atelectasis cardiomegaly consolidation object pleural_effusion

Sternotomy wires noted in situ. There is a new atelectatic band in the left mid-zone. Patchy air-space opacity also demonstrated in the right lower zone in keeping with consolidation, this has slightly improved compared to previous CXR on 28/4/2014. Small bibasal pleural effusion persists, with some fluid loculated in the right horizontal fissure. Transverse cardiac diameter is larger than previously at 19.4cm.

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atelectasis comparison consolidation object pleural_effusion


The oesophagus is dilated and there is an air-fluid level within it. There are questionable surgical clips and soft tissue opacification behind the heart. No major lung lesion seen.

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Even allowing for the AP projection, there is a degree of cardiomegaly. Perihilar oedema is present, more marked on the right, and there is upper lobe vascular prominence. The appearances would suggest a degree of fluid overload/pulmonary oedema, which she has developed since previous film 24 hours prior.

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There is some minor linear scarring or perhaps pleural thickening in the left lower zone laterally which was certainly evident in October 2013 and probably also in 2007 so is of doubtful relevance. The rest of the lungs are clear with no new lesion identified. Slight widening of the mediastinum was also present before and likely relates to a retrosternal thyroid goitre or increased adipose tissue in this area (again irrelevant). The mediastinum is otherwise normal. Left shoulder replacement is noted with no adverse features seen related to this.

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atelectasis cardiomegaly consolidation object

(PA) Moderate cardiomegaly with normal lung vascular pattern noted. Minor linear shadowing in the left mid zone may be due to infection. No evidence of pleural effusion or pneumothorax. Metallic wire sutures from previous sternotomy and previous cardiac valve replacement noted. -

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cardiomegaly consolidation normal object possible_diagnosis


AP semi-erect view. Tunnelled central line through the right internal jugular vein is adequately sited with its tip in the distal SVC. No pneumothorax. The lungs are congested. The upper lobe pulmonary veins are slightly distended. The heart may be enlarged. No evidence of free gas under the diaphragm.

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


There was a right hydropneumothorax on 3 July 2014, but now the right pleural cavity is filled with fluid and the air has resolved. Vague opacification in the right mid zone is not dissimilar to the previous image. The left lung remains clear. Heavy subclavian artery calcification noted.

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Comparison has been made with previous chest x-ray dated on the 10th of August 2013. Poor inspiratory result. There is upper lobe diversion and congestion in keeping with heart failure. Heart is borderline enlarged. No large pleural effusions seen. Bilateral apical scarring most likely due to previous granulomatous infection.

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There is mild pulmonary congestion. Blunting of both costophrenic angles. Lungs are clear.


The lungs are large volume and the diaphragms flattened in keeping with COPD. There are some old rib fractures bilaterally. A new opacity overlies the 8th posterolateral left rib which is probably another rib fracture but this was not evident previously. If the patient proceeds to further transplantation assessment I would recommend up to date CT to characterise this for certain.

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Slight rotated AP erect. The tips of a tunnelled right internal jugular line are in the right atrium. There is a moderate size right pleural effusion. Slightly smaller left pleural effusion. There is pulmonary venous congestion. No interval change since previous examination dated 7/10/14.

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AP portable semi-erect rotated film which is suboptimally inspired. Some soft tissue in the upper mediastinum likely relates to tortuous vessels or retrosternal extension of the thyroid and has not changed since June 2013. There is a small hiatus hernia. Some coarse markings in the lungs in the right lower zone probably relate to some mild bronchiectasis. No new lung collapse or consolidation.

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There is mild pulmonary venous congestion and upper lobe blood diversion in keeping with interstitial oedema. Heart size is enlarged. Small bilateral pleural effusions. Metallic heart valve in situ. Pulmonary artery pressure device noted. Sternotomy wires noted. Normal soft tissue and bones.

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Slight rotated AP semi-erect. Shallow inspiration. The hemidiaphragms are splinted by ascites. The lungs are congested. No active focal lung lesion. Unfolded thoracic aorta.

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Cardiomegaly is noted (CTR 0.58) . There is prominence of the pulmonary vessels in keeping with venous hypertension. No alveolar oedema is seen around the hilum. There is pleural effusion on the right. This is small. Ill-defined potentially inflammatory changes are seen medially at the base. Otherwise hilar and mediastinal contours are satisfactory with some evidence of unfolding of the thoracic aortic arch.

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Slightly rotated PA. There is a tunnelled left internal jugular line with its tip sited in the right atrium. Heart enlarged. There is pulmonary venous congestion. No active focal lung lesion.

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Slight rotated PA view. Comparison to previous examination dated 15/12/2014. There is bilateral mild chronic apical pleural thickening. There is upper lobe pulmonary venous blood diversion. Otherwise the lungs and pleural spaces are clear. Unfolded and ectatic thoracic aorta. No evidence of infection.

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PA view. Comparison to previous examination dated 31/10/2014. Left pleural effusion is smaller. There is still bilateral small pleural effusions. Cardiac pacemaker noted. Sternotomy wires and prosthetic heart valve. The heart is enlarged. There is pulmonary venous congestion. Features are suggestive of cardiac failure.

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


Slightly rotated PA view. Comparison to previous examination dated 22/12/2014. Left pleural effusion has since resolved. Mild linear atelectasis in the left mid zone noted. There is mild pulmonary venous congestion. The heart is enlarged. Multiple bilateral old healed rib fractures are noted.

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Portable rotated AP semi-erect view. There is a moderate right pleural effusion. There is linear atelectasis in the left lower zone. There is pulmonary venous congestion. Features are suggestive of cardiac failure/fluid overload. There may be superimposed infection.

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The heart is enlarged, there is upper lobe diversion with pulmonary venous congestion, air space opacification pleural effusions consistent with heart failure. Biventricular pacemaker noted.

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Portable AP semi supine view. Comparison to previous examination dated 22/12/2014. There is persistent pulmonary venous congestion. There is increasing air space opacity in the left lower lobe. There is now patchy perihilar air space opacity in the right lower and mid zones. The thoracic aorta is unfolded and heavily calcified. Features could be due to infection or pulmonary oedema. Old healed right-sided rib fracture is noted.

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PA view. CABG noted. Normal heart size. Unfolded thoracic aorta. There is pulmonary venous congestion. Mild linear atelectasis in the mid zones of both lungs. Features of cardiac impairment are unchanged since previous examination dated 26/12/2014. There may be superimposed infection.

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Rotated PA view. Comparison to previous examination dated 20/12/2014. Previously moderate size left pleural effusion is smaller. Previously small right pleural effusion has enlarged and is now moderate in size. Pulmonary venous congestion noted. Old healed right-sided rib fractures.

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PA view. There is eventration of the right hemidiaphragm. There is pleural thickening or small effusion at the right costophrenic angle. The left lung and left pleural space are clear. Normal heart size. Calcified aortic arch. There has been previous screw fixation to the left glenoid. Marked degenerative changes of the left shoulder are noted.

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


Rotated AP erect view. There is mild upper lobe pulmonary venous blood diversion. No consolidation or collapse. Despite projection, the heart appears slightly enlarged. Slightly unfolded and heavily calcified thoracic aorta is noted. Features of cardiac impairment are unchanged since previous examination dated 24/07/2013.

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PA view. There is mild pulmonary venous congestion. No consolidation or collapse. The heart is slightly enlarged. Unfolded and calcified thoracic aorta.

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


No previous radiographs for comparison. The patient is rotated on this AP radiograph. Nevertheless, the heart and mediastinal contours appear within normal limits. There is non-specific prominence of the bronchovascular markings. Blunting of the right costophrenic angle consistent with a pleural effusion but underlying collapse/consolidation cannot be excluded. Electronic cardiac reader device in situ.

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Slight rotated AP semi-erect view. Comparison to previous chest radiograph dated 06/01 and CT study dated 09/01/2015. Right basal intercostal drain has since been removed. There is mild linear atelectasis and pleural thickening in the right lower zone. No pneumothorax. Mild pulmonary venous congestion noted. Unfolded thoracic aorta. Multiple old healed right-sided rib fractures.

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atelectasis cardiomegaly interstitial_shadowing object scoliosis

PA erect view. Comparison to previous examination dated 14/01/2015. Left internal jugular line has since been exchanged. The tip of the new line is in the proximal SVC. The tip of the tunnelled right internal jugular line is unchanged in the right atrium. There is no pneumothorax. There is pulmonary venous congestion. There is mild linear atelectasis in the left lower zone.

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atelectasis comparison interstitial_shadowing normal object


PA erect. There is pulmonary venous congestion with upper lobe blood diversion. No consolidation or collapse. Normal heart size. Prominent pericardial fat pads. Features are suggestive of cardiac impairment. No change since previous examination dated 02/11/2014.

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AP erect view. Comparison to previous examination dated 05/11/2014. There is an enlarging left pleural effusion, which by now is causing whiteout of the left hemithorax. There are left subclavian and axillary vascular stents. There is mild pulmonary venous congestion. There is blunting of the right costophrenic angle suggestive of small effusion or pleural thickening. There is patchy sclerotic infiltration of the skeleton.

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Slight rotated PA view. Sternotomy wires are noted. The heart is enlarged. There is pulmonary venous congestion. There are bilateral small pleural effusions. There are bilateral small apical pneumothoraces, unchanged since previous examination dated 17/01/2015.

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Rotated AP semi-erect view. There is mild pulmonary venous congestion. No consolidation or collapse. Despite projection, the heart appears enlarged. Slightly unfolded thoracic aorta noted. Marked degenerative changes of the right shoulder are present.

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PA view. The tip of a left-sided PICC line is in the distal SVC. No pneumothorax. The lungs and pleural spaces are clear. There is widening of the superior mediastinum in keeping with lymphadenopathy.

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No free gas below the diaphragm. Right PICC line tip overlies the cavoatrial junction. There is elevation of left hemidiaphragm with pleural thickening/effusion. I suspect consolidation at the left lower zone, likely representing infection. I recommend repeat chest x-ray in 6 weeks, following appropriate treatment. Remaining lungs are clear. There is cardiomegaly but no pulmonary oedema. ORIF of the right clavicle noted.

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AP erect view. The tip of a nasogastric tube is adequately sited in the stomach. There is pulmonary venous congestion. No consolidation or collapse. There is a small right pleural effusion. Despite projection, the heart appears enlarged. Features are suggestive of cardiac failure.

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PA view. SVC stent is noted. There is linear atelectasis in the right lower and mid zones and at the left lung base. Pleural thickening or small effusion on the right side. Bilateral apical pleural thickening. There is pulmonary venous congestion. The heart is slightly enlarged. No change since previous examination dated 15/01/2015.

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Portable slightly rotated AP semi-erect view. The costophrenic angles are clipped. There is pulmonary venous congestion. There may be a small right pleural effusion. No consolidation or collapse. The heart is enlarged.

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AP semi-erect view. Dual chamber pacemaker with intact leads is in situ. Despite projection, the heart appears moderately enlarged. There is pulmonary venous congestion. There are bilateral small pleural effusions. Features are suggestive of cardiac failure. Old healed right-sided rib fracture is noted.

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PA and lateral views. Comparison to previous examination dated 06/02/2015. Dual chamber pacemaker with intact leads in unchanged positions is in situ. The heart is enlarged. The thoracic aorta is unfolded. There is mild pulmonary venous congestion.

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cardiomegaly comparison consolidation object unfolded_aorta


Rotated PA view. Dual chamber pacemaker with intact leads is in situ. Mesh stent noted in the aortic root. The heart is enlarged. There is pulmonary venous congestion. When compared to previous examination dated 02/10/2014, previous pulmonary oedema has resolved.

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cardiomegaly comparison interstitial_shadowing normal object technical_issue


PA view. There is pulmonary venous congestion. No focal lung lesion. No evidence of pulmonary TB. The heart size is borderline. Prominent left pericardial fat pad. Tortuous descending thoracic aorta. Old healed left-sided rib fractures.

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PA erect. Shallow inspiration. Comparison to previous examination dated 17/03/2015. Previous left lower zone patchy air space opacity has resolved. There is persistent mild pulmonary venous congestion. Slightly unfolded and calcified thoracic aorta. There are several old healed right-sided rib fractures. No new fractures are identified. No pneumothorax.

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Slightly rotated PA view. Surgical clips noted in the left breast. There is pulmonary venous congestion with cardiomegaly. Small right pleural effusion. Unfolded and calcified thoracic aorta. There is a well-defined rounded opacity projected over the left mid zone, which is probably a button and is external to the patient. This is not visualised on subsequent chest radiographs. The heart is enlarged.

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Rotated AP view. There is mild pulmonary venous congestion. Otherwise the lungs and pleural spaces are clear. Unfolded and calcified aortic arch. Osteoporotic and degenerative changes throughout the thoracolumbar spine with scoliosis.

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Portable slightly rotated AP semi-erect view. Sternotomy wires and prosthetic heart valve are noted. Tip of a left internal jugular line in the SVC. The heart is enlarged. There is pulmonary venous congestion. There are bilateral small pleural effusions. Features of cardiac failure/fluid overload are unchanged since previous examination dated 10/04/2015.

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PA view. There is mild pulmonary venous congestion with upper lobe blood diversion. No consolidation or collapse. There are bilateral small pleural effusions. The heart is enlarged. Unfolded thoracic aorta. Features are suggestive of heart failure.

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Rotated AP semi-erect view. The tips of a tunnelled right internal jugular line are in the distal SVC and right atrium. There is pulmonary venous congestion. No consolidation or collapse. The heart is enlarged. There are multiple displaced right-sided rib fractures. No change since previous examination dated 10/04/2015.

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There is evidence of pulmonary oedema bilaterally. Upper lobe venous diversion seen. Heart size is enlarged despite AP projection. No major collapse or consolidation demonstrated. Normal mediastinal outline.

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cardiomegaly consolidation normal upper_lobe_blood_diversion


Slightly rotated PA erect view. There is mild pulmonary venous congestion with upper lobe blood diversion. No focal lung lesion. The heart is slightly enlarged. No pneumothorax or rib fracture.

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PA view. Tracheostomy tube adequately sited. Sternotomy wires and mediastinal surgical clips noted. The heart is enlarged. There is mild pulmonary venous congestion. No consolidation or collapse. Features are suggestive of cardiac impairment.

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atelectasis cardiomegaly emphysema interstitial_shadowing object pleural_effusion

LVAD and biventricular pacemaker noted. The small left pleural effusion and atelectasis at the left base have improved a little since the previous radiograph. Remainder of the lungs are clear. LV calcification noted.

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abnormal_non_clinically_important atelectasis comparison normal object pleural_effusion


AP view. There is emphysema. Granulomatous change in the left upper lobe. Pleural thickening at the apices and costophrenic angles. Patchy air space opacity in the left lower zone suggestive of infection. Normal heart size. Heavily calcified thoracic aorta.

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Pleural effusion with subjacent collapse/consolidation is noted on the right side. Note is made of venous stents in the left cephalic arch and left brachiocephalic vein. Patchy lucency is noted in the right humeral head may represent a degree of avascular necrosis.

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Slightly rotated AP erect view. Dual chamber pacemaker with intact leads is in situ. The heart is enlarged. Unfolded and calcified thoracic aorta. There are multiple large calcified bihilar and mediastinal lymph nodes suggestive of old TB. There are several granulomata in the right upper lobe. There is pulmonary venous congestion. There is chronic linear scarring at the right costophrenic angle. No active focal lung lesion. No pleural effusion. Features of cardiac impairment are unchanged since previous examination dated 27/02/2015. Marked rotator cuff arthropathy of the right shoulder noted.

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Slightly rotated PA view. There are multiple displaced right-sided rib fractures with large flail segment. No pneumothorax is identified, but there is surgical emphysema in the right lateral chest wall adjacent to the fractured ribs tracking up into the right side of the neck. There is air space opacity laterally in the right mid zone suggestive of lung contusion. There is pulmonary venous congestion. Unfolded thoracic aorta. Previous internal fixation to the left proximal humerus. The patient has since had CT of thorax.

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PA view. There is mild pulmonary venous congestion. No consolidation or collapse. Normal heart size. Unfolded and calcified thoracic aorta. Marked degenerative changes of both shoulders.

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PA view. Sternotomy wires and prosthetic heart valves are noted. The heart is moderately enlarged. There is pulmonary venous congestion. No pulmonary oedema. No focal lung lesion. No change since previous examination dated 27/05/2015.

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cardiomegaly comparison interstitial_shadowing normal object


PA view. There is mild S-shaped thoracic scoliosis. There is pulmonary venous congestion with cardiomegaly. No consolidation or collapse. No change since previous examination dated 09/03/2015.

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cardiomegaly comparison interstitial_shadowing normal scoliosis


atelectasis cardiomegaly consolidation interstitial_shadowing object scoliosis unfolded_aorta

AP erect view. Mild thoracic scoliosis convex to the right may be positional. There is pulmonary venous congestion with cardiomegaly. Bilateral perihilar patchy air space opacity is suggestive of pulmonary oedema. Features are in keeping with cardiac failure. No infection.

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Rotated AP erect view. The tips of a tunnelled right internal jugular line are in the distal SVC and right atrium. There is pulmonary venous congestion. There are bilateral small to moderate pleural effusions. The heart is enlarged. When compared to previous examination dated 04/05/2015, features are suggestive of worsening heart failure/fluid overload.

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AP erect view. Cardiac pacemaker with intact leads is in situ. The heart is markedly enlarged. There is pulmonary venous congestion. Bilateral small pleural effusions. Bilateral calcified pleural plaques. Features of heart failure and previous asbestos exposure are unchanged since previous examination dated 23/04/2015. No pneumothorax or haemothorax. No rib fracture.

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Moderate cardiomegaly. There is ground-glass change in the left upper zone and throughout the right lung with a strikingly central distribution. There appears to be some associated mild bronchial wall thickening. It is possible that appearances could represent pulmonary oedema but Pneumocystis infection or alveolitis could also have this appearance. Recommend follow-up film after treatment for pulmonary oedema to see if changes persist.

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Comparison is made with a previous chest x-ray from July 2010. The previous cardiac surgery with valve replacement is noted. The heart size is normal CTR 0.46. The lungs are overinflated consistent with COPD. There is possible added density seen overlying the inferior pole of the left hilum. This may be vascular but I will arrange an urgent CT to further assess this area.

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abnormal_non_clinically_important comparison consolidation emphysema hyperexpanded_lungs normal object possible_diagnosis recommendation


Rotated AP semi-erect view. There is pulmonary venous congestion with cardiomegaly. No consolidation or collapse. Unfolded, ectatic and calcified thoracic aorta. Features are suggestive of cardiac impairment. No pneumothorax or haemothorax. Note is made of a displaced fracture of the right humeral neck. The humeral shaft is impacted against the inferior margin of the glenoid. This fracture has not been previously imaged and may be acute. There is also a fracture of the lateral end of the right clavicle. Recommend radiographs of the right shoulder. Report emailed.

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Slightly rotated PA erect view. There is mild pulmonary venous congestion with interstitial oedema. No consolidation or collapse. The heart is slightly enlarged. Unfolded and calcified thoracic aorta. Osteoporotic and degenerative changes of the thoracolumbar spine with scoliosis convex to the left.

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Portable rotated AP erect view. The left costophrenic angle is clipped. There is emphysema. Suture marks noted in the left upper zone consistent with previous lung resection. There is adjacent rounded opacity suggestive of a recurrent malignancy as confirmed on previous CT study dated 26/03/2015. There is mild chronic linear scarring at the right lung base. No evidence of acute infection.

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XR Chest AP erect. Comparison made with the CXRs dating back to 08/07/2014. There is longstanding opacification in the right upper zone abutting the mediastinum, but does not efface the paratracheal stripe, is most likely therefore vascular. There is pulmonary venous congestion but no significant pleural effusion. Lungs and pleural spaces are otherwise clear. No collapse, consolidation or pneumothorax. Multiple old left-sided rib fractures.

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cardiomegaly consolidation interstitial_shadowing object

AP erect view. Sternotomy wires and mediastinal surgical clips noted. The heart is enlarged. There is pulmonary venous congestion. No consolidation or collapse. No change since previous examination dated 02/10/2014.

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


Slightly rotated AP semi-erect view. Shallow inspiration. There is pulmonary venous congestion. No consolidation or collapse. Despite projection, the heart appears enlarged. No change since previous examination dated 30/08/2012.

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atelectasis cardiomegaly consolidation interstitial_shadowing

PA view. There is mild pulmonary venous congestion with cardiomegaly. No consolidation or collapse.


AP erect view. The nasogastric tube has gone down the right main bronchus. Subsequent re-siting noted. No pneumothorax. There is pulmonary venous congestion. Small left pleural effusion. Old healed left-sided rib fractures.

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


AP erect view. There is pulmonary venous congestion with cardiomegaly. No consolidation or collapse. No change since previous examination dated 09/03/2015.

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


PA view. Comparison was made to previous chest radiograph dated 13/08/2015 and prior CT study dated 02/02/2015. The previous left apical nodule is no longer visualised. There is chronic scarring at the left apex. Background of emphysema. There is pulmonary venous congestion with cardiomegaly. There has been removal of metalwork from the left proximal humerus. Old fracture and secondary degenerative changes of the humeral head.

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 E B 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 E B I I I I I I


Rotated AP semi-erect view. Dual chamber pacemaker with intact leads is in situ. Sternotomy wires and prosthetic heart valve noted. The heart is moderately enlarged. There is pulmonary venous congestion. No consolidation or collapse. No change since previous examination dated 22/06/2015.

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Portable AP erect view. There is pulmonary venous congestion. No consolidation or collapse. The heart is enlarged. There are bilateral total shoulder replacements. There is mild thoracic scoliosis convex to the left.

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

abnormal_non_clinically_important cardiomegaly consolidation normal object scoliosis


Compared with previous film, there is improvement but shadowing in the left upper lobe still persists. Chest Dr [REDACTED] 2-/-1/2000 18: 1 UNKNOWN 35 A little further clearing of the consolidation in the left mid zone when compared with the study of 12.9.00. No previous films are available for comparison. See the above previous reports of 2000 and 2004. Calcific opacities present throughout the left lung and also on the right mainly in the mid zone. There is some bronchiectasis and old cavities present bilaterally and left upper lobe fibrosis. There is a 3cm solid opacity in the left mid zone. A crescent sign is visible and appearances would be consistent with an aspergilloma. However in the absence of more recent imaging a CT thorax would seem prudent. In line with Improving Cancer Outcomes Guidelines, this patient is being booked for an urgent low dose CT of the chest. Imaging Code DX15 low dose. Fax this report to GP urgently and Email CT Bookings (Judith Job, Elena Marshall and Christine Roberts (x-ray) code X15 low dose

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Slightly rotated AP erect view. Single chamber pacemaker with intact lead is in situ. The heart is enlarged. There is pulmonary venous congestion. There is perihilar alveolar oedema. Features are suggestive of heart failure with mild pulmonary oedema. No evidence of infection.

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Reference made to most recent CXR of 05/03/15. Oxygen tubing present. As seen previously, there is enlargement of the superior mediastinum due to a soft tissue mass, causing significant tracheal deviation to the left, and effacement of the tracheal lumen, in keeping with a retrosternal thyroid goitre. This appears to have increased in size since the most recent film. There remains diffuse fibrotic changes in both lungs, with additional areas of cavitation in the left mid and lower zones. There is some increased soft tissue at the left apex which may be increased pleural thickening or increased thickening throughout the wall of the previously demonstrated left upper lobe cavity. No new pleural effusion. No obvious bony abnormality demonstrated.

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Slightly rotated AP erect view. There is pulmonary venous congestion with cardiomegaly. No consolidation or collapse. No change since previous examination dated 05/01/2014.

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


AP erect view. There is upper lobe pulmonary venous blood diversion. Otherwise the lungs and pleural spaces are clear. The heart is slightly enlarged. Unfolded and calcified thoracic aorta. Osteoporotic and degenerative changes throughout the thoracolumbar spine.

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


PA view. Sternotomy wires, mediastinal surgical clips and prosthetic heart valve are noted. The heart is enlarged. There is pulmonary venous congestion. No consolidation or collapse. No change since previous examination dated 17/04/2015.

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


Slightly rotated PA view. Sternotomy wires and prosthetic heart valve are noted. The heart is moderately enlarged. There is pulmonary venous congestion. There are bilateral small pleural effusions. No change since previous examination dated 27/07/2015.

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cardiomegaly consolidation object pneumothorax subcutaneous_emphysema volume_loss

PA view. Comparison to previous examination of several hours earlier. There has since been insertion of a right basal intercostal drain. There is persistent large right pneumothorax. Complete collapse of the right lower lobe. The heart is enlarged. No mediastinal shift. Small amount of surgical emphysema in the right lateral chest wall at the drain insertion site.

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

cardiomegaly comparison consolidation normal object pneumothorax subcutaneous_emphysema volume_loss


Portable AP erect view. Cardiac pacemaker with intact leads is in situ. The heart is moderately enlarged. There is pulmonary venous congestion. No pulmonary oedema. No change since previous examination dated 01/09/2015.

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


PA view. Comparison was made to previous examination dated 23/10/2014. There are persistent features of cardiac failure. There is pulmonary venous congestion with moderate cardiomegaly. Bilateral pleural effusions, slightly larger on the left side, are again noted.

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


Slightly rotated AP erect view. There is pulmonary venous congestion with upper lobe blood diversion. No consolidation or major collapse. Unfolded and calcified thoracic aorta. Old healed right-sided rib fracture noted. There is a right shoulder hemiarthroplasty. No interval change. No pneumoperitoneum.

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Slightly rotated AP erect view. Electronic device projected over the left hemithorax. Two leads are trailing off towards the left side of the neck. There is pulmonary venous congestion with cardiomegaly. No consolidation or collapse. Old healed right-sided rib fractures noted.

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PA view. Sternotomy wires and mediastinal surgical clips are noted. The heart is slightly enlarged. There is mild pulmonary venous congestion. There are bilateral small pleural effusions. Features are suggestive of mild heart failure.

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


PA view. Sternotomy wires and mediastinal surgical clips are noted. The heart is enlarged. There is pulmonary venous congestion. There is chronic linear scarring in both lungs. No major collapse or consolidation.

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 E B I I I I

cardiomegaly comparison consolidation interstitial_shadowing normal object


AP erect radiograph with suboptimal inspiration. The previously visualised right-sided pleural effusion has improved in appearance. Longstanding raised right hemidiaphragm. No consolidation or collapse. The heart appears enlarged. Calcification of the bronchial tree noted. No destructive bony lesion.

O O O O O O O O O O B 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 E B


Sigmoid volvulus noted. The no definite free air beneath the diaphragm as transverse colon is grossly distended. Urgent surgical review advised. Email sent to referrer.

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Large volume lungs suggest a degree of COPD. Patchy inflammatory changes are present just obscuring the left cardiac apex, suggesting some lingular consolidation. Remaining lungs and pleural spaces appear clear. There is some old left rib fractures.

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Marked volume loss in the left lung. Apical pleural thickening bilaterally and scarring in the right upper zone. Appearances are overall unchanged compared with the previous radiograph from January 2015.

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Slightly rotated AP semi-erect view. There is pulmonary venous congestion. There is left perihilar ground-glass opacity. Normal heart size. Unfolded thoracic aorta. Features are suggestive of mild heart failure with early pulmonary oedema.

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Slightly rotated AP erect view. Cardiac pacemaker with intact leads is in situ. Sternotomy wires and mediastinal surgical clips are noted. The heart is enlarged. There is pulmonary venous congestion. There is blunting of the costophrenic angles suggestive of small pleural effusions. Features are in keeping with heart failure. No pulmonary oedema.

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Slightly rotated AP erect view. There is bilateral chronic apical pleural thickening. The lungs and pleural spaces are otherwise clear. The heart is enlarged. Unfolded and calcified thoracic aorta. No pneumothorax, haemothorax or acute rib fracture. Old healed fracture of the left 10th posterior noted. Marked degenerative changes of the right shoulder noted.

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


AP erect view. Right basal intercostal drain is adequately sited with its tip pointing medially. There are bilateral small pleural effusions. There is pulmonary venous congestion with moderate cardiomegaly. Moderate degenerative changes throughout the thoracic spine with upper thoracic scoliosis convex to the left.

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


PA view. There is mild pulmonary venous congestion. No pulmonary oedema. No consolidation or collapse. The heart is enlarged (CTR 0.53). Slightly unfolded thoracic aorta.

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


Rotated AP erect view. There is pulmonary venous congestion with upper lobe blood diversion. No consolidation or collapse. The heart is slightly enlarged. Unfolded thoracic aorta. There are several old healed left-sided rib fractures. No change since previous examination dated 20/10/2015.

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Slightly rotated AP erect view. There is pulmonary venous congestion with cardiomegaly. No consolidation or collapse. There has been previous instrumentation to the mid thoracic spine. There are thoracic vertebral collapses and multiple left-sided rib fractures, unchanged since previous examination dated 10/12/2015.

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PA view. There is pulmonary venous congestion with interstitial oedema. No consolidation or collapse. Normal heart size. Unfolded thoracic aorta. There is a S-shaped thoracolumbar scoliosis. Features are suggestive of cardiac impairment rather than infection.

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


PA chest radiograph. No focal lesion, collapse or consolidation. Normal lung volumes. Normal heart size. Normal hilar vessels. No effusions. No acute bony abnormality. Note is made of soft tissue density seen in the left paraspinal region, possibly below the diaphragm.

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


PA view. Comparison was made to previous examination dated 30/01/2016. Right intercostal drain has since been removed. There has since been insertion of a right-sided PICC line whose tip is at the junction between the SVC and right atrium. There is no pneumothorax. Persistent pleural thickening or small effusion at the right costophrenic angle. Adjacent linear atelectasis in the right lower and mid zones. The left lung remains clear. Sternotomy wires, mediastinal surgical clips and mild cardiomegaly noted. Bilateral cervical ribs.

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abnormal_non_clinically_important atelectasis cardiomegaly comparison normal object other pleural_abnormality pleural_effusion


PA view. There is pulmonary venous congestion with cardiomegaly. No consolidation or collapse. Unfolded thoracic aorta. Left internal jugular line has been removed since previous examination dated 24/01/2016. Old healed right-sided rib fractures are noted.

O O O B I 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 E B I I I


The heart is markedly enlarged. Again there is smooth widening of the upper mediastinum but this is considered due to vascular prominence. There is now a moderately sized right pleural effusion which has increased in size since February 2015 at which time a small effusion was present. There is also some peribronchial cuffing and some mild ground-glass change in the upper zones with overall appearances suggest overload/failure. However the effusion is unilateral (obviously is usually bilateral in heart failure) and there may be worth obtaining a chest clinic referral if you think it clinically appropriate ?

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Slightly rotated PA view. Large volume lungs with flattened hemidiaphragms appear emphysematous. No consolidation or collapse. There is pulmonary venous congestion. Normal heart size.

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PA view. Comparison was made to previous examination dated 28/12/2015. Sternotomy wires and mediastinal surgical clips are noted. Previous bilateral small pleural effusions have resolved. Pulmonary venous congestion has improved. Sternotomy wires and mediastinal surgical clips are noted.

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 E B I I I I I I I I E

comparison interstitial_shadowing normal object


PA erect view. Shallow inspiration. Sternotomy wires, mediastinal surgical clips and temporary pacing wires are noted. There is pulmonary venous congestion. Bilateral small pleural effusions. Features are in keeping with heart failure. No pneumothorax. No evidence of infection.

O O O O B I I E B 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


The heart is grossly enlarged with a CTR of 0.16. There is pulmonary venous congestion. No focal consolidation or collapse. No pleural effusion seen. The tip of the right-sided central line is demonstrated in the cavo-atrial junction.

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cardiomegaly interstitial_shadowing normal object


There is gross cardiomegaly and pulmonary venous congestion. There is a small pleural effusion on the right side. Combined appearances are consistent with congestive heart failure. Median sternotomy wires noted.

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PA view. Large volume emphysematous lungs. Bilateral chronic apical pleural thickening. No active focal lung lesion. The heart is enlarged. Unfolded and calcified aortic arch. Pulmonary venous congestion has improved since previous examination dated 14/07/2016. No evidence of infection.

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


Dilated, gas-filled loops of small and large bowel. The cecum measures up to 12 cm in maximal dimension. There is a subtle curvilinear radiolucency projected adjacent to the lateral border of the caecum suggestive of pneumatosis. No rectal/distal colonic gas is identified implying a sigmoid/descending colon obstruction. Cemented right hip prosthesis with heterotopic ossification. PA erect examination. Comparison is made to the prior examination of March 2013. Normal heart size, cardiomediastinal and diaphragmatic contours. Minor linear parenchymal scarring noted laterally in the right lower zone. Right cardiophrenic fat pad. 2 tiny right midzone nodules are longstanding. No subdiaphragmatic free gas.

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abnormal_non_clinically_important atelectasis comparison hernia normal parenchymal_lesion


AP semi-erect view. Shallow inspiration. The lungs are congested. No consolidation or collapse. Unfolded and calcified thoracic aorta.


Bilateral hilar and mediastinal lymphadenopathy along with a nodular density in the left lower zone gross remain unchanged. Features consistent with sarcoidosis. No superadded infection. X20

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AP erect. No subdiaphragmatic free gas. No lobar collapse, acute consolidation or pleural effusion. No hilar/mediastinal lymphadenopathy. Multiple loops of gas filled large bowel within normal calibre limits are seen. There is gas in the rectum. No convincing features of mechanical bowel obstruction. Age-related costal cartilage calcification, marked spinal degenerative change and right hemiarthroplasty are noted.

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


PA view. There is pulmonary venous congestion with cardiomegaly. Unfolded and heavily calcified thoracic aorta. There is a lytic defect in the right seventh posterolateral rib, which was not present on previous examination dated 27/01/2016. This could be a skeletal metastasis. The rib was normal on a previous CT study from November 2009. Recommend repeat CT assessment. Report e-mailed.

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 I I I I I I I I I I I I I I I I I I I I I I I E


AP study. I note that there is in fact a history of disseminated malignancy, which was not mentioned in any of the clinical information. There is a 22mm nodule in the right mid zone, corresponding to a metastasis seen here on the previous CT scan from November 2016. There is also widening of the superior mediastinum, which again corresponds to mediastinal lymphadenopathy. There is some minor fibrotic scarring in both lung bases. Mild elevation of the left hemidiaphragm. Some of the ribs appear mildly sclerotic, in keeping with bony metastases. Overall little change compared with the previous CXR dated 10/01/2017. E-mailed The bowel gas pattern is within normal limits.

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


PA view. Cardiac pacemaker with intact leads in situ. The heart is slightly enlarged. Large hiatus hernia is noted. Unfolded thoracic aorta. There is pulmonary venous congestion. No consolidation or collapse. No change since previous examination dated 01/11/2016.

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

cardiomegaly comparison hernia interstitial_shadowing normal object unfolded_aorta


There is a persistent pleural effusion tracking the right chest wall. There is some air space shadowing in the right lung. There is pulmonary venous congestion. Combined appearances are suggestive of fluid overload. Infection cannot be ruled out. The heart is not enlarged..

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There is mild atelectasis/scarring left lung base which is unchanged since July 2016. No new collapse or consolidation in the lungs to suggest current infection. Degenerative change is seen in the thoracic spine. The aorta is tortuous but unchanged and not overtly aneurysmal.

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There is cardiomegaly with a CTR of 16.4: 30.1. There is central venous congestion which may be due to mild congestive cardiac failure however there is no upper lobe blood diversion nor overt pulmonary oedema. No focal active lung lesion. No pleural effusions.

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There is evidence of previous thoracotomy with cardiomegaly, pulmonary venous congestion and small bibasal pleural effusions. No major collapse or consolidation, normal appearances of the bony thorax.

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cardiomegaly consolidation normal object pleural_effusion


The heart appears enlarged despite projection. There is pulmonary venous congestion. There is obscuration of the left hemidiaphragm suggestive of consolidation/collapse.

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atelectasis cardiomegaly consolidation interstitial_shadowing


Rotated AP projection. Bilateral coarse lung markings in keeping with chronic airways disease. Left basal atelectasis. Calcified Pleural plaques noted as before in keeping with previous asbestos exposure. Patchy lung markings at the right lung base may be in keeping with localised bronchitic infection.

O O O O O B 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 E B I I


PA study. Normal cardiomediastinal appearances. The lungs are emphysematous. Some scarring in the right upper zone is similar to the previous CXR from April 2016. There has been interval endobronchial valve insertion in the right lung. Although appearances of the right apex are stable compared with the CXR from April 2016, a prior CT scan from October 2015 demonstrated a new abnormality here. Although the stability on CXR is reassuring, a repeat low dose CT chest scan is recommended to ensure stability here.

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apical_fibrosis comparison emphysema normal object other recommendation


PA view. There is pulmonary venous congestion with cardiomegaly. Perihilar ground-glass and patchy air space opacity. Features are in keeping with heart failure with mild pulmonary oedema.

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


cardiomegaly hernia pleural_effusion scoliosis

PA view. There is pulmonary venous congestion with marked cardiomegaly. No consolidation or collapse. Bilateral small pleural effusions. Features are suggestive of heart failure. Large hiatus hernia also noted. No evidence of malignancy. Thoracic scoliosis convex to the left with associated chest wall deformity.

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


AP erect view. Cardiac pacemaker with intact leads is in situ. Despite projection, the heart appears moderately enlarged. There is pulmonary venous congestion. No consolidation or collapse. No pulmonary oedema. No change since previous PA chest radiograph dated 26/05/2017.

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


AP semi-erect view. There is pulmonary venous congestion with interstitial oedema. No consolidation or major collapse. There may be a small left pleural effusion. Unfolded and calcified aortic arch. Features are suggestive of mild heart failure.

O O O O O O O B 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


Multiple pulmonary metastatic lesions are noted. Malignant left pleural thickening as noted before. There is volume loss in the left lung along with the left lower lobe collapse. X20

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Bilateral apical spiculated mass lesions are noted. No lobar collapse /consolidation. Small pleural effusions are noted. X20


There is elevation of the left hemidiaphragm, longstanding. There is atelectasis at lung bases bilaterally. Degenerative change noted in the shoulder joints. X20

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PA view. Cardiac monitoring device noted. The heart is enlarged. Unfolded and diffusely calcified thoracic aorta. Pulmonary venous congestion with interstitial oedema. Fracture of the right fifth posterior is noted, probably acute, not present on previous chest radiograph dated 18/11/2016. Old healed left lower lateral rib fracture. No pneumothorax. Report e-mailed.

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


AP semi-erect view. There is pulmonary congestion with cardiomegaly. On comparison to previous examination dated 19/06/2017, there is now bilateral perihilar patchy air space and ground-glass opacity, suggestive of development of pulmonary oedema. Features are suggestive of heart failure rather than infection.

O O O O O O O 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


Slightly rotated AP semi-erect view. There is pulmonary congestion with cardiomegaly. There is perihilar patchy air space opacity in the lower zones, suggestive of pulmonary oedema. Bilateral lung nodules noted on recent CT study dated 15/07/2017.

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PA view. Cardiac pacemaker with intact leads is in situ. The heart is enlarged. There is pulmonary venous congestion with interstitial oedema. No consolidation or collapse. No pneumothorax or visible rib fracture.

O O O B 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


Portable slightly rotated AP erect view. Cardiac pacemaker with intact leads is in situ. There is marked pulmonary venous congestion with cardiomegaly. There is bilateral perihilar patchy air space opacity and generalised ground-glass opacity. Features are in keeping with heart failure with pulmonary oedema.

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


There is mild cardiomegaly with early pulmonary venous hypertension consistent with fluid overload. No pleural effusion or pulmonary oedema.


PA view. Cardiac monitoring device. There is pulmonary venous congestion. Moderate right pleural effusion, small left pleural effusion. Features of heart failure are unchanged since previous examination dated 25/07/2017.

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


Portable AP semi-erect view. Dual chamber pacemaker with intact leads is in situ. There is pulmonary venous congestion with cardiomegaly. Small right pleural effusion with indwelling intercostal drain. No pneumothorax.

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Findings: Comparison is made to the previous chest x-ray dated 3 September 2017. I note from the previously provided clinical information and imaging that the patient is known to have COPD and right upper lobe collapse with bronchiectasis. Overall appearances are similar to the previous study. Once again, there are increased bronchovascular markings with flattening of the diaphragm and increased definition of the inferior heart border. There is cavitation in the left upper zone. There is volume loss and dense opacity in the right upper zone. There is no new focal consolidation or collapse.

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Persistent cardiomegaly with pulmonary venous hypertension and small pleural effusions. Previous CABG. CVP lines removed.


Comparison made with previous chest radiograph dated 28/11/14. Erect AP projection. Poorly inspired film. Right clavicular fracture noted. No penumothorax demonstrated. Bilateral upper zone volume loss and pleural thickening in keeping with past TB, unchanged from previous. Increased shadowing in the left and right lower lung zones likely secondary to soft tissue shadowing.

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PA view. Dual chamber pacemaker with intact leads is in situ. There is pulmonary venous congestion with cardiomegaly. No consolidation or collapse. Features of heart failure are unchanged since previous examination dated 19/03/2017.

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cardiomegaly comparison interstitial_shadowing normal object possible_diagnosis


Atrial and ventricular pacing leads in position. Persistent pleural effusions with cardiomegaly and pulmonary venous hypertension but no pulmonary oedema, largely unchanged since the previous study done on 15 September 2017. Comment: Left ventricular failure.

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Since the previous study done on the 28 September, the heart is increased in size and there is now pulmonary venous hypertension consistent with early left ventricular failure.

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PA chest x-ray. Increased density in the suprahilar region with tracheal deviation to the right could be consistent with thyroid goitre. Ultrasound is advised for further assessment. Coarse opacification is noted in the right mid and lower zones suggestive of infection. Follow-up image is recommended 6 weeks after appropriate treatment.

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No sinister mass lesion to suggest a bronchial carcinoma. Prominent left nipple shadow. COPD. Bilateral bronchial wall thickening. Previous cardiac surgery. Ectatic aorta. Normal sized heart. Noobvious cause for LOW.

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PA view. There is pulmonary venous congestion with upper lobe blood diversion and interstitial oedema. No consolidation or collapse. Mild emphysema is present. The heart size is at the upper limit of normal. Superior mediastinal widening due to retrosternal goitre, confirmed on previous CT study dated 16/08/2017.

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PA view. Sternotomy wires, mediastinal surgical clips and prosthetic heart valve are noted. There is pulmonary venous congestion with cardiomegaly. Unfolded and calcified aortic arch. No consolidation or collapse.

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Heart size normal. There is pleural thickening with calcifications surrounding the right hemithorax with associated volume loss. This was present on an old chest x-ray from 2014 and is unchanged. It is likely to represent an old haemothorax or TB empyema. The right lung remains highly abnormal containing multiple ring opacities. Abnormality has progressed since the previous film. This could represent bronchiectasis, or less likely fibrosis with honeycombing. However there is only very minor basal reticulation on the left and the remainder of the left lung appears normal. Appearances are likely to be chronic; however a routine CT of the chest would be reasonable to assess the lung parenchyma. We can perform this directly for you if you wish, or it could be facilitated by a respiratory referral.

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Rotated semi-erect AP view. Comparison is made with the previous radiograph from 07/07/2017. There is left mid zone and lower zone air space opacification with ill-defined left hemidiaphragm. The appearances are in keeping with chest infection with possible partial collapse of the left lower lobe. Left basal pleural effusion. The right lung is clear. Thoracic scoliosis with convexity to the right. Repeat radiograph in 4-6 weeks is suggested following appropriate treatment.

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atelectasis comparison consolidation normal pleural_effusion scoliosis technical_issue


Slightly rotated AP semi supine view. Shallow inspiration. There is pulmonary venous congestion. No consolidation or collapse. Unfolded and calcified thoracic aorta. Thoracic scoliosis convex to the left with associated chest wall deformity. Osteoporotic changes in the thoracic spine. No pneumoperitoneum.

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Slightly rotated AP erect view. Shallow inspiration. Cardiac monitoring leads. There is pulmonary venous congestion. No consolidation or collapse. Unfolded and calcified thoracic aorta. Features are suggestive of heart failure.

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aortic_calcification atelectasis cardiomegaly hernia

AP view. Shallow inspiration. There is pulmonary venous congestion. Linear atelectasis in the lower zones bilaterally. The heart is enlarged. Calcified thoracic aorta.

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PA erect study. Comparison made with previous chest x-ray 28/09/2015. Large volume emphysematous lungs with flattened hemi diaphragms in keeping with COPD. No signs of bronchopneumonia. No signs of focal infection. Heart size is moderately enlarged. Thoracic aorta is calcified. Left hilum appears increased in size and density compared to previous images. This may represent lymphadenopathy here. The large right hilum remains enlarged, this has previously been attributed to prominent pulmonary vasculature, and remains similar to previous appearances (28/09/2015). The 6th left posterior rib is fractured, or shows signs of erosion. I note from previous imaging the patient has a history of osteoporosis, does the patient have a history of fall or injury to this area? Does the patient have a history that may indicate rib erosion? Please correlate clinically. Further investigation may be warranted, nuclear imaging may be indicated dependent on the patient''s history. Should malignancy be a concer

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No previous comparable imaging. Midline sternotomy wires from previous CABG. Sub optimal inflation of the lungs. Mild cardiomegaly (CTR of 0.56). Mild pulmonary venous congestion particularly in the perihilar region. However,No focal collapse, consolidation or effusions. Cardiomediastinal contours are intact.

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cardiomegaly comparison interstitial_shadowing normal object technical_issue


Median sternotomy wires in situ. The tip of the left-sided PICC line is projected in the SVC. The heart appears enlarged and there is pulmonary venous congestion and small right-sided pleural effusion. Appearances are consistent with heart failure. No significant interval change when compared with previous examination dated 07/01/2018.

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There is a moderate right-sided pleural effusion and a small left-sided pleural effusion. The heart appears mildly enlarged despite the AP projection. There is pulmonary venous congestion. Combined appearances are suggestive of congestive heart failure. Infection cannot be ruled out. No significant interval change when compared with previous chest x-ray. There is non-union of an old fracture of the lateral end of the right clavicle.

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Comparison with the prior study done at another hospital in May 2017 shows no significant change. There is persistent severe right upper lobe cystic bronchiectasis with fibrotic scarring, contracture and secondary COPD. The left lung demonstrates bullous formation in the upper mid zone with severe lower airway obstruction. The heart and mediastinum normal although trachea deviated right following the severe contraction of the right upper lobe. The right upper lobe bullous is more obvious than previously but there is no separate infection or congestion.

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The tip of the dual lumen right internal jugular central line lies in distal SVC. There is marked elevation of the left hemidiaphragm with added soft tissue in the left superior mediastinum. The aerated lungs are clear with no pleural effusion.

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There is marked cardiomegaly. Mild pulmonary venous congestion and mild interstitial oedema at the bases. No overt pulmonary oedema. Blunting of the left and possibly also the right costophrenic angle suggests small bilateral pleural effusions. No major collapse or consolidation. Multiple old left-sided rib fractures noted.

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There is mild cardiomegaly and there is pulmonary venous congestion. No overt pulmonary oedema. Poor visualisation of the left costophrenic angle is likely due to overlying soft tissue. No major collapse or consolidation. Linear atelectasis at the right base.

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Hyperexpanded lung volumes in keeping with COPD. There is a vague area of increased density in the left lower zone projected over the anterior aspect of the left sixth rib which is almost certainly a composite shadow. The longstanding peripheral bibasal reticular changes are stable. No new collapse or consolidation. No pleural effusion.

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PA chest radiograph. Right middle and lower lobe collapse, consolidation and pleural effusion. A large soft tissue abnormality is projected over the right lateral chest wall. There is underlying destruction of lateral ribs. Small left sided pleural effusion.

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PA erect rotated study. No previous chest x-ray for comparison. Large volume emphysematous lungs. There are bilateral small pleural effusions, more prominent on the right. There is upper lobe blood diversion suggesting pulmonary venous hypertension. There is peribronchial cuffing and mild perihilar consolidation. Findings are in keeping with a degree of interstitial oedema, likely due to left heart failure. Difficult to asses mediastinal structures/heart size due to projection. No signs of focal infection. There are multiple sclerotic lesions within the distal right clavicle, right scapula and right humerus. These are in keeping with the known history of bone metastases.

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AP erect chest x-ray. Right-sided subclavian line in situ. Cardiac and mediastinal contours are difficult to accurately assess. Well-defined calcified opacity in the right mid zone remains unchanged when compared with the previous chest x-ray dated 22/11/2012. There is minor blunting of the left costophrenic angle, with subtle basal subsegmental atelectatic change and prominent coarse bronchovascular markings in both lower zones, which could represent a source of infection. A follow-up image is recommended in 6 weeks after appropriate treatment to reassess appearances.

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The heart is not enlarged. The main pulmonary artery appears slightly prominent but this is likely projectional as the pulmonary vasculature is otherwise normal. Lungs are clear. No pleural effusion. No pneumothorax.

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AP supine portable study. Cardiac monitoring leads noted. There is a complete white out of the left lung. This is likely consolidation due to infection. It may represent collapse due to mucous plugging, however this is less likely as the trachea remains central. Unable to asses cardiac or mediastinal structures due to projection. See subsequent film which shows an improvement.

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Multiple chest radiographs reviewed dating back to 28/04/2019. Patchy consolidation in the left lung zone with small bilateral pleural effusions, not present on previous chest radiographs.. Large upper mediastinal adenopathy once again seen. Lung metastases seen bilaterally. I note CT has been performed after this date.

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Clear lung fields. No pleural effusion. No free air under diaphragm. No consolidation. Focal loops of dilated small bowel in the left upper quadrant. Previous splenic artery embolisation. incidental left iliac wing bone island, of no clinical consequence.

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Comparison made with previous chest radiograph dated 22 October 2009. Normal heart and mediastinal contours. Allowing for the overlying breast shadows, the lungs show no acute pulmonary pathology. Non-specific prominent bronchopulmonary markings - is the patient a smoker or ex-smoker? No pleural effusions. No collapse/consolidation. No significant bony findings. Are there any significant auscultatory findings?

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abnormal_non_clinically_important comparison emphysema normal other possible_diagnosis


PA chest x-ray. Previous cardiac surgery is noted. Cardiac and mediastinal contours are within normal limits. Pleural thickening is seen at the periphery of the right upper zone, consistent with healed rib fractures. No major collapse, consolidation or pleural effusion is identified.

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COPD with moderate ventricular cardiomegaly, small pleural effusions but no consolidation or significant congestion. Aorta calcified and unfolded Degenerative changes in both shoulders and in the thoracic spine.

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PA erect study. Comparison made with previous chest x-ray 08/03/2011. Normal heart size and mediastinum. There is linear scarring in the right upper zone which likely relates to previous infection. There is eventration of the right hemidiaphragm and the right hilum appears raised, these changes likely relate to volume loss in the right upper zone. There is zome mild air space opacification at the left costophrenic angle, this may represent infection or long standing scarring. Further trivial atelectasis is seen in the left mid zone. No significant bone abnormality. If there is clinical suspicion of infection, a follow up chest x-ray 6 weeks post treatment is advised to check for resolution of left basal changes. emailed

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atelectasis comparison consolidation normal recommendation volume_loss


PA chest x-ray. Cardiac contour is at the upper limits of normal CTR. There is deviation of trachea to the right, with increased density in the superior mediastinum. This appearance could be due to a thyroid dated. Ultrasound is advised in the first instance to assess appearances. Coarsened bronchovascular markings are noted, slightly confluent in the left lower zone, but no major collapse, consolidation or pleural effusion is identified.

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PA erect study. No previous chest x-rays for comparison. Normal heart size and mediastinum. There is bilateral upper zone fibrotic scarring with volume loss. Pleural thickening is seen in the left apex, with adjacent consolidation and a cavity which appears to contain gas fluid level. There is air space opacification in the right upper zone, abutting the horizontal fissure which has been displaced superiorly due to volume loss. No significant bone abnormality. Findings are concerning for reactivation of old TB. The patient requires urgent referral to TB clinic for sputum collection, and if appropriate, contact tracing. Report e-mailed to referrer.

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XR Chest PA projection. The heart is enlarged with hilar vascular prominence. Coronary stent noted. Right-sided dual-lumen central line in situ. There is diffuse groundglass opacity throughout both lungs. Slightly more confluent areas of shadowing in the lower zones as well as within the right upper lobe demarcated inferiorly by the horizontal fissure. No sizable pleural effusion. The differential for these appearances includes infection and failure/fluid overload. Subsequent plain film imaging and CT request noted. Report Date : 17/12/2018 Reporting Radiographer, Iain Petford HCPC: RA42235 Medica Reporting Ltd

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Rotated AP erect view. There is pulmonary venous congestion with cardiomegaly, suggestive of heart failure. No consolidation or collapse. The lungs appear emphysematous. Unfolded and calcified thoracic aorta. No change since previous examination dated 09/04/2018.

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Slightly rotated PA view. There is pulmonary venous congestion with cardiomegaly, in keeping with heart failure. No consolidation or collapse. No focal lung lesion. Unfolded and calcified aortic arch. Degenerative changes in the thoracolumbar spine with scoliosis.

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PA erect study. Normal heart size. Unremarkable mediastinum. There are coarse bronchovascular markings in keeping with the history of smoking. There is a small round density projected between the seventh and eighth left postero-lateral ribs. This remains unchanged since previous imaging and is likely due to composite shadowing. Lungs are otherwise clear. No signs of focal infection. No pleural effusion. Partial healing of old fracture of the right distal third of clavicle. No other significant bone abnormality.

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Mild cardiomegaly. CRT-D device present. Deformity of one of the upper right ribs with some adjacent pleural thickening is unchanged from the previous radiograph. Has there been previous trauma here? No focal lung lesion.

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PA erect study. Comparison made with previous chest x-ray 02/10/2014. Surgical staples seen projected over the right breast in keeping with previous surgery. There is mild cardiac enlargement. Normal mediastinum. There is upper lobe blood diversion and fluid is seen at the horizontal fissure. There is longstanding blunting of the left costophrenic angle. Mild peribronchial cuffing is seen in the right mid zone. Findings are in keeping with a degree of heart failure. No significant bone abnormality.

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AP supine portable There has been clinical concern over the side labelling on the film. The correct side will be confirmed on the pending CT scan. ( discussed with Dr [REDACTED]). There is a right pleural effusion with subcutaneous emphysema over the right chest wall. Left upper lobe/ para mediastinal opacity is seen ? segmental consolidation / lymphadenopathy. Small left pleural effusion. No pneumothorax.

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As has been seen previously the vessels are prominent suggesting pulmonary venous hypertension. There is no change compared to films dating back to December 2009. --

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Dual chamber PPM noted with wires apparently satisfactorily sited in the RA and RV. The lungs are congested and there is cardiomegaly.

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cardiomegaly consolidation object paratracheal_hilar_enlargement


Sternotomy sutures, NG tube and right IJV line in situ. Epicardial pacing wires. Aortic graft noted. Collapse/consolidation of the left lower lobe with a small pleural effusion. --

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Changes of COPD are noted in both lung fields. Dextrocardia noted. There is now an ill defined opacity in the left mid zone. There is no other feature of note.

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consolidation dextrocardia emphysema hyperexpanded_lungs normal possible_diagnosis


Supine projection with some rotation. There is marked asymmetry of the lungs with diffuse increased density seen on the left. This could reflect a left sided effusion and be positional however there is abnormality at the left hilum which was not present on the CXR from Jan 2011. This could represent a hilar mass but would be very rapid progression and if the generalised increase density reflected upper lobe collapse I would expect more volume loss. In the first instance a repeat PA radiograph is suggested, if this shows persistence of the abnormality at the left hilum then a CT should be considered. --

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AP portable erect. There is a localised bulge to the left heart border with a rim of calcification in keeping with left ventricular aneurysm. This is unchanged since a previous examination dated 20/8/08. Density seen behind the heart is in keeping with hiatus hernia. No active focal lung lesion seen. -

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Supine portable examination. Large volume lungs with coarsened markings inkeeping with a COPD. No active focal lung lesion seen.


PA/lateral. Moderate cardiomegaly. Complex defibrillator device with what appears to be 5 leads. The newest lead since 15/2/12 seems to be over coronary sinus rather than the usual right ventricle tip. No pneumothorax. Chronic mild congestive looking changes in the lungs.

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cardiomegaly consolidation normal object


XR Chest AP Supine, Rotated image. Tracheostomy tube, NG tube and RIJ line appear appropriately sited. Surgical fixation of the right clavicle and humerus. Multiple rib fractures bilaterally. Poor expansion of the lungs with hazy infiltrates bilaterally and likely collapse/consolidation of the left lower lobe even allowing for the image''s rotation.

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Request form not available. Ill-defined nodular airspace opacification and bronchial wall thickening left lower zone. Also increased nodularities right upper zone. Appearance a s most probably represents infective pneumonic change, but specifically tuberculosis needs to be considered and excluded clinically. I note the patient had a CT head scan performed at the same attendance and a history of given was of fitting. It is possible that the lung changes are the result of aspiration. Report to be emailed to referring A & E consultant.

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cardiomegaly consolidation mediastinum_widened object

Post aortic arch replacement. Tracheostomy in situ. AP projection excludes accurate comment upon heart size but mediastinum is widened even allowing for this. NG tube tip is below the level of the film and looks probably in the region of the stomach. There is patchy opacification in both lungs more so on the left than the right and this appears fairly constant to films dating back to 26/2/13.

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comparison consolidation mediastinum_widened object


XR Lumbar Spine and S.I. Joints : Minor degeneration is noted, L4/5 level. CABG noted. Heart is mildly enlarged. Lung shows changes of venous congestion and COPD changes.

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The lungs are clear. No free subdiaphragmatic gas. Normal heart size (CTR 0.5). No free subdiaphragmatic gas. The right sided abdominal wall is incompletely demonstrated on this film. Bilateral total hip replacement in situ. No dilated loops of bowel are identified. There is a left concave long axis lumbar scoliosis with no underlying segmentation anomaly although note is made of degenerative change in the lower lumbar spine extending into the lumbosacral junction. Bilateral sacroiliac joint sclerosis is also noted.

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NG tube appropriately sited. There is increasing opacity within the left hemithorax, I suspect there may be a degree of left lower lobe collapse with some mediastinal shift to the left side. The right lung remains relatively clear, there is perhaps a small basal effusion. Previously noted left rib fractures and clavicular fracture.

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Ap semierect. Marked aortic calcification. Poor inspiration. There appears to be extensive interstitial oedema. There is prominence of the right hilum. This could represent an underlying tumour. Features are suggestive of cardiac failure. Repeat chest x-ray after treatment to better clarify the nature of the right hilum prominence is recommended Hiatus hernia noted. AN ADDENDUM HAS BEEN ENTERED AT THE END OF THIS REPORT ADDENDUM START

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Slight rotated PA view, lateral view. Cardiac pacemaker with intact leads is in situ. The heart is enlarged. No pneumothorax. There is pulmonary congestion with upper lobe blood diversion. There is a small right pleural effusion. Features of cardiac failure are unchanged since previous examination dated 03/12/2014 prior to the insertion of the pacemaker.

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PA and lateral views. Comparison to previous CT study dated 13/06/2014. Dextrocardia and situs inversus are confirmed. Dual chamber pacemaker with intact leads is in situ. The heart is enlarged. The thoracic aorta is unfolded. Sternotomy are wires noted. There is no pneumothorax. There is pulmonary venous congestion. Otherwise the lungs are clear.

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Rotated AP semi-erect view. Comparison to previous examination dated 13/01/2015. There is persistent fairly marked pulmonary venous congestion. There are bilateral small pleural effusions. There is now bilateral perihilar patchy air space opacity. The heart is enlarged. The thoracic aorta is unfolded and ectatic. Features are suggestive of worsening cardiac failure with development of pulmonary oedema.

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cardiomegaly object pneumoperitoneum upper_lobe_blood_diversion

Portable rotated AP semi-erect view. The tip of a right internal jugular line is adequately sited in the proximal SVC. The tip of nasogastric tube has looped back into the distal oesophagus and needs to be repositioned. No pneumothorax. There is pulmonary venous congestion. Normal mediastinum. Air is noted under the right hemidiaphragm.

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consolidation normal object pneumoperitoneum recommendation technical_issue


Portable slightly rotated AP supine view. The tip of a right internal jugular line is adequately sited in the SVC. No pneumothorax is demonstrated. There is pulmonary venous congestion. There is patchy air space opacity in the lower zones both lungs. The heart appears enlarged. Hiatus hernia noted.

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cardiomegaly consolidation hernia interstitial_shadowing normal object technical_issue


PA view. There is mild pulmonary venous congestion with upper lobe blood diversion. Otherwise the lungs and pleural spaces are clear. No pneumothorax. The heart is slightly enlarged.

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The tip of a right internal jugular line is adequately sited in the proximal SVC. No pneumothorax. There is pulmonary venous congestion. There are bilateral pleural effusions. There is air space opacity in the left lower lobe. Unfolded and calcified thoracic aorta. Features are suggestive of cardiac failure. There may be superimposed infection.

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PA erect view. There is bilateral upper lobe fibrosis consistent with old TB. There is left hilar distortion. Elevation of the left hemidiaphragm. The lungs appear emphysematous. No active focal lung lesion. Normal heart size. Unfolded and calcified thoracic aorta. No change since previous examination dated 16/01/2015.

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Rotated AP erect view. There is pulmonary venous congestion with marked cardiomegaly. No consolidation or collapse. No pulmonary oedema. Marked degenerative changes of both shoulders. No change since previous examination dated 21/01/2015.

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abnormal_non_clinically_important cardiomegaly comparison consolidation normal technical_issue


Slightly rotated AP erect view. There is pulmonary venous congestion. No consolidation or collapse. The heart is slightly enlarged. Unfolded thoracic aorta. There are old healed fractures of several left-sided ribs and of the left humeral neck.

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(30.03.2006) Large left hilar mass and associated moderate size pleural effusion. Multiple metastatic deposits seen throughout the right lung.


PA view. Shallow inspiration. There is pulmonary venous congestion with cardiomegaly. Bilateral small pleural effusions. Associated compressive linear atelectasis in the lower zones. Features are suggestive of heart failure.

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Minor scarring/chronic atelectasis is seen at the left lung base, unchanged since 2008. Old rib fractures on the right. No new or significant abnormality within the lungs. Heavily calcified aortic arch. Otherwise normal mediastinum for age.

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The heart appears enlarged despite projection. There is blunting of the right costophrenic angle suggestive of a small pleural effusion. There is pulmonary venous congestion. Combined appearances are suggestive of a degree of heart failure.

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The heart appears enlarged despite projection. There is pulmonary venous congestion. No florid pulmonary oedema or pleural effusion. Median sternotomy wires and MVR in situ.

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cardiomegaly interstitial_shadowing normal object


Advanced malignancy is seen within the mediastinum with unchanged appearance of the left upper lobe mass lesion. There is elevation of the left hemidiaphragm with dense consolidation of the left lower zone, appearances are worse in comparison to previous chest x-ray of 05/06/2017, suggestive of superadded infection. Lymphangitis carcinomatosa as noted before. The right lung is well-aerated. X20

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Moderate left ventricular cardiomegaly with bilateral bronchial wall thickening but no congestion or consolidation. Superior mediastinum widened . Trachea deviated to the left. Probable enlarged thyroid. No tracheal compression. Ultrasound recommended.

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Portable rotated AP erect view. Cardiac monitoring leads. Sternotomy wires noted. There is pulmonary venous congestion with cardiomegaly. No consolidation or collapse. Evidence of previous right breast surgery noted.

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abnormal_non_clinically_important cardiomegaly consolidation normal object technical_issue


Comparison made with previous chest radiograph dated 12/07/2017. Portable AP erect RESUS. Right-sided pleural effusion has decreased in size. Left pleural effusion is similar in size. Upper lobe dilation. Allowing for projection, heart size appears enlarged (previously seen cardiomegaly on chest radiograph dated 25/07/2014). Features are consistent with congestive heart failure. Bibasal air space opacification in this context is compatible with consolidation of changes secondary to infection. No major collapse. Satisfactory appearance of the hilar and mediastinal contour.

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AN ADDENDUM HAS BEEN ENTERED AT THE END OF THIS REPORT No previous x-ray available for comparison. There is a homogenous opacity in the right lower zone which may indicate some collapse of lung. The right hemithorax also appears slightly smaller than the left. In view of persistent cough, lung neoplasm cannot be excluded. Therefore your patient has been fast tracked for further investigation. ADDENDUM START CLINAPPT. MONDAY 07/09/09 WITH DR [REDACTED] 13.30pm

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Portable slightly rotated AP erect view. Cardiac monitoring leads. The lungs and pleural spaces are clear. Normal cardiac contour. Calcified aortic arch. There is tracheal deviation to the left with widening of the superior mediastinum, probably due to retrosternal goitre. Previous left mastectomy is noted.

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Portable slightly rotated AP supine view. Cardiac monitoring leads. The costophrenic angles are clipped. There is pulmonary venous congestion with cardiomegaly. No consolidation or collapse.

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cardiomegaly consolidation normal object technical_issue


PA view. Comparison to previous examinations from December and November 2017. There is chronic linear scarring in the lower zones bilaterally. There is pulmonary venous congestion. The heart size is at the upper limit of normal. Unfolded and calcified thoracic aorta. Features of heart failure are unchanged. No evidence of infection. Previous surgery to the right shoulder noted.

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The bilateral lower lobe pneumonia has improved dramatically since the previous study done 8 days ago but there is residual consolidation in both lower lobes. There is cardiomegaly with COPD and very mild pulmonary venous hypertension.

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Slightly rotated radiograph. Comparison is made with the previous radiograph of 13/10/12. No free subdiaphragmatic gas. There is a new right lower zone peripheral region of airspace opacification with a dense ill defined border measuring 4 x 2.5cm. Reticular markings are noted emanating from this region of airspace density. There is pleural thickening with volume loss in the right lower zone which is likely to relate to the effusion is seen on an old film from 2012. The parenchymal abnormality may therefore represent associated folded lung. The cardiomediastinal contours are within normal limits. The thoracic aorta is unfolded. Further assessment with pleural protocol CT is advised after the acute episode. Report e-mailed to referrer. Moderate colonic faecal loading noted. Non specific bowel gas pattern noted. No evidence of bowel obstruction or pneumoperitoneum.

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> ADDENDUM TO THE FINAL REPORT BY [REDACTED] DATED 14/06/2018 13:06 Dual-lead pacemaker, NGT, right chest drain, ETT and right internal jugular central line in situ, appropriately positioned. There are multiple rib prostheses on the right. There is no residual pneumothorax on the right. Right-sided surgical emphysema has improved. There is lucency in the left upper zone, particularly adjacent to the mediastinum. This was present on the previous film 2 days earlier. It was not apparent on the baseline chest x-ray earlier that day. In addition the surgical emphysema over the left chest wall has progressed quite markedly. Whilst appearances on the left are not definitive for a pneumothorax the upper zone lucency and the progression of surgical emphysema are concerning. If this would alter management then a low dose CT of the chest could confirm definitively. I note there were no rib fractures on the left on the baseline CT but of course the pneumothorax, if confirmed, could relate to ventilation. < > Addendum Addendum Validated /. TATTERSALL, Deborah

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comparison emphysema normal object possible_diagnosis recommendation subcutaneous_emphysema


AP portable erect radiograph. Prior cardiac surgery. Bilateral pleural effusions and basal air space opacity more suggestive of cardiac failure than infection. Vascular calcification. Right shoulder replacement. Severe degenerative change in the left glenohumeral joint.

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