear. Well defined areas of calcification are seen in both axillary regions, which may represent calcified axillary lymph nodes, or alternatively given the fact that there is bilateral underlying glenohumeral joint degenerative change, these could represent calcified loose bodies within the joint capsule. --

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Heart is not enlarged. No major collapse or consolidation seen. Minor scarring and apical pleural thickening in the apical region. --

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Satisfactory position of wide bore left sided central line tip overlying the SVC. Pleural thickening or small effusion at the left base is a little more than on 18.3.2010. No major collapse or consolidation in the lungs. Deformity of 6th left rib laterally has been evident before and is probably a healed rib fracture. Tortuous calcified thoracic aorta.

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Clinical XR Chest A faint linear tubular artefact is noted extending across the right axillary region to the right apex. If this correlates with the PICC catheter, the tip lies within the region of the right subclavian vein. Elsewhere there is loss of volume within the right lung with right apical scarring and right apical pleural thickening. There is evidence of bilateral nodular and reticular interstitial opacities which are consistent with the diagnosis of widespread metastasis. There are no large effusions. Incidental note is made of old left clavicular fracture.

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There is large pleural effusion occupying the majority of the right hemi-thorax. The very tip of the apex remains aerated. The left lung is comparatively clear. There is minor air space shadowing within the lingula, and a pleural reaction at the left hemi-diaphragm. There is no significant mediastinal shift, allowing for projectional difficulties. However, it is likely that there is a degree of underlying basal collapse, associated with the large right sided effusion. Aortic calcification noted. There is an NG tube. The tip lies below the diaphragm.

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Heart size within normal limits. The lungs appear generally congested. There has been previous surgery. There is a thoracic scoliosis. The heart appears a little more to the right than the left. Similar to previous film.

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abnormal_non_clinically_important comparison consolidation mediastinum_displaced normal scoliosis


cardiomegaly consolidation emphysema interstitial_shadowing object parenchymal_lesion

Although an AP projection, the heart appears enlarged. Chronic inflammatory changes at both bases, more confluent in the right lower zone in keeping with active infection. Disorganisation of upper lobe vasculature in keeping with emphysema. When compared with previous chest radiographs from 2009 there are a number of new pulmonary nodules - projected over the anterior ends of the left 3rd and 5th ribs and within the right mid zone. An urgent CT scan is recommended for further assessment. Authorised by [REDACTED] absence of reporting Radiologist.

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cardiomegaly comparison consolidation emphysema other parenchymal_lesion recommendation


Semi erect AP film Despite the projection there is marked cardiomegaly. There is right pleural thickening or pleural fluid in the right chest and a quite prominent right apical pleural cap of soft tissue opacity. A less prominent soft tissue cap is noted at the left lung apex. There is marked volume loss with elevation of the right hilum in the right upper zone and the appearances of the right lung apex are likely to be long standing although this cannot be confirmed without old films.

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AP portable semi-erect. T-tube, NG tube and RIJ lines all appropriately sited. There is mild right basal consolidation on a background of congested lungs. --

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AP erect radiograph. Comparison has been made with the earlier radiograph dated 24/6/10. Left shoulder replacement noted. The heart is enlarged, there is bilateral air space shadowing particularly towards the bases as demonstrated previously consistent with bi basal consolidation. Central upper lobe pulmonary venous congestion noted. A right sided pleural effusion is also noted extending along the right lateral aspect of the thoracic cage and to the right apex. Elsewhere there are chronic left lateral rib fractures noted. No evidence of pneumothorax. Overall appearances remain largely unchanged with a significantly enlarged heart, evidence of congestive cardiac failure and persistent bi basal consolidation.

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Heart size normal. Large volume lungs with flattened hemidiaphragms consistent with COPD. No focal lung lesion. There is a mild thoracic scoliosis concave to the right and loss of height of the mid thoracic vertebral bodies. --

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Appearances are similar to the previous examinations ie., there is marked cardiomegaly, pulmonary venous hypertension and perihilar congestion - features consistent with heart failure. ---

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There are no previous films at this institute. The heart is enlarged with a CTR 17.0:27.7. There is evidence of previous cardiac surgery with median sternotomy sutures noted. The descending thoracic aorta is ectatic and there is early central venous congestion. No overt pulmonary oedema. No pleural effusion. --

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cardiomegaly comparison interstitial_shadowing normal object unfolded_aorta


AP supine radiograph. There is prominence of the aortic contour which could be partly projectional but does suggest an underlying ectasia of the thoracic aorta. Prominent bronchovascular markings are noted in both lung upper zones suggesting a degree of pulmonary venous imbalance. Linear shadowing in the left lower zone is likely longstanding. No pleural effusion.

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Left lower lobe collapse and adjacent left sided pleural effusion are noted, but effusion is significantly reduced in size from previous film in July 2010. There is the suggestion of a perihilar or left lower zone mass in addition. Has there been a previous CT scan? Calcified left sided thyroid nodule appears unchanged. No new right lung pathology. --

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There is a stent likely within the SVC - systemic baffle. Enlarged heart as before. There ae prominent vessels and perhaps basal pulmonary oedema but no major collapse or consolidation.

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cardiomegaly consolidation object paratracheal_hilar_enlargement


There is a small left sided pleural effusion but this is essentially unchanged from previous film from 6/9/10. Right cardiophrenic angle eventration or lipoma unchanged from previous films. Healed right posterior rib fractures noted. -

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No previous film at this institute. Median sternotomy sutures and a prosthetic intracardiac valve noted. There is elevation of the left hemidiaphragm compared to the right. Widening of the superior mediastinum is noted which in part appears to be due to unfolding and ectasia of the thoracic aorta. There is patchy air space change throughout the left mid zone which may be due to aspiration.

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There is a dual chamber permanent pacemaker in situ. Compared to the previous film from 4th June 2008 the transverse cardiac diameter has increased. The heart is now enlarged with a CTR of 17.5:32.3. Although there is chronic elevation of the right hemidiaphragm which is unchanged, there is new abnormality at the right base with an enlarged right hilum. Appearances could be due to proximal right lung lesion with peripheral lung collapse. NB In line with Improving Cancer Outcomes Guidelines, this patient is being booked for an urgent CT scan of the chest. ** Urgent report to GP and CT Booking Officer (Fax: 0121 460 5817) please fax whole number including STD

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AP erect film. A rather lordotic view. There is an underlying diffuse abnormality in both lungs probably the known COPD. Also increased shadowing in the left lower zone and a prominent opacity in the left mid zone. I think this opacity has been present on several previous films where some scarring and left pleural thickening have been apparent. It is more obvious on this projection. Infection in the left lower zone is certainly suspected. Pulmonary embolus cannot be excluded by a plain film like this.

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The heart is enlarged. Mild thoracolumbar scoliosis, convex to the left with loss of vertebral body height of two lower thoracic vertebrae, probably T9 and T10, in keeping with wedge fractures. The lungs are clear.

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AP. A single lead cardiac pacemaker. The odd-appearing 23mm well-circumscribed lucency just above the aortic arch is longstanding and of doubtful significance. Coarse bronchovascular lung markings and costal cartilage calcification. Some mild increased interstitial markings perhaps favour mild overload over infection as the cause of her breathlessness.

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(AP) There is pulmonary venous congestion and a small left pleural effusion. Appearances in keeping with heart failure. There is also a little collapse/consolidation in the left lower zone, seen through the cardiac shadow.

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It is subtle but there is very minimal new patchy air space opacity in the left mid and lower zones compared to 27.5.2010 film. The vessels are also more prominent before suggesting new pulmonary venous hypertension. Heart graft is upper limit of normal size CTR 18:36 similar to before. The lung abnormality may relate to a little pulmonary oedema or infection. Email to Sharon Beer.

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Single chamber PPM noted. Retained pacing wire from a previous device is present. Lungs show pulmonary venous hypertension, perihilar congestion and a small right pleural effusion - features consistent with heart failure. There is some added parenchymal shadowing at the right lung base consistent with either pneumonic change or some asymmetric pulmonary oedema. I suspect pneumonic change is more likely given the asymmetry.

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Cardiomegaly, pulmonary congestion and small pleural effusions would suggest heart failure. The pulmonary arteries are enlarged suggesting pulmonary hypertension.


No free air under the diaphragm. Rotation results in distortion of the mediastinum but no major mediastinal lesion is seen. There is a small nodule in the left upper lobe which have been seen on past CT''s back to at least 2009. XR Abdomen : There is normal bowel gas pattern. There is calcification of the abdominal aorta which is probably related to tortuosity and only mild aneurysmal dilatation (I note it measured 3.9 cm on a CT from 17.2.2009). Marked degenerative change of the spine with a scoliosis.

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There is marked cardiomegaly with a CTR of 17.1:26. Enlargement of the left atrial appendage suggests underlying left atrial enlargement. The main pulmonary artery is enlarged and there is associated pulmonary venous hypertension. There is unfolding and widening of the aortic arch which is unchanged compared a previous film dated 20/10/10. There is however increased dilatation of the descending thoracic aorta. This may be ectatic or aneurysmally dilated. There is no focal lung lesion and no pleural abnormality. Conclusion : There is cardiomegaly and pulmonary venous hypertension. The descending thoracic aorta is enlarging and may be aneurysmal. If further investigation is appropriate a cardiology referral is advised.

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The heart is not enlarged. There is an air filled lucency behind the left side of the heart which I suspect is a rather large incarcerated hiatus hernia. However, there does look also to be a little linear atelectasis in the left lower zone which may represent inflammatory change. Right lung clear. There is marked deviation to the left of the upper trachea with a large superior mediastinal mass. This is likely to represent a retrosternal thyroid. Advise repeat PA chest with a lateral projection to ensure inflammatory change in lower zone resolves and to more clearly characterise described abnormalities. Authorised by [REDACTED] absence of reporting Radiologist.

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There is evidence of volume loss within both upper lobes with thickening and elevation of the right horizontal fissure as well as bilateral diaphragmatic tenting. This remains unchanged in comparison with the previous chest x-ray. More importantly there are now small bilateral pleural effusions which were only just visible on the previous chest x-ray. There is a background generalised nodularity in the both lungs and as previously suggested further evaluation with HRCT may be prudent if deemed appropriate. There is a stent in the left brachiocephalic vein.

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atelectasis cardiomegaly pleural_abnormality scoliosis

There is cardiomegaly. Mediastinum appears relatively wide but this is unchanged since April and appears to be likely be the result of unfolding and mediastinal fat. The lungs and pleural spaces are clear.

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There is an increase in the degree of left sided mid and lower collapse/consolidation, presumed to be in relation to the known left lung tumour. Given the location of the tumour on previous CTs, a degree of collapse and consolidation is almost inevitable. Addition opacification is demonstrated in the right lower zone which may represent metastatic deposit in the contralateral lung. There is likely to be a left sided pleural effusion in association with the collapse/consolidation. Note is made of a grossly flattened humeral head, with marked joint space narrowing at the glenohumeral joint. This is likely to be due to an element of avascular necrosis at this site. -

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There is a marked thoracic scoliosis which is convex to the right with compensatory curves at the cervicothoracic junction and a the thoracolumbar junction. Presumed old rib fractures are noted. There is some interstitial shadowing seen bilaterally in the right lower zone and in the left mid and lower zones. This may be due to interstitial lung disease although this is seen on the background of presumed emphysema. An HRCT is further advised to further assess this.

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Surgical clips in the left axilla. Diffusely abnormal sclerotic bones, suggestive of metastatic infiltration. There is also inhomogenous opacification in the lungs, with suspicious nodularity in the upper left lung. Calcified aneurysmal thoracic aorta.

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There is increased opacity at the left costophrenic angle which is probably a small effusion developing. Throughout the lungs despite the suboptimal breath in there are prominent vessels and a suggestion of diffuse interstitial opacity which to a certain extent has been seen on films back to 2008. This suggests mild interstitial oedema possibly from left ventricular failure. There is no major collapse or consolidation or clear evidence of acute aspiration. Sub acute healing rib fractures are seen in the mid ribs posteriorly on the right.

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There is a degree of cardiomegaly (CTR 14.5:27). In the upper mediastinum/lower neck a soft tissue density mass displaces the trachea towards the right of midline. This is most likely to represent an enlarged thyroid. Would this fit clinically? The lungs and pleural spaces appear otherwise clear. There is possibly some buckling of the cortex of the mid/upper sternum, which may indicate a healing fracture in this region. . --

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No previous chest xrays on PACS for comparison. There is marked vascular calcification. There is increased interstitial markings and subpleural reticular change throughout both lungs with reduced volumes in keeping with pulmonary fibrosis. No pneumothorax or pleural effusions.

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(AP portable erect film) Comparison is made with chest xray dated 13/01/2011. There is consolidation in both lower lobes, worse on the right. The bilateral lower zone nodules seen on the previous CXR are partly obscured by the consolidation. There has been increase in size of the left upper zone nodule which now measures 2cm x 1.8cm in diameter (previously 0.7cm). There is a further new nodule in the right mid zone measuring 0.8cm in diameter. Subcutaneous calcification in the neck is noted. Conclusion : There is consolidation in both lower lobes. There has been increase in size of the left upper zone nodule and a new right mid zone nodule.

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There is cardiomegaly with a CTR of 18.1:34.3. Median sternotomy sutures noted with a dual chamber permanent pacing device and mitral valve replacement in situ. There is abnormality laterally in the right hemithorax with loss of volume, elevation of the right hemidiaphragm and relatively rounded soft tissue opacities confluent with adjacent pleural thickening. However, appearances are essentially unchanged from a previous film dated 20th October 2010 and I note a CT earlier in the year (15/2/11) showed this to be due to areas of rounded atelectasis adjacent to pleural thickening. No new adverse feature. Marked degenerative change is seen in the left shoulder.

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Large volume lungs. There is increased opacification in the right lower zone and the lower right heart border is indistinct. These changes would be concerning for RML consolidation. subsegmental atelectatic changes are noted at the left base. Treatment and interval re-imaging is advised to check for resolution. The pulmonary vasculature is generally prominent, suggesting a degree of fluid overload. No pleural effusions. A couple of small peripheral soft tissue nodules measuring no more than 3mm in maximal diameter are noted in either upper zone, in the absence of prior imaging for cross-correlation a CT study needs to be considered, please advise accordingly. The heart is not enlarged. Ectatic descending aorta, but otherwise unremarkable mediastinum.

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Mild cardiomegaly. There is a triangular density adjacent to the right heart border which is suggestive of right middle lobe collapse this has been present as far back as April 2011 but was not present in December 2010. There is some bronchial wall thickening and dilatation in the left lower lobe. There is evidence of emphysema. I note that a CT from October 2008 has shown chronic volume loss in the right middle lobe which presumably accounts for the right paracardiac findings.

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XR Chest (AP Erect Portable) ECG leads overlie the chest. The patient is rotated to the right. There is a single chamber cardiac pacemaker with the tip in the right ventricle. Despite the projection, the heart is enlarged. There is enlargement of the pulmonary vessels in the upper zones suggestive of early pulmonary oedema. Blunting of the left costophrenic angle noted, suggestive of an effusion. Calcification of the aortic knuckle noted.

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No previous radiographs on PACS. Sternotomy wires and a prosthetic (presumed pulmonary-) valve with ectopic calcification. Left pneumonectomy with resultant shift of the mediastinal structures to the left. There is air in the left upper zone. There is scarring/fibrosis at the right apex and an odd tubular structure projected over the medial right clavicle. A well-defined 12mm nodule in the right mid zone is presumed to be nipple shadowing. The remainder of the right lung is clear.

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There is a previous left mastectomy. Heart is not enlarged. The lung volumes are slightly increased and there are increased bronchovascular markings in the lower lobes which is likely to be due to underlying asthma/COPD. No convincing focal lung lesion or evidence of pulmonary metastases. No pneumothorax. No pleural effusion.

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Large volume lungs in keeping with a degree of COPD. There is some scarring and right apical bulla formation, but these features are unchanged from previous film in June 2010. No active focal lung lesion or focal consolidation demonstrated currently. --

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bulla comparison emphysema hyperexpanded_lungs normal possible_diagnosis


No previous radiographs. There is extensive bilateral pleural calcification. There is complete whiteout of the right hemithorax suggesting a large right pleural effusion, although clearly solid tissue is also possible. The right main bronchus is not visible suggesting complete collapse of the underlying right lung.

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Comparison is made with the chest xray dated 24.12.11. The tracheostomy has been removed. The right sided tunneled CVP line remains with the tip in the region of the right atrium. There is a moderate right pleural effusion which extends along the periphery of the lung. The previously noted small right pneumothorax appears to have resolved. No significant change in the diffuse parenchymal change noted in the right lung. The left lung remains clear. Marked vascular calcification. No free gas is noted under the diaphragm.

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No pneumothorax. The lungs are of a large volume in keeping with COPD. Old rib fracture involving 10th posterior rib on the left.

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The heart is enlarged (CTR 19/36). No significant effusion. There is ill defined increased density in the right mid zone which may reflect a degree of subsegmental infective consolidation. There is prominence of the interstitial markings and of the upper lobe vessels on the left but no convincing evidence of established pulmonary oedema. There are old healed rib fractures of the left 6th and 7th rib.

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AP semi-erect Comparison is made with the CXR from 15/11/06 and the findings are similar. There is cardiomegaly and pulmonary plethora consistent with pulmonary oedema.

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atelectasis cardiomegaly consolidation pleural_abnormality scoliosis

Mild cardiomegaly, CTR 17/33. There remains parenchymal distortion and consolidation in the lingula of the left upper lobe. Appearances have not changed since the previous film. The right lung remains clear. -

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cardiomegaly comparison consolidation normal


Comparison is made with the chest x-ray dated 24/8/08. Heart size is normal. The lungs are hyperinflated. The left lung demonstrates some atelectasis in the left base. In the right lower lobe projected over the anterior aspect of the 6th rib there is a spiculate density, this could represent composite shadows with vascular markings however a CT thorax will be organised to clarify.

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Comparison is made with the chest xray dated 06.12.10. A metallic closure device is noted in the region of the ductus arteriosis, clinical correlation is advised. Increased density in the superior mediastinum on this AP view is likely vascular in nature, however a PA chest xray is advised to assess further. There is left basal atelectasis. No pneumothorax. No free gas under the diaphragm. Dilated loops of bowel are noted below the diaphragm.

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No major collapse or consolidation. There is however some ill defined patchy lung opacity at both bases which may represent infection. The pleural spaces are clear. There is aortic arch calcification. There is quite marked spondylotic change.

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Comparison is made with the previous study dated 28.01.67 The cardiothoracic ratio is increased (18:31) indicating cardiomegaly, with some associated central plethora. There is some fluid in the horizontal fissure. Otherwise, there is no focal lung lesion, consolidation or collapse. No pleural effusions. No skeletal abnormality noted.

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Comparison is made with the previous chest x-ray from 18/3/08. Left sided pneumonectomy with resultant opacification of the left hemi thorax with an air fluid level and mediastinal shift to the left side is noted. Apical scarring is noted within the right lung. No other focal abnormality within the right lung. The heart is not clearly visualised due to opacification of the hemi thorax.

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There is collapse/consolidation of the left lower lobe. Allowing for suboptimal inspiration the right lung is relatively clear. A repeat chest x-ray is advised. Severe degenerative changes with flattening of the left humeral head is noted.

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AP examination. Comparison is made with the previous CXR dated 16/04/2012. I note the patient had a CT dated 08/05/2012. The lungs are hyperinflated with chronic changes consistent with severe COPD. The patchy airspace opacity and right-sided pleural effusion identified on the previous CXR is resolving. Ring shadows in the right lower zone are suggestive of bronchiectasis. There is long-standing right upper lobe fibrotic change and volume loss.

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There is marked cardiomegaly with a CTR 21.3:31.3. There is a implantable pacing/defibrillator device in situ. The right lung is clear. The left heart border is indistinct and there is evidence of left lower lobe collapse with a left pleural collection. Around the aortic arch there is new added soft tissue which may be related to recent pericardial window and mediastinal haematoma. A CT scan would evaluate more fully.

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AP semi-erect. Even allowing for the projection utilised the cardiopericardial silhouette is enlarged. Hazy opacification noted throughout the right lower hemithorax presumably inflammatory/infective in nature. Blunting of both costophrenic angles in keeping with small pleural effusions. A subtle small crescent of subdiaphragmatic free gas indicative of pneumoperitoneum, possibly post operative. Post thoracotomy defect appreciated in the right lower posterior rib cage. Centrally plethoric lungs, the distal tip of the right internal jugular central venous line is projected over the expected position of the SVC. No associated haemo/pneumothorax. Mediastinal drains appreciated. No other finding of note.

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There is a hiatus hernia. I have some concern that there is some free gas around the hernial sack on this AP semi supine view. A repeat chest x-ray is initially recommended as I note that this film is now 3 weeks old. There are changes in the left lower lobe which are similar to changes seen on a previous chest x-ray in May. These may be inflammatory or due to aspiration. The apparent gas around the hernial sack is unlikely to be clinically significant if the patient is still well. Report emailed to referring clinician.

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comparison hernia other possible_diagnosis recommendation


PA view. Comparison is made with previous chest xray from 26th April 2012. Heart size within normal limits. Large lungs with flattening of the hemidiaphragms, consistent with COPD. The previously noted triangular air space opacity in the left mid zone is not seen on current xray. There is 5mm nodule seen in the right upper zone, but this has not altered since the previous CXR. Long-standing left apical opacification has not changed. No other new changes seen. The pleural spaces are clear. Scoliotic thoracic spine remains unchanged. No new destructive bony abnormality. Thoracolumbar spine, AP and lateral : Comparison is made with previous thoracolumbar xray from 21st July 2011. Previously noted multiple level wedge compression fractures secondary to generalised osteopaenia due to osteoporosis remain unchanged. These are more prominent in the lumbar spine. Scoliotic thoracic spine with kyphosis secondary to the wedging. No new changes noted in the lumbar spine. No previous thoracic spine xrays available. A displaced biliary drain is noted overlying the lumbosacral spine.

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The most recent film available for comparison is April 2009. At that point there was a right lower zone opacity which was determined to be an empyema. On today''s film there are new changes in the right upper lobe with erosion of the fourth or fifth posterior rib. These features are likely representative of malignancy. I will arrange a CT scan. NB In line with Improving Cancer Outcomes Guideline

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The heart is enlarged. Acute pulmonary oedema on 19.06.12 has considerably improved. There may be a small amount of bibasal pleural fluid remaining. Old upper left rib fractures.

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Comparison made with chest radiograph from 25 June 2012. Right spiculated ill-defined pericardiac mass in the right lower lobe as previously seen, representing a neoplastic process. Parenchymal nodular seen bilaterally, likely to represent thoracic metastatic disease. There is no major collapse or consolidation but minor patchy airspace opacification in the periphery of the right mid-zone may suggest an infective process. The pleural spaces are clear. Normal heart size.

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There is loss of volume on the right side following the previous reception of lung cancer. Compensatory mediastinal shift of the left lung. No focal lesion. No specific abnormality seen in relation to the left ribs. On the right side there are several areas of sclerosis which could possibly represent sites of previous rib fractures. Could the current pain be due to fracture of a left lower rib? If not it may be appropriate to refer the patient for an isotope bone scan and review by the oncologist or chest physician.

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There is elevation of the oblique fissure with a solid density right hilar mass. There is also a paucity of markings in the right apex which could represent a small pneumothorax or alternatively a bulla. There is much focal air space consolidation in the left, mid and lower zones. The left upper zone appears clear. Cardiac outline is slightly distorted but falls within normal expected limit. Conclusion: The signs could represent a chronically collapsed right middle lobe with a small right apical pneumothorax but the most florid signs are the focal air space consolidation in the left mid and lower zones.

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There does appear to be some narrowing of the trachea and left main bronchus. This raises the possibility of added soft tissue within the mediastinum. The heart size is at the upper limit of normal. Lung changes at the apices may be related to previous radiotherapy. There is slight blunting of the right costophrenic angle. Rib fractures noted, particularly in lower left ribs. An urgent CT scan of the chest is advised. Clinician phoned.

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AP erect. The previous right pneumothorax has resolved. No change in the right upper lobe lung lesion. Compared to the previous film from 27.7.12 there is significant increase in the left pleural effusion with persisting left upper lobe collapse. A subacute, probable pathological fracture of the distal right clavicle is noted. There is some evidence of healing.

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Semi erect. There is a little patchy shadowing at the left base. The right lung appears clear. Appearances of the chest may be due to infection. A repeat film following treatment is advised. Marked degenerative changes are noted at both shoulder joints. There does appear to be an increased distance at the right acromioclavicular joint.

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There is cardiomegaly with a CTR of 15.5:28.4. There is central venous congestion but no overt pulmonary oedema.


Heart size normal. Relatively large volume lungs with flattening of the diaphragms consistent with COPD. No gross consolidation. There is a little increased shadowing on the left side possibly related to the left breast. This is visible on previous films in 2010 and 2008. Also there is some apical and left lateral pleural thickening. Small opacity just to the left of the left hilum. This may be some peribronchial inflammatory shadowing but also possibly a very small but significant lesion. We will arrange for a chest CT and if necessary review by a chest physician.

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A suboptimal inspiration. The left hemidiaphragm is obscured raising the possibility of left lower lobe collapse/consolidation. Small pleural effusions are present bilaterally with some linear atelectasis in the left lower zone. The shoulders are arthritic.

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Semi-erect. The pigtail catheter has bee removed. There is quite a large left sided pleural effusion with evidence of underlying collapse and shift of mediastinal structures towards the left side. Severe shoulder arthropathy noted.

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AN ADDENDUM HAS BEEN ENTERED AT THE END OF THIS REPORT. Ap erect. allowing for the projection the heart is enlarged. Mild bilateral pulmonary. No major collapse or consolidation. ADDENDUM START Mild Bilateral pulmonary plethora

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Comparison made with the imported ROH CXR 28/8/10. The heart size is normal, CTR 12.4:24.5. There is calcified atherosclerosis of the aorta which is unusual for a 36 year old. Coarse bronchovascular lung markings in the right lung with some nodular opacities, but there were previously more florid changes in the right lung in 2010. It would probably be worth repeating the CXR now to see if these have resolved, as the current image is now over 2 months old. Faxed to GP. -

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aortic_calcification comparison consolidation normal other recommendation


There is cardiomegaly (CTR equals 16/27). There is pulmonary venous hypertension. The lungs are clear.


No significant change in appearance when compared with the previous chest radiograph dated 22/8/12. There remains significant abnormality in the left lung mid and lower zones which has previously been identified on CT examination as cystic bronchiectasis.

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B/G myeloma CXR please to compair with if develops neutropenic sepsis XR Chest - PA erect slightly rotated projection. No previous radiograph available for comparison. Right subclavian line with tip is probably within the proximal aspect of the inferior vena cava/atrial junction. There is no major consolidation however there are linear atelectatic changes bibasally. The left hilar appear enlarged which might be due lymphadenopathy and in absence of previous scans difficult to determine if this is a recent finding or an existing finding. I note that there has been no other follow up imaging since please correlate clinically. email to referring consultant.

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CTR 166:273. The heart is enlarged. There is some aortic arch calcification. There is blunting of the right costophrenic angle consistent with a small right basal pleural effusion. There is also evidence of some upper lobe blood diversion. There is no collapse or consolidation.

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The patient is rotated slightly on this PA chest radiograph. Thoracic scoliosis is noted. The lung show no acute pulmonary pathology. Non-specific bronchopulmonary markings evident at the mid and lower zones I note that the patient is a smoker.

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Heart size normal. There is a moderate sized right pleural effusion. There is some mild nodular consolidation in the right perihilar region and upper zones. The left lung is clear. Given the patient''s symptoms infectio

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PA erect examination. Previous midline sternotomy and clips along the course of the LIMA consistent with CABG. There are Kerley B lines present at both lung bases more marked on the right than the left with a trace of fluid seen in the horizontal fissure and in the oblique fissure on the left. Features are consistent with a degree of pulmonary fluid overload. No focal collapse or consolidation.

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The heart is enlarged. There is calcification and aneurysmal dilatation of the thoracic aorta. There is no focal consolidation or lung lesion seen.

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Compared with the previous of 1/2/13. Previously noted right-sided pleural effusion appears to have resolved. The heart is enlarged (CTR 16:28) and there is prominence of the vasculature in keeping with fluid overload. Some increased density seen in the left base may be due to atelectasis. Increased opacity behind the heart is unchanged from films dating back to 2011 and most likely relates to aortic root dilatation.

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Heart size normal. There is bronchiectasis in both lungs. There is apical volume loss on the right with collapse which was present on a recent radiograph. There are similar appearances at the left apex but to a lesser extent. These features were not present on CT scan from 2008. Given the history I will arrange a CT scan for further evaluation.

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There is loss of volume and opacification of the left lower zone in keeping with the previous surgery. A small left pleural effusion is noted. No further abnormality seen in either lungs.

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(PA Erect): Poor inspiration. The previous cardiac surgery with enlarged left atrium is noted. There is some loss of clarity of the left heart border, this was present on a previous chest xray of January 2013 and I note that the patient had a subsequent CTPA. I note that there is some para-cardiac fat which may account for this. No new consolidation. Upper lobe vessels are slightly prominent suggest a degree of raised pulmonary venous pressure.

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Tracheostomy tube in situ with an NGT, the distal end of which lies below the left hemidiaphragm. Although the heart is not enlarged there is a degree of central venous congestion. No significant lung lesion with minor subpleural atelectasis at the left base only.

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AP semi-erect film. The heart is not enlarged. There is elevation of the right hemidiaphragm but no intrathoracic cause. There is ill-defined increased density projected over the superior left hilum. This may be a composite shadow and a repeat PA film advised to assess more fully.

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AP erect portable chest radiograph. Patient is slightly rotated. No pneumothorax. There is increased lung volume bilaterally with flattening of the hemi diaphragms in keeping with emphysematous change. Fibrotic changes are seen in both upper lobes with upward migrations of both hilar regions and tenting of the right hemi diaphragm. There are new bilateral small small pleural effusions. Heart size is within normal limits. Longstanding dilated oesophagus.

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The raised left hemidiaphragm appears longstanding. There is a small left pleural effusion and there is also blunting of the right costophrenic angle. Upper zone vessels are distended but this is also longstanding. No frank consolidation seen.

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There is a large hiatus hernia with probably most of the stomach within the chest. The heart is enlarged CTR 15:24. There are interstitial oedematous changes within the lungs and small bilateral pleural effusions in keeping with left ventricular failure. The bones are osteopenic.

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Right sided volume loss with mediastinal shift to the right. The right lower zone parenchymal lung changes appear improved compared to previous examination dated 23 10 11. There is a further dense opacity in the right lower zone that may be a nipple shadow, however this is not immediately apparent in the more recent previous examinations and suggest re-X-ray with nipple markers. Chronic right apical pleural thickening. Email report please.

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Compared to the film from 04.08.13. Median sternotomy wire and x metallic valve replacement noted. Despite the projection, the heart is enlarged. There are persistent linear atelectases in both and middle zones, but the pulmonary plethora and patchy perihilar airspace opacities evident on the previous films have improved. No new focal collapse or consolidation. Tiny left pleural effusion.

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atelectasis cardiomegaly comparison consolidation interstitial_shadowing normal object pleural_effusion


AP. Comparison made to previous radiograph 2/8/13. Single electrode PPM noted. There is patchy increased airspace opacification in both lower zones which would be in keeping with scattered infection. There is an acute fracture of the left clavicle with subluxation of or the right humeral head.

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Overall appearances are unchanged compared to the previous film dated 7/7/11. Median sternotomy sutures and mediastinal vascular clips noted consistent with previous CABG. There is cardiomegaly with a CTR of 17.6: 33.2. There is elevation of the right hemidiaphragm which would account for the reduced breath sounds. A hemi-spherical curvilinear density laterally in the right mid zone is unchanged. This may be related to a peripheral lung bulla or a peripherally calcified soft tissue mass.

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There is some slight loss of clarity of the left heart border. This may be due a para cardiac fat pad but lingual pathology cannot be excluded. The heart appears enlarged, CTR 18.6/33.2. The right lung is clear. There is some upper lobe blood diversion consistent with mild heart failure. email report to referring clinician.

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cardiomegaly consolidation normal other possible_diagnosis upper_lobe_blood_diversion


Comparison is made with radiograph of 11/08/2013. Portable AP radiograph. No definite focal lung consolidation. There is upper lobe diversion of vessels. There are also increased interstitial lung markings. No pleural effusion. The heart is not enlarged despite the projection. The appearances may represent fluid overload. Left humeral fracture is noted.

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Single chamber pacemaker noted. The lungs are congested. Calcification project over the left heart is of long-standing.

abnormal_non_clinically_important comparison consolidation object


Large volume lungs indicate COPD with notable lucency within the left lung relative to the right compatible with more bullous formation on this side. A band of old scarring seen medially in the right upper zone similar to past radiograph and CT. There is a new triangular wedge shaped nodule opacity in the right upper zone laterally which was probably there before but cannot be clearly correlated so if the patient proceeds to part 2 I would recommend that we perform a CT to be certain a small lung lesion is not present here. email to referring consultant

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Cardiomegaly and pulmonary congestion with small pleural effusions consistent with heart failure. No definite consolidation.


There is evidence of perihilar haze and interstitial oedema. There is some more focal shadowing at the right base which may be due to infection as well as heart failure. Previous cardiac surgery noted. Satisfactory position of right sided central line. The heart size is not enlarged. There are bilateral small pleural effusions.

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Comparison made with previous film dated 26/10/13. The cardiomediastinal outline is within normal limits. The proximal pulmonary arteries are a little prominent. There is subpleural atelectasis at the left base and atelectasis with inflammatory changes at the right base. No significant volume loss. No pleural effusion.

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atelectasis comparison consolidation normal paratracheal_hilar_enlargement


AP rotated projection. Comparison is made with the radiograph 11.6.2012. There is right apical scarring with calcification in the right lower zone. There are some cavitary changes in the right apex as well. There is evidence of pleural thickening encaseating the right lung. These are likely to represent old TB related changes. There is some increased shadowing in the left lung base which is most likely due to projection and relatively poor inspiration. No definite new focal lesions are identified.

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Comparison made with the radiograph of 11/11/2013. There are no other previous radiographs for comparison. There is a cavitatory change in the left upper zone with some parenchymal scarring and fibrosis around it. The left hilum is pulled up. There is a nodularity in the right upper zone peripherally with some cavitatory and fibrotic change in the right apex as well. The appearances have not change significantly since the previous radiograph. There is blunting of the left costophrenic angle and a nodularity in the right lower zone peripherally as well. These changes were present in the previous radiograph as well and the appearances are likely to represent old TB and no new features are seen since the radiograph of 11/11/2013. If the patient has persistent shortness of breath he needs further evaluation by a Respiratory Physician.

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The position of the midline mediastinal metallic stent and further smaller metallic structure projected over the left ventricle is unaltered in appearance or position compared to previous film from 17.12.12. Right sided aortic arch noted. There is thoracolumbar scoliosis and extensive posterior spinal instrumentation. Marked gaseous distention of the stomach and imaged bowel loops, evident also on previous films. Lungs and pleural spaces clear.

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cardiomegaly comparison dilated_bowel normal object scoliosis


Shoulder appearances are unusual with apparently separated screwed bony fragments from the humeral head. There is a large right shoulder effusion with a few locules of gas evident. Calcification is also noted in the lateral soft tissues of the left arm. Appearances are not significantly changed from the dedicated shoulder view of 04/12/13 following trauma post ORIF. I note from an ultrasound request of 16/12/13 the patient underwent removal of metalwork on 6/12/13. The lungs and pleural spaces are clear. Normal heart size.

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PA study. I note the history of oesophagectomy. The mediastinum is widened and contains gas within, in keeping with the previous surgery. No pneumothorax identified. There is a small left sided pleural effusion with a background of interstitial oedema in the lungs. Patchy airspace opacity noted in the right lower zone, which may be infective in nature.

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Old left rib fractures and heavy mitral valve calcification. Coarse bronchovascular lung markings but no definite acute lesion.


Heart size normal. The consolidation in the right upper lobe present on the previous film has improved slightly. There remain coarse reticular changes in both upper and mid zones consistent with fibrosis and emphysema. The right hilum appears slightly dense and distorted. However this has changed little since previous films. No new lung lesion.

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The bilateral upper lobe predominance and fibrosis with cystic change at the right apex. Relative sparing of the left lower lobe. Small volume lungs particularly the right. The trachea is deviated to the right.

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There is possibly a little peribronchial shadowing at the lung bases but there is no major collapse or consolidation. The pleural spaces are clear. Old left humeral fracture noted.

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The heart size is noted. There are interstitial changes seen within the lungs bilaterally. I suspect that there is more clinical history that is not available to me. There are no previous chest x-ray for comparison. Is the patient known to have interstitial lung disease? There is blunting of both costophrenic angles. There is a probable small hiatus hernia. Clinical correlation is needed. ACT scan of the chest is advised if the lung changes are not to known about. There does appear to be an added soft tissue mass on the left chest wall which does appear well defined.

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