Further history from the referring clinician, patient had surgery for tetralogy of Fallot 40 years ago. Sternotomy wires are noted, the size of which suggest that the patient had surgery when he was a child. There is a right-sided aortic arch. There is a large well-defined soft tissue opacity at the left hilum, and left hilar vessels can be seen projected through this. The appearances are suggestive of a pulmonary artery aneurysm. There is no airspace opacification. There is no bony lesion. Given the presentation with pain, suggest CT PA to evaluate the pulmonary arterial system further.

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Heart size is at the upper limit of normal with a CTR of 0.5. There is widening of the right superior mediastinum associated with a rounded area of focal calcification. The calcification could relate to lymph nodes or even a retrosternal goitre. Unfortunately there are no comparison films currently available, but I suspect these appearances are of long standing. There is a fracture of at least of the right lower ribs and associated with this there is a little pleural fluid and fairly extensive right basal consolidation. The lung appearances could all represent a contusion, but the consolidation is rather patchy and I think your clinical suspicion of a complicating bronchopneumonia may well be correct. The lung fields are generally hyperinflated and also show old post inflammatory changes. The patient was asked to remain in the department whilst the radiographer discussed with the on duty radiologist appropriate referral. Unfortunately she seems to misunderstood the instruction and the left the department immediately.

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A comparison is made with the previous chest xray from 10/6/2014. Suboptimal film. Sternotomy sutures are noted. There is mild pulmonary venous imbalance. Some collapse/consolidation in both lung bases noted which can be related to the heart failure but an infection is also a possibility. Small pleural effusions bilaterally.

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Chest. Multiple fluid levels in the right upper zone are suggestive of loculated abscess formation or infected bullae, mass like opacity in multiple tiny nodularity is noted inferiorly. Similar appearance is seen in the left upper and mid zone with a large masslike opacity (6 cm) in the left mid zone. Left lower chest wall pleural-based calcification and calcified left hilar node suggest prior TB infection complicated by haemothorax/empyema. CT chest and abdomen has been arranged.

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Poor inspiration. The heart appears enlarged, CTR 0.52. The lungs appear a little congested but otherwise clear. An old fracture of the right fourth rib is noted.

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There is soft tissue opacity seen at the left base which is seen on the previous CT as a small diaphragmatic hernia. Hyperinflated lung fields with increased vascular markings but no focal active lung lesion seen.

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There is some clearing of the right basal infective changes however there continues to be consolidation in the left mid zone and upper lobe pleural thickening and scarring along with cavitation in the right apex and blunting of the right costophrenic angle. the NG tube has been removed.

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There is increased shadowing in the left lower zone with subsegmental atelectasis in the left lower lobe. There is also a small left pneumothorax. Has there been any previous intervention?. There is increased shadowing in the right paracardiac region suggesting middle lobe collapse/atelectasis. Appearances are in keeping with infection possibly on a background of bronchiectasis. There is also a new left pneumothorax.

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There is a borderline sized heart with congestive changes and septal lines suggestive of LVF of second degree. Bilateral small pleural effusions are seen. Calcification in the mitral valve is noted. There is also bibasal compressive atelectasis.

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There is a borderline sized heart. Bilateral small pleural effusions are seen. ET tube, RIJV line and left sided chest drain were in a good position and have been subsequently removed. On the most recent CXR there are bibasal hypoventilation changes and CCF of the 1st degree. Midline sternotomy and CABG noted.

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No previous images are available for comparison. Heart size normal. There is elevation of the left dome of the diaphragm and there appears to be some fibrosis and volume loss in the left upper zone. There is a large bulla at the right apex. There is an area of fairly dense shadowing in the right mid zone which could be due to infection. An old fracture of the right clavicle which has been plated is noted. A repeat chest x-ray in one month following treatment for infection is recommended.

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There is mild dorsal scoliosis with cardiomegaly. Lung fields are showing increased vascular markings with no change in the previously noted increased density at the right base suggesting that this could be of longstanding.

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cardiomegaly comparison interstitial_shadowing scoliosis


The right hemithorax is completely opaque. I suspect that this is a combination of a pleural effusion and lung collapse and there may well be a lesion obstructing the right main bronchus near its bifurcation. The left lung is clear. In view of the patients age and relative lack of symptoms she returned to her care home.

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Series of chest xrays from 21.11.2014 to 24.11.2014. There has been right sided thoracic surgery in keeping with the history. On the most recent film the right chest drain has been removed with a residual pneumothorax. There is some improvement the right basal consolidation. There is a right pleural effusion.

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comparison consolidation object pleural_effusion pneumothorax


bilateral pleural effusion noted left more than right. Older fractures noted in rib on the right side. Back pressure changes noted in both lung fields.

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There is a new left sided small pleural effusion with possible basal consolidation. Cardiomegaly and hiatus hernia noted. Biapical pleural thickening and calcified upper mediastinal lymphadenopathy noted.

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AP erect. Comparison is made with the previous chest xray from 28/11/2014. Suboptimal film. The patient is rotated. The appearances are in keeping with heart failure. Some collapse/consolidation noted in both lung bases which is most likely related to the heart failure but an infection is also a possibility. Small pleural effusions bilaterally. Degenerative changes demonstrated in both shoulder joints. No significant interval change.

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AP view. Lungs are congested. No focal consolidation.


The right pleural effusion has increased significantly in size. There is associated pulmonary collapse as the mediastinum is slightly towards the effusion rather than away.

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AP erect. Comparison is made with the previous chest x-ray from 16.12.11. The patient is rotated. Chin on chest. Right sided pneumothorax noted. Some collapse/consolidation seen in the right lung base. Small right sided pleural effusion. Surgical emphysema noted in the right chest wall and in the right neck. A few recent right lower rib fractures seen.

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Previous sternotomy noted. The heart is considerably enlarged, CTR 0.68. There is an increased density seen through the heart which could be due to a hiatus hernia or a tortuous or dilated descending aorta. There are bilateral pleural effusions. There is evidence of upper zone blood diversion but no evidence of overt pulmonary oedema. The appearances are consistent with heart failure. Multiple bilateral old rib fractures are noted.

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There is persistent complete opacification of the right hemithorax secondary to the known large tumour and associated pleural effusion. Of note in comparison to previous imaging the trachea and mediastinum is now pushed towards the left, suggestive of increasing volume within the right hemithorax. There is also apparent narrowing of the distal trachea. Left basal atelectasis noted. Single lead pacemaker noted, and there is movement of the tip towards the left, I presume this is secondary to mediastinal shift. Reported faxed to referrer.

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Complete opacity of right hemithorax noted. The NG tube is in an abnormal position, possibly within a left lower bronchus.


Mobile AP film. There are bilateral areas of peribronchial thickening and nodularity. There is a more focal 3 cm mass like area peripherally in the right midzone. The left hilum is elevated indicating there is some likely fibrosis associated with the left upper lobe changes.

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Comparison is made with the previous radiographs. There is a left sided pneumothorax. The patient is rotated - there is no significant mediastinal shift. Large calcified lesions in the right apex, right hilar region and within the partially collapsed left upper lobe corresponding to known old pulmonary TB. Please see the subsequent CTPA.

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No Pneumothorax or # rib seen. The cardiac shadow is enlarged with congestive features.


There is a borderline sized heart with congestive changes of the first degree. No pleural effusion is seen. There are fibrotic changes seen in both upper lobes worse on the right, this is a long-standing finding.

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apical_fibrosis cardiomegaly comparison consolidation normal upper_lobe_blood_diversion


Hx. of CCL,IHD , Lymphadenopathy & Background chronic lung changes rt.upper lung with atelectasis.No active lung lesion seen. The cardiac shadow appeared slightly enlarged,prominence of the hilar with congestive features.Hazy left mid/both lower lung with obscured rt. CP angle,suggestive of infection with effusion & CCF.

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Mild cardiomegaly with superior mediastinal widening secondary to retrosternal goitre displacing the trachea to the right side. Both lung fields show increased vascular markings.

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Chest. Slightly rotated PA projection. Volume loss on the right with blunting of the right costophrenic angle unchanged from the previous study of October 2014. No significant interval change in appearances from the previous exam. There is apparent linear atelectasis/scarring at the right apex.

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No prior examinations for comparison. The heart is enlarged. There is pulmonary oligaemia. No focal lung lesion. No pneumothorax. No effusions. Large air fluid level in the stomach. No free air under the diaphragm.

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abnormal_non_clinically_important bulla cardiomegaly comparison normal


Chest. PA projection. No convincing hilar or mediastinal lymphadenopathy. Cardiac shadow is mildly enlarged. There is linear atelectasis in the left lower zone. Slightly prominent hilar vasculature. Lungs appear mildly congested. No convincing evidence of active infection on this study.

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atelectasis cardiomegaly consolidation normal paratracheal_hilar_enlargement undefined_sentence


Thoracoplasty noted on the right side with dorsal scoliosis. There is cardiomegaly with congestive changes seen in both lung fields. No change compared to previous x-ray of 24.05.16.

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cardiomegaly comparison consolidation object scoliosis


At the time of reporting the patient is deceased. RI P. Cardiomegaly with congested lung fields and small volume effusions. Overall appearances supportive of cardiac decompensation. Coexisting infection cannot be excluded.

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Both lung fields are showing increased vascular markings with chronic atelectasis noted at both lung bases. No new abnormality seen. No change compared to previous CXR of 06.11.15.

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atelectasis comparison normal paratracheal_hilar_enlargement


Reported as part of a series of chest radiographs from 17/03/2016. No films prior to this series. Thickening of the right paratracheal stripe with widening of the upper mediastinum This does not appear to affect the middle or posterior structures and therefore lies within the anterior part fo the superior mediastinum. Hiatus hernia is noted. Sternotomy wires and AVR in situ for the later films in the series. Right basal consolidation is present on the most recent radiograph, along with a right pleural effusion. A CT chest is recommended for assessment of the superior mediastinal widening. T O'Neill. ST2 Radiology. 7281080.At the time of verifying, a subsequent CXR had been performed and reported and lymphoma MDT had been flagged.

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Patient is kyphotic with thickening of the horizontal fissure noted. No acute abnormality seen. Ectatic descending aorta noted. Prosthesis noted in the left humerus with marked degenerative changes seen at the right shoulder joint.

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There is a borderline sized heart with mild congestive changes. Revealed device in situ is noted.


Comparison made with the previous chest radiograph from 2/8/2016. The heart is enlarged. There are prominent vascular markings. There is some residual opacification in the left upper zone but this improvement in the generalised airspace shadowing.

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cardiomegaly comparison consolidation interstitial_shadowing


Comparison made with chest x-ray dated 1/7/2016. The heart size is normal. The previous right basal consolidation, right perihilar and upper lobe ground glass have almost completely resolved. There is some remaining mild right perihilar atelectasis/scarring. Hiatus hernia with gastric band noted. There are no pleural effusions.

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atelectasis comparison consolidation ground_glass_opacification hernia interstitial_shadowing normal object


Bilateral predominant upper lobe fibrosis and bronchiectasis is again noted. The trachea is deviated to the right by known retrosternal goitre. No new consolidation or collapse.

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In comparison with the previous film on 12/6/2016, there's been no significant interval change. Left pneumonectomy with complete whiteout of the left lung. Good aeration with compensatory hyperinflation of the right lung with mild herniation into the left hemithorax. No focal consolidation. Previous thoracotomy and sternal wires are noted.

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Chest. Portable AP projection. Tip of the nasogastric tube is within the stomach. There is marked elevation of the left hemidiaphragm as seen previously. Mild to moderately size left pleural effusion. No pneumothorax. Right hemithorax remains clear. Sternotomy wires, prosthetic heart valves and an atrial clip are noted.

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Chest. PA projection. Elevated left hemidiaphragm with intraluminal stomach gas beneath. There is minor atelectasis in the left lung base as well as a linear band in the left mid/upper zone. No major collapse or consolidation. There is subtle hazy density in the left mid zone which may be inflammatory in nature. Advanced degenerative change seen in the right shoulder.

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Comparison is made with the CXR from 30/3/16. Rotated radiograph. Large right pleural effusion with right paratracheal mass consistent with known mediastinal lymphadenopathy seen on the more recent CT whole body from 31/10/16. Right mastectomy and axillary surgical clips noted. Patchy sclerosis in the 1st and second ribs on the right is in keeping with bone metastases.

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AP projection. Mediastinotomy sutures noted. There is evidence of mild pulmonary venous congestion. No active lung lesions seen.


Chest. PA projection. No previous for comparison. Small left basal pleural effusion with coarse markings and atelectasis in the left lower zone. This may be inflammatory/infective in nature. Lungs otherwise clear. No right-sided pleural effusion. No pneumothorax. Normal cardiac and mediastinal contour. Subsequent plain film imaging noted.

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atelectasis comparison normal other pleural_effusion possible_diagnosis


Post biopsy, there is a very subtle tiny right apical pneumothorax. Increased opacity in the right perihilar region corresponds to the perilesional haemorrhage. No other interval change.

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XR Chest 06-10-2016 to 01/11. The left lower lobe is nearly entirely collapsed. Within this there are multiple areas of low attenuation containing locules of gas. The appearances indicate signficant abscess formation throughout the collapsed left lower lobe. There is no effusion present. Multiple small nodules with surrounding ground glass opacification throughout the right lung in keeping with infection or inflammation. No mediastinal lymphadenopathy. The upper abdominal organs appear unremarkable allowing for the phase of contrast. No bony lesion demonstrated.

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There is mild bilateral perihilar bronchitis and mild atelectasis at both lung bases posteriorly. The emphysema is not obvious, is probably subtle. No bullous disease. There are subtle pleural plaques posteriorly overlying the left lower lobe. No diffuse bronchiectasis or interstitial fibrosis. Moderate aortic leaflet calcification extending to the sinus. No porcelain aorta. Severe triple-vessel coronary artery calcific plaques are noted. Limited images of the upper abdomen and the imaged axis skeleton are unremarkable. Normal cardiac and mediastinal contour. There is minor atelectasis at the right lung base. No significant change since the prior film in September 2004.

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atelectasis bronchial_wall_thickening comparison emphysema normal


Cardiomegaly with a CTR in the specimen, upper lobe venous imbalance and bilateral perihilar congestive changes. Increased vascular markings throughout both lungs are no confluent consolidation or collapse. Small right pleural effusion. No subdiaphragmatic free gas pneumothorax. Appearances consistent with cardiac failure.

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A series of Chest radiographs from 26/10/2016 to 2/11/2016. A right sided chest drain is in situ. The right sided pleural effusion has reduced in size following the chest drain insertion with minimal residual effusion at the right costophrenic angle. No active lung lesion. No pneumothorax. Heart size is normal. The wedge shaped opacification in the right upper lobe remains grossly unchanged. Right sided tracheal deviation remains unchanged.

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comparison consolidation mediastinum_displaced normal object pleural_effusion


CT Chest/Abdo. The left -sided loculated complicated pleural collection is little smaller when compared to the previous CT. Please consider withdrawing the left-sided chest drain by 6 cm. As the fluid is seen superiorly and inferiorly to the left hemidiaphragm, I suspect the fluid origin is intraperitoneal (please check pleural fluid amylase level). In addition to the previously seen atelectasis, there is now left basal consolidation. There is persistent focal collection with pockets of gas around the splenic hilum and anterior to the left kidney measuring approximately 7.1 x 5.6 cm which communicates with small flat anterior localised collection with rim enhancement. The previously noted free ascites has significantly improved, small pockets of free fluid are seen along the para colic gutters bilaterally extending to the pelvis. IVC filter is well placed, there is suspected small thrombus above the IVC confluence. Splenic artery/vein embolisation clips are noted. Tip of the NG tube is in the gastric antrum/pylorus. No other significant or new finding.

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comparison normal object pleural_effusion recommendation


THIS REPORT HAS BEEN CHANGED. CT confirms extensive multi compartmental mediastinal mass encasing major mediastinal vessels, right main pulmonary artery, proximal bronchi and the bronchus intermedius. As clinically felt, there is a large right supraclavicular right paratracheal mass and multiple supraclavicular nodes. Imminent SVC obstruction. Multiple right-sided pulmonary nodules may represent either primary or metastatic lung nodules. Background severe centrilobular emphysema and relatively mild bronchitis. Small right-sided pleural effusion, no pericardial effusion. Bilateral non calcific pleural plaques would be consistent with history of asbestos exposure. No PE, however, the right inferior pulmonary vein ostium appears involved and partially stenotic. There are extensive diffuse liver metastasis, bilateral adrenal metastasis and probable vertebral metastasis (heterogeneous vertebral bodies). No neural canal compromise. Paucity of intra-abdominal fat makes bowel interpretation challenging. Nonobstructive right renal calculus. Dr [REDACTED] (vascular interventionalist). Asked to review regarding a SVC stent. According to the clinical team there is no significant SOB, head and neck swelling or headache. SVC stenting is for these symptoms and is a palliative procedure when other treatment options have been exhausted or if symptoms are ex

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No previous cross-sectional chest imaging available for comparison. CXR from earlier today considered as part of the report. There is extensive bilateral PE involving bilateral main, lobar, segmental and subsegmental pulmonary arteries. No saddle embolus. No right heart strain. The main pulmonary artery is not dilated measuring 2.5cm. There is co-existing mild consolidation and ground glass change in the lingula which may be secondary to infarction. There is diffuse peribronchial thickening with upper lobar predominant centrilobular and paraseptal emphysema. No concerning lung nodules. No mediastinal or hilar lymphadenopathy. No pleural or pericardial effusion. The left ventricle is severely dialated. There is an aneurysmal defect at the apex of the left ventricle - likely secondary to a previous apical wall infarct. There is a rounded filling defect measuring 2.9 x 2.3cm in the left ventricle. It is continuous with the left ventricular wall (anterior). ICD in-situ. Allowing for the early arterial phase of contrast, there is no significant abnormality of the partially imaged upper abdomen. No destructive bone lesion.

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bronchial_wall_thickening cardiomegaly comparison consolidation emphysema ground_glass_opacification normal


Previous left sided lung volume reduction surgery, with associated leftward tracheal deviation noted. Endobronchial valves in the left upper lobe. The two superiorly placed valves are patent, but the inferiorly placed valves are occluded with associated partial upper lobe collapse. There are severe bilateral emphysematous changes and a small left sided pneumothorax. No evidence of fluid collection. No pleural or pericardial effusion. No axillary, hilar or mediastinal lymphadenopathy. Well defined hypoattenuating lesion the imaged liver, in keeping with a cyst. The imaged upper abdominal organs are otherwise normal in appearance. Degenerative changes in the spine, but no destructive bone lesion.

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CT Chest/Abdo. No previous CT images for comparison. There is left lower lobe posterior segmental consolidation. Patchy subsegmental atelectasis is the right lower lobe posterior segment, middle lobe and lingular segments. Clusters of tree in bud nodules are seen in both lungs. Few enlarged mediastinal lymph nodes. No pleural effusion. No pneumothorax or pneumomediastinum. Small hiatus hernia. No rib fractures seen. CT abdomen and pelvis. Liver, spleen, gall bladder and pancreas appear normal. Small renal cyst in the left kidney. There is mild enhancement of the cyst wall. But, no soft tissue nodules seen within it. Multiple diverticula in the sigmoid colon. Rest of the unprepared bowel appear unremarkable. No ascites. No pneumoperitoneum. No bone fractures. Degenerative changes in the spine.

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abnormal_non_clinically_important atelectasis consolidation hernia normal rib_lesion


CXRs dated 21 and 22 November 2017 were reviewed. There is a large mediastinal mass with collapse of the right upper lobe. On the most recent rotated AP CXR there are stents in both main bronchi and the distal trachea in a good position.

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There is good opacification with contrast of the pulmonary arterial trunk. No pulmonary emboli demonstrated. No focal lung lesion. There is a 5 mm nodule within the upper lobe of the right lung (Se 4 Im 129). This has not changed since the CT dated 03/05/2013 and should not require follow-up (likely to represent a intrapulmonary lymph node). No pleural effusions. Dependent lung changes noted bilaterally. Bilateral mildly calcified pleural plaques. Left upper lobe calcified granuloma. There are several tiny scattered liver cysts. The rest of the liver parenchyma is unremarkable. There are bilateral renal cysts, predominantly on the right side. The note the spleen, pancreas and adrenals are normal. The unprepared bowel is unremarkable. There is a infrarenal aortic aneurysm measuring up to 5.4 cm. There is no abdominal pelvic lymphadenopathy. No focal concerning bone lesion.

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Comparison is made with previous chest radiograph dated 09/11/2017. PPM in situ. There remains marked cardiomegaly. The previous pulmonary venous congestion and right basal consolidation have significantly improved. There is improved right mid zone atelectasis. There remains chronic blunting of the left costophrenic angle.

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atelectasis cardiomegaly comparison consolidation interstitial_shadowing object pleural_effusion


Comparison made with the CT dated 27/03/2017. Right central venous catheter with the tip within the distal SVC. Normal calibre of the ascending aorta and the aortic arch, with only minimal atherosclerotic disease. Type B aortic dissection of the descending aorta is again demonstrated. No interval change in the calibre of the thoracic aorta measuring 4 cm at the level of the left pulmonary artery and 3.9 cm on the at the level of the left inferior pulmonary vein. No interval changes of the infrarenal abdominal aortic aneurysm measuring up to 4.2 cm. Significant iliac calcified atherosclerotic disease with only minimal atherosclerotic disease. No parenchymal lesion within the imaged lungs. Unchanged appearances of the mild degree of paraseptal emphysema. No mediastinal lymphadenopathy. The tail of pancreas cyst has increased in size from 1.1 cm to 2.8 cm. There is low attenuation within the tail of the pancreas. The pancreatic duct is dilated however this remains unchanged. Allowing for the phase of the contrast, the rest of the solid and hollow abdominal viscera remain unchanged.

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emphysema mediastinum_widened normal object


Serial last 3 chest x-ray demonstrates moderate moderate lamellated left-sided pleural collection. The present CT confirms peripherally enhancing thickened pleura with moderate left-sided pleural effusion with small locules of gas at the left lung apex (hydropneumothorax). There is significant loss of lung volume in the left lower and lingula lobes with multifocal atelectasis in the lingula lobe and partial collapse in the left lower lobe. Small pericardial fluid is also noted along with a few small left paracardiac fat pad lymph nodes. A few small anterior mediastinal nodes are also probably reactive. No focal consolidation. The right lung is clear. Tip of the right jugular dual lumen central line is in the right atrium. Probable left renal atrophy/scarring on limited images of the upper abdomen.

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atelectasis comparison consolidation normal object pleural_effusion volume_loss


CT Chest/Abdo. There is a 3.8 x 2.1cm peripherally calcified lesion at the left apex with scarring. Smaller 1cm similar lesion antero superiorly. Further 6mm partially calcified nodule in the right upper lobe. No other lung nodules. Background emphysematous change. Atelectasis in the lingula. No mediastinal or hila lymphadenopathy. No pleural effusion. There is suspicion of PE in a middle lobe segmental pulmonary artery (image 91/239). There is diffuse colonic thickening with submucosal oedema and enhancment. Trace of ascites. No significant inflammation of the pancreas. Normal pancreatic enhancement. There is a 6mm hypodense lesion in the unicinate process. No pancreatic duct dilatation. Indeterminate hypodense 6mm liver lesion in segment 7/8. The spleen, both kidneys and pancreas are unremarkable. No destructive bone lesion. Reported with chest radiograph dated 13/1/18 - the left apical mass lesion is stable in appearance from 26/7/17. Lungs otherwise clear. Normal mediastinal contours. No free air under the diaphragm.

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comparison emphysema normal parenchymal_lesion


CT Chest/Abdo. There is a large unilateral left pleural effusion which on delayed phase imaging shows only very mild smooth pleural enhancement. There is associated lingula and left lower lobe collapse as well as left upper lobe atelectasis. There is a 1.3 cm right apical ground-glass nodule. There is multifocal atelectasis in the right lower lobe with associated bronchial dilation as well as more mild middle lobe atelectasis. There are no proximal endobronchial lesions. There is borderline subcarinal lymphadenopathy but certainly no generalised mediastinal or hilar lymphadenopathy. The cardiac configuration is normal. The spleen appears bulky. There is no large or small bowel dilation. There is no abdominal, pelvic or inguinal lymphadenopathy. Partially imaged left dynamic hip screw noted. There is a mild superior endplate depression of L2 vertebral body. There is no destructive bony lesion.

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Significant loss of left lung volume, as well as patient complaining of haemoptysis. CT Chest to better visualize any pathology, keeping pt's complicated background with cancer in mind. Thank you. Comparison is made with previous chest radiographs. There is a 2.3 cm spiculated central lesion in the right upper lobe adjacent to the azygos vein. Tree in bud nodularity in the middle lobe, lingula and both lower lobes with bronchial wall thickening and mucus plugging in keeping with infective bronchiolitis. Calcified granuloma in the left lower lobe noted. No pleural or pericardial effusion. There is probable enlarged right hilar lymph node, however this is difficult to assess on a non-contrast scan. Calcified left hilar lymph nodes noted. Triple-vessel coronary calcification. Pneumobilia noted in keeping with previous cholecystectomy. The imaged upper abdominal viscera in this noncontrast scan is unremarkable. 4.2 cm simple cyst noted in the left kidney. Multilevel sclerotic metastases noted throughout the imaged spine. Chronic anterior wedge fracture of T2 noted body noted.

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Cardiomegaly with congestive changes seen in both lung fields in keeping with heart failure with worsening compared to previous x-ray of 04/05/2006 and follow-up x-rays suggested.

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The central nodule in the right upper lobe has minimally increased in maximum diameter from 4-5 mm. The peribronchial ground-glass opacity measuring 8 mm at the extreme right lung base is essentially unchanged. No new nodules have appeared. The peribronchial ground-glass opacity in the left upper lobe just anterior to the superior oblique fissure is essentially unchanged, likely to represent parenchymal scarring. No thoracic lymphadenopathy. Reconstructive sternal plate and deficiency of the left anterior chest wall noted. Fifth anterior rib fracture with callus formation, no destructive osseous lesion. Right humeral head prosthesis noted. No new finding.

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CT Chest/Abdo. Left-sided PE at the bifurcation of the left main pulmonary artery. Significant partial collapse and consolidation in the left upper lobe. Prominent consolidative changes in the left lower lobe. Partial collapse of the right middle lobe. Patchy consolidative changes in the right upper and lower lobes. No intrathoracic or axillary lymph nodes. Small nodules noted at the anterior periphery of the right upper lobe measuring up to 3 mm. Impression of multiple calculi within the gallbladder some of which are partially calcified. I would recommend an ultrasound scan for further. Atrophic left kidney. There is a cystic lesion at the pancreatic head measuring up to 1.1 x 1.2 x 1.4 cm. No significant distal pancreatic duct dilatation. No dilatation of the CBD or intrahepatic biliary tree. Aortic atherosclerosis. Mild diverticular disease within the distal sigmoid. No other small or large bowel pathology. No omental or mesenteric disease. Bilateral adnexal cysts. No free fluid. Degenerative levoscoliosis of the lumbar spine and minor right-sided curvature of the thoracic spine. Multiple lucencies within the proximal femora contain fat and are likely related to an element of disuse. No destructive bone lesion.

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atelectasis consolidation normal parenchymal_lesion


Right internal jugular CVC demonstrated with the tip overlying the SVC, no evidence of postprocedural pneumothorax. Midline sternotomy and CABG noted. Cardiomediastinal contours cannot be assessed due to projection. Bibasal pleural effusions and inflammatory change. Midline sternotomy and CABG noted. Background changes to both lungs, however no focal consolidation or lobar collapse. CTR measured at 54%.

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CT Chest/Abdo. No previous cross-sectional imaging available for comparison. There is a large left sided pleural effusion. This is causing complete collapse of the underlying lower lobe and partial collapse of the upper lobe and some associated mediastinal shift. I cannot convincingly see a pulmonary mass separate to the collpased lung. There is associated pleural enhancement and mild pleural thickening. No calcified plaques. The right lung is clear. A 37 mm cyst noted in the left liver lobe with several small low density foci in both lobes which are too small to charectarise on CT. Contracted gall bladder. Unremarkable remaining upper abdominal solid viscera. Redundant loop of collapsed left colon with sigmoid diverticulosis on this unprepared study. Bulky prostate noted. No lymphadenopathy within the torso. Bilateral L5 pars defects. No destructive bone lesion.

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Hyperinflated lung fields in keeping with COPD with mild cardiomegaly no change compared to previous x-ray of 27/12/2017 with increased vascular markings and no new abnormality seen.

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CT Chest/Abdo. Comparison made with previous CT CAP dated 01/12/2017. There is increase in size of the multiple opacities within the left lung and there are multiple new scattered nodules in both lungs. The opacities are encasing the left upper and lower bronchi but these remain patent. There is new bilateral areas of consolidation and ground-glass changes in keeping with infection. New bilateral pleural effusions, greater on the left. Mediastinal lymphadenopathy noted as previously. The liver, spleen, pancreas, both kidneys and adrenals are normal. Uncomplicated sigmoid diverticulosis. No focal mass lesion within the unprepared large bowel. No interval change in the para-aortic lymph node. No free fluid. Chronic compression fractures of L3, T12 and T11 vertebrae and thoracic scoliosis noted. No destructive bone lesion.

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Endotracheal tube, nasogastric tube, ECMO cannulae, right femoral venous access, right chest drain in situ. Bladder is catheterised. Moderate volume right hydropneumothorax. Small volume left-sided pleural effusion. Bilateral lung consolidation with relative sparing of the left lung apex. There are no PE. Below the diaphragm, there is a small volume pelvic ascites. There is also trace of perihepatic ascites tracking into the right para colic gutter. Where there is access into the right femoral vein, there are multiple gas locules within dermal fat and muscular wall.? Iatrogenic? Infective. Trace ascitic fluid at this level is slightly higher attenuation. A fat containing hernia in the right inguinal region. A few oedematous bowel loops seen centrally are likely due to hypeproteinaemic state. Rest of the infradiaphragmatic viscera are unremarkable aside an enlarged prostate. Spondylotic bony change.

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consolidation object pleural_effusion pneumothorax


THIS REPORT HAS BEEN CHANGED. Cardiomegaly with midline sternotomy noted with dual-chamber permanent pacemaker seen and early congestive changes seen in both lung fields in keeping with heart failure with old right-sided rib fractures noted. Follow-up x-rays suggested after treatment. There is a right-sided lead from previous implant.

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The images are degraded by respiratory motion artefact, the images are acquired in part inspiration but expiration. Large body habitus. There are multifocal atelectasis at both lung bases, the mid lobe is collapsed. Cannot exclude additional infection, particularly in the collapsed middle lobe. No CT features of pulmonary oedema. Satisfactory proximal pulmonary artery opacification, no right/left main pulmonary artery thrombus. The images are too degraded (respiratory motion artefact) to comment on lobar or segmental pulmonary arteries. No diffuse established interstitial fibrosis. No pleural effusion or pericardial effusion. No pneumothorax. There is however cardiomegaly. Small hiatus hernia noted. Limited images of the upper abdomen demonstrate moderate to severe medium vessel atherosclerotic calcific plaques and mild to moderate bilateral renal cortical thinning. Probable 1.6 cm left adrenal adenoma (low to intermediate density), if appropriate, please correlate with adrenal function test. Large body habitus, there are multiple mid and lower thoracic anterior vertebral collapse/fractures with degenerative changes in the thoracolumbar disc spaces.

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To x-rays reviewed, most recent reported to 318. Left-sided PICC line demonstrated with the tip overlying the upper SVC. There is right basal inflammatory change with low volume pleural effusion within the costophrenic recess. Background changes of remaining lungs. There remains a CTR of 55%. No subphrenic free gas or evidence of pneumothorax.

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cardiomegaly comparison consolidation normal object pleural_effusion undefined_sentence


CT ratio 20/31. Changes of LVF are noted in both lung fields. There is no other feature of note.


no interval change allowing for technical differences. Background emphysematous changes bilaterally. There is again right apical scarring with a very small pneumothorax as previously demonstrated on CT pulmonary angiogram. Persistent elevation of the left hemidiaphragm consistent with previous lobectomy. Heart and mediastinum cannot be assessed. No subphrenic free gas.

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Background severe centrilobular emphysema. There is a dominant thin-wall cavity (4 cm diameter) in the anterior segment of the left upper lobe with surrounding ground-glass opacity. No obvious internal solid "ball" to suggest aspergilloma. Further multiple similar but much smaller bronchocentric lesions are seen in both the lower lobes and to a lesser extent in the upper lobes. Bilateral bronchial /bronchiolar mucous retention/plugging is also noted. AP window lymph node measures maximum 1 cm in short axis, no other significant mediastinal or hilar lymphadenopathy. There is partial collapse in the middle lobe. Extensive hepatic metastasis in both the lower lobes with background diffuse hepatic steatosis. As on the previous CT, the left calix and pelvis is dilated, more so on the present CT when compared to the previous CT. Limited images of the right kidney are unremarkable. Left adrenal hyperplasia/hypertrophy is again noted. Multiple "coudroy" lucency is in the mid thoracic spine" are suggestive of haemangiomas. No convincing destructive osseous lesion.

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Left-sided ICD in situ. There is marked collateral vasculature around the ICD and left shoulder draining into the brachiocephalic artery. There is focal stenosis of the left subclavian artery between the left clavicle and first rib. No PE. Normal calibre of the pulmonary trunk. No evidence of right heart strain. There is a 2.3 cm spiculated lesion in the apicoposterior segment of the left upper lobe extending superiorly in contact with the oblique fissure and pleura. There are multiple satellite nodules within the same lobe and further nodules scattered throughout both lungs. Further 1.7 cm lesion in the apical segment of the right upper lobe noted. There is tree in bud nodularity in the right upper lobe. There is extensive mediastinal and hilar lymphadenopathy bilaterally. The largest measures 2 cm in short axis in the subcarina region. These are causing narrowing of the pulmonary vasculature bilaterally, predominantly the right upper lobe pulmonary artery. No pleural or pericardial effusion. The imaged upper abdominal viscera in this phase of contrast is unremarkable. No destructive bone lesion.

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THIS REPORT HAS BEEN CHANGED. There is AVR, ascending aorta replacement and TEVAR for aortic dissection. The false lumen of almost whole descending aorta is thrombosed. There is contrast enhancement in the false lumen from the level of the lower segment of the descending aorta and in the abdominal aorta. The SMA and left renal artery are both arising from the false lumen and enhance. There is no evidence of ischemia of the intraabdominal and retroperitoneal organs. The reentry of the dissection is at the level of the aortic bifurcation. There is a passive collapse of the of both lower lobes. Multiple patches of consolidation and ground-glass opacities are seen in the aerated parts of the lungs, the changes have anterior basal gradient. There is no significant pleural or pericardial effusion. The pulmonary artery is dilated to 38 mm. The heart is enlarged. There is small ascites seen predominantly in paracolic gutters and in the pelvis. The liver, the gallbladder, the pancreas, the spleen, both adrenals, both kidneys, unprepared bowel and cavity bladder with a catheter in situ appear unremarkable. There is generalised swelling of the subcutaneous soft tissues of the of both lungs. There is a venous cannula inserted into the left common femoral vein on the right. The ET tube and NG tubes are in a good position. Images reviewed with Mr Vainas. In addition to above report. No signifincant interval change in the sac size. The stent appears compressed by the dissection flap and sten lumen appears ovoid(T8/T9 level,.

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cardiomegaly consolidation ground_glass_opacification object other volume_loss


Bilateral pulmonary venous congestion noted. Right basal consolidation noted. Fetaures are suggestive of infection and failure.Suggest repeat post-treatment.


Good opacification of the pulmonary arteries with no filling defects in the central, lobar or segmental branches. The main pulmonary artery is enlarged and measures 3.5 cm. Cardiomegaly noted. No pleural effusions. No pericardial effusions. A few small volume mediastinal nodes noted. The lung fields are clear. No interlobular septal thickening to suggest interstitial pulmonary oedema. Mild to moderate aortic leaflet calcification and moderate or LAD/circumflex coronary artery calcific plaques are noted. Incidental uncomplicated gallstones, otherwise the imaged upper abdominal viscera are unremarkable in this phase of scan. Degenerative changes noted at C7/T1 level. No focal destructive bony lesion. Multiple left posterolateral old rib fractures with callous formation are noted.

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There has been a previous oesophagectomy. Heart size normal. There are at least three small opacities in the right lung suspicious of pulmonary metastases. These were also demonstrated on the CT scan of 28/11/06. Soft tissue swelling is noted on the right side of the neck and in the supraclavicular fossa.

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Median sternotomy sutures noted. The heart is enlarged. There is evidence of pulmonary venous congestion. Atelectasis is seen in both lower zones.

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atelectasis cardiomegaly interstitial_shadowing object


The heart size is mildly enlarged (CTR 0,519).-Cardiology assessment is suggested. No consolidation seen in both lung fields. The left costophrenic angle is mildly blunted , due probably to an old pleural reaction. Atheromata seen in the aortic arch. Clinical correlation is suggested.

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CXR SUPINE MOBILE IMAGE. Almost total opacified left hemithorax probably of extensive consolidation collapse and with significant pleural effusion. Moderate left pleural effusion.

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There is bilateral pneumoperitoneum, possibly related to the chest drain removal, however acute abdomen cannot be excluded without knowledge of clinical condition. Cardiomegaly with mild congestion. Otherwise lungs are clear. There is significant progression of the stomach dilatation, NG tube is advised. ET tube and RIJV sheath were removed. RIJV line in a good position. Midline sternotomy noted.

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cardiomegaly comparison dilated_bowel interstitial_shadowing normal object pneumoperitoneum possible_diagnosis recommendation


Compared to the 03.12.2009, there is no evidence of any significant changes. No acute chest pathology. Multiple chronic changes. Hyperinflation of both lungs. Cylindrical bronchiectasis in both medial lower lung fields and around the hilar. Scars in both lung apices, right more than left. CTR 0.5.

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


No previous films available for comparison. No acute chest pathology. There are bilateral cylindrical bronchiectasis in both medial lower lung fields. Slight hyperinflation of both lungs. No signs of a tumour or pulmonic infiltrates. There are small scars in both lung apices, right more than left. Vascular enlargement of the right hilum. CTR 0.44. Slight right convex scoliotic posture.

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


Left sided chest drains remain in position. There is consolidation/collapse in the left lower lobe with a thin rim of gas below which could represent free gas in the peritoneum. Small right pleural effusion. Right lung otherwise clear.

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 E B

consolidation normal object pleural_effusion pneumoperitoneum volume_loss


Compared to the 27.07.2011, there are no significant changes. No acute chest pathology. No signs of tumour. Hyperinflation of both lungs. Slightly enlarged heart, CTR 0.54. Mild chronic cardiac congestion. No signs of acute failure. OA of the right AC joint, otherwise normal.

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


Bilateral mid and upper zone fibrosis with loss of volume. The area of ground glass shadowing in he left upper zone seen on previous film appears to have improved.

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


Compared with radiograph of 19.10.12 and 4.5.11. Rotated film. The lungs are hyperinflated with increased bronchovascular markings in keeping with COPD. The lungs are clear. No evidence of heart failure. Old left clavicle fracture noted.

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


Comparison made with previous CXR dated 25/02/13. The right mid and upper zone predominantly pleurally based changes are still evident, although there has been no significant progression in appearances since the previous examination. Some of these changes may be longstanding, as RML collapse and some peripheral nodularity was demonstrated on a CT from 2011. However, there does appear to be new nodularity, and again the differential includes infection and metastases (given the previous history of breast cancer).

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 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 E B I I I I I I I


Hyper inflated lungs with reticular shadowing in the right mid zone. Changes are in keeping with infection. Heart size normal. Unforlded thoracic aorta. I note the patient had a solitary right lung nodule in 2011, which is not clearly visible on this film.

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


Surgical sutures are noted in the right mid and left lower zone. There are multi focal predominantly right sided pleuro-parenchymal bands. No focal active lung lesion. No change since 06.06.2012.

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 I I I I


Sternotomy and MVR noted. The heart is markedly enlarged with pulmonary congestion and small pleural effusions with overlying atelectasis. Appearances are of LVF.

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


There are persistent changes of LVF with little change from the previous film.


AP. There is marked prominence of the right hilum however this is of longstanding and essentially unchanged compared to 27.05.2011. Increased bilateral lung shadows particularly in the right mid and lower zone and left lower zone are again of longstanding. There has been clearing of the left lung base.

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

comparison consolidation normal paratracheal_hilar_enlargement


The heart is not enlarged. There is bibasal pleural shadowing, more extensive on the right with some overlying atelectasis and scarring, however this appears to be long standing. Widening of the superior mediastinum is unchanged, presumed vascular.

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


Known ca lung with possible bilateral pleural mets showing bilateral pleural effusion, with underlying basal lung opacities. Prominent cardiac & mediastinal shadows.

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


RIJ line has been removed. Right basal drain remains. There is pleural shadowing around the right lung with basal collapse consolidation and a short air fluid level in the mid zone suggesting a small hydropneumothorax. There is subcutaneous emphysema as before. Left lung remains clear.

B I I I I I E B 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

atelectasis comparison consolidation normal object other pleural_effusion pneumothorax subcutaneous_emphysema


Normal cardiothoracic ratio. A large Lt. parahilar consolidation seen that is progressive in size as compared to the prior CXR done on 12/4/2013, with possible breaking down. Other lung fields & CP angles are clear. Mild thoracic spondylosis.

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

comparison consolidation normal scoliosis


There is a new dual lead pacing system. No pneumothorax. S shaped spine noted. No active lung lesion.


The heart is a little enlarged with pulmonary congestion. Bilateral pleural effusions are present, larger on the right and this has increased since previous CXR of 3.5.2013. There is bilateral lower lobe collapse. The findings could be due to infection but there is also evidence of LVF.

B 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 E B


SUpine. ET tube, RIJ line and drains noted. There is mild pulmonary congestion and left basal collapse/consolidation. No pneumothorax.

atelectasis consolidation normal object pleural_effusion


Cardiomegaly with mild congestion. Moderate pleural effusion on the right and minimal effusion on the left. No change in comparison with the previous CXR from 29.04.2013.

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

cardiomegaly comparison consolidation pleural_effusion


Lt. apical fibrosis seen, with bilateral pleural caps, more prominent on the Lt. side & a peripheral faint Rt. reticulonodular shadow seen as well with shallow Rt. CP angle., yet no significant interval changes detected as compared to the prior CXR done on 27/4/2012. Other lung fields & Lt. CP are clear. Mild thoracic spondylosis, with marginal osteophytes.

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


Chest. The right hemidiaphragm is elevated, I suspect there is right basal atelectasis and small effusion. Multiple tiny nodules are noted in the right upper zone. AVR and significant calcification in the right hilar node is again noted. There are surgical clips in the left upper quadrant.

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


Previous sternotomy noted. There are chronic changes with pleural calcification bilaterally. There is some pulmonary venous imbalance in keeping with heart failure. No significant pleural effusions. The heart is mildly enlarged.

B 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 E B


consolidation object pleural_effusion pneumothorax scoliosis subcutaneous_emphysema

AP semi erect. left sided drain noted. There is patchy shadowing in the left lower zone with minimal residual pleural fluid and a little overlying surgical emphysema. No pneumothorax.

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

comparison consolidation normal object pleural_effusion subcutaneous_emphysema


AP Erect. A comparison is made with the previous chest xray from 6/7/13. Suboptimal film. Chin on chest. Dual chamber pacemaker in situ. Some atelectatic changes in both lung bases noted. There is pulmonary venous imbalance. Small pleural effusion bilaterally. Degenerative changes in the right shoulder joint demonstrated.

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


Stent noted in right main bronchus with right lower lobe collapse. There is mediastinal widening suggesting mediastinal lymphadenopathy and irregular opacification just lateral to it.

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


There is a new finding of right basal consolidation with small pleural effusion, that might represent infective changes. Otherwise there is a stable finding of cardiomegaly with CCF and left sided pleural effusion. There is a spinal fixation. I recommend to repeat CXR after treatment of the infection.

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


Right apical chest drain remains in position. There is bilateral upper lobe fibrosis. Extensive right chest wall surgical emphysema as before. Slight increase in right basal pleural shadowing.

B 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


No prior imaging is available for comparison. Normal cardiac contours. There is suggestion of a 5 mm calcified nodule at the right lung apex and a thin-walled 14 mm dumbbell shaped cavity in the right upper lobe. A subtle right paratracheal bulge may represent adenopathy. In view of the above findings, CT chest with contrast is suggested. Referral to the TB service is advised. Glenfield Hospital ext. 3766 For GP patients a referral proforma is enclosed

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


There has been progression of the left sided surgical emphysema. A minimal left apical pneumothorax is seen. There has been moderate improvement of pulmonary oedema. Otherwise no change.

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 I

comparison consolidation pneumothorax subcutaneous_emphysema


Cardiomegaly with mitral shape and left atrium dilatation. There are congestive changes of the second degree and minimal pleural effusion on the left. Lungs are clear.

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


Cardiomegaly with CCF of the 2nd degree. There is a small pleural effusion on the left. In comparison with the CXR from 12/12/13, there has been improvement of congestion.

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 I I


PA erect view. Compared to x-rays from 18 November 2013. Clips artefact in the left lung middle zone and left axilla in keeping with recent mastectomy and axillary procedure. There is bilateral basal consolidation with pleural effusions. There has been no significant improvement since the last x-rays.

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

comparison consolidation object pleural_effusion


The heart is enlarged (CTR 16/26), with pulmonary congestion in keeping with LVF. Left mastectomy is noted.


AP. Left IJ line noted with its tip in the right atrium. There is evidence of mild pulmonary venous congestion. Fluid is seen in the horizontal fissure.

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 E B


The heart size is normal. No active lung lesion. Old calcified lymph node in the left axilla unchanged. The bronchiectasis mentioned in history is not well demonstrated on plain film.

B I I I I E 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 have reviewed all the previous chest x-rays going back to 2004, and there is definitely a new opacity within the left mid zone. This does not have the typical spiculated border of a malignant lesion, and appears to be well-defined. It is bilobed and measures 1.8 cm in total length. I am not certain of the specific location of this, it may well represent a small calcified pleural plaque rather than an intrapulmonary lesion. Elsewhere, there changes of emphysema. There is minor blunting of both costophrenic angles. Both pulmonary arteries are enlarged, in keeping with pulmonary hypertension. The heart is not enlarged. The left mid zone lesion, although new, does not have any specific worrying characteristics. It would be sensible to keep this under follow up, initially with a chest x-ray in 2 months time.

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 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 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 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


AP erect. ET tube and drains have been removed. RIJ line remains. There is bibasal collapse/consolidation with right mid zone atelectasis. No pneumothorax.

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

atelectasis comparison consolidation normal object


The important history of metastatic breast cancer has not been given. There is a complex right sided pleural effusion with a widening mediastinal contour indicating progressive disease. Left-sided calcified pleural plaques are also noted.

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 I I I I I I I


Borderline sized heart with CCF of the first degree and small right basal pleural effusion. Flattening of the left hemidiaphragm is suggestive of pulmonary emphysema.

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


Compared to previous Xray from 11/10/2013, there is a new inhomogenous opacity in right lower zone obscuring the right hemidiaphragm and CP angle to suggest atelectasis/ consolidation and possibly pleural fluid too. In view of history of trauma there could be a lung contusion. No pneumothorax. No obvious new rib fracture. Previous rib fracture deformity involving right 6th and 7th ribs noted. Rest of the lungs are clear. Normal heart size. Clinical correlation needed if there are signs of infection. Hospital referral advised if appropriate. Repeat radiographs advised in 3 weeks time or earlier if worsening symptoms. Report to be FAXed to GP.

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


Both lung fields are showing increase vascular markings with mild cardiomegaly. No focal active lung lesion seen.


Previous sternotomy and mild in situ. The lungs appear congested and appearances suggest pulmonary venous imbalance. There is a small right pleural effusion.

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


A large Lt. sided pneumothorax seen, with partial collapse of Lt. lung. Rt. lung is clear.

consolidation normal pneumothorax volume_loss


Comparison has been made with the CXR of 18.07.2013. There is left basal pleural thickening/effusion with marked shift of the mediastinum towards the left side indicating significant volume loss, multiple cavities are seen in the left apex. Increased predominantly linear shadowing is seen in the right apex. There has been some clearing of the air space shadowing seen in both upper zones compared to the previous CXR film. The right mid and lower zones remain clear.

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


Previous films reviewed. 01.11.2013. AP erect. There is a small pleural effusion on the left. Otherwise the heart size is normal. No active lung lesion seen. Median sternotomy and AVR noted. There is a mediastinal drain in situ. 04.11.2013. There is only minimal CCF. There has been progression of small pleural effusions bilaterally.

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


Previous CT and CXR imaging reviewed. The bilateral hilar adenopathy remains but is less prominent compared to the previous CXR. Right apical fibrotic change is unchanged. Smaller nodules in the the lungs are unchanged.

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


Comparison is made with the previous CXR 14.03.13. The right basal pleural effusion remains unchanged. There continues to be a loss of volume and a hazy opacity within the right lower zone that has not changed in size. The bronchiectasis changes are also again noted. There is a new linear shadow within the left lower zone in keeping with a degree of atelectasis. The widened mediastinum looks unchanged from the previous x-ray. The heart is marginally enlarged. Some of the collapsed thoracic vertebrae are again noted.

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


There is a single congestive changes with atelectasis at both bases and mild elevation the right hemidiaphragm. The appearance has improved since 20/12/213.

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


normal cardiac size. No focal active lung lesion. Large volume COPD lungs. Recent right middle lobe consolidation is regressing with residual atelectasis. A repeat radiograph is recommended in 3 months.

B I I E B 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

atelectasis comparison consolidation emphysema hyperexpanded_lungs normal possible_diagnosis recommendation


Cardiomegaly, with unfolded aorta. Both lungs & CP angles are clear, apart from exaggerated BV markings. Rt. total shoulder replacement. Flattening of the head of Lt. humerus?AVN, with 2ry OA.

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 I E B I I


AP view. Pulmonary venous congestion present. Right basal effusion and possible on the left.Features represent heart failure. Clinical correlation is required.

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


The heart is markedly enlarged with pulmonary venous congestion. No active lung lesion.

cardiomegaly consolidation normal possible_diagnosis


The heart is enlarged, CTR 53. Lungs are mildly congested. There is a little shadowing at the left base which is probably due to pleural thickening or fat pad rather than a pleural effusion. The lung fields are clear. A fairly large hiatus hernia is noted.

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


The heart is generally enlarged with a CTR of 0.56. There is bilateral apical pleural thickening with some associated calcification seen on the left side. A further well defined triangular shaped opacity in the left mid to lower zone is probably also calcified, in view of this I suspect it is of longstanding, but we have no previous comparison films to confirm this. The lung fields do appear a little hyperinflated, but this may be secondary to age rather than any specific pathology. Some degenerative change with osteophyte formation is seen related to the thoracic spine. There are also appears to be an abnormal lucency seen through the mediastinal outline and projecting over the mid & lower thoracic spine. The radiological appearances not specific, but are perhaps most likely to represent air within a dilated oesophagus. Does patient have any symptoms of dysphagia that might be consistent with this?. There is some increased reticular shadowing at the left lung base which may represent an old basal inflammatory change, no more obviously active focal lung lesion seen however.

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


Pacing lead is unchanged. There is chronic right lower lobe collapse on a background of bronchiectasis. There is some chronic right pleural thickening. There is some new left perihilar air space shadowing which may represent pulmonary oedema.

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


The heart is a little enlarged. ICD in situ. Calcified LV aneurysm in keeping with old infarct. No active lung lesion.

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

abnormal_non_clinically_important cardiomegaly normal object


The heart appears enlarged as before. Two left apical chest drains present and there is extensive soft tissue density swelling over the left chest wall. There is some air space shadowing in the left lung, probably haemorrhage. No pneumothorax.

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

cardiomegaly comparison consolidation normal object possible_diagnosis


PA erect. No previous films available for comparison. Suboptimal film. The patient is rotated. Poor inspiratory effort. No major areas of collapse or consolidation. Background chronic lung changes. In this scenario, some superimposed inflammatory/infective changes especially in the left lung base cannot be completely ruled out. If clinically indicated, follow up is suggested. The heart size is normal. No sizable pleural effusions.

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

comparison emphysema hyperexpanded_lungs normal other recommendation technical_issue


No change from previous film of 19.3.2014 showing features of heart failure.


AP erect. RIJ line and left apical drain noted. There is pulmonary congestion with bibasal collapse/consolidation. The pneumothorax has resolved. There is an area of subcutaneous emphysema over the left chest wall. Mediastinum is now central.

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

atelectasis comparison consolidation interstitial_shadowing normal object subcutaneous_emphysema


portable ap. RT jugular line in position, the tip is projected over SVC. ET tube in position. The tip of the NG tube is projected over gastric fundus. The lungs are congested suggesting failure. Bibasal consolidation persists.

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


PA ERECT. A comparison is made with the previous chest xray from 9.5.2012. No major areas of collapse or consolidation. There is pulmonary congestion. Heart size is mildly enlarged. No sizeable pleural effusions.

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 E B I I I

cardiomegaly comparison interstitial_shadowing normal


Chest. The round well-defined 18mm nodule medially in the right upper zone (right paratracheal region) is essentially unchanged, is likely benign, may represent a mediastinal/bronchogenic cyst. Minor atelectasis at the left lung base persists. No interval change since the prior film. CT chest with contrast is suggested for further characterisation.

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

atelectasis comparison other parenchymal_lesion recommendation


No previous films available for comparison. The heart size is normal. No active lung lesion seen. The 1st ribs are dysplastic. Soft tissue density in the left supraclavicular fossa. Is there a palpable swelling in this region?.

B 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 E B I I I I I I I


AP semi erect film. Right IJ line, ET tube and NG tube noted in situ and appear very appropriately sited. There is evidence of pulmonary venous congestion. Partial collapse of the left lower lobe. There is evidence of a pulmonary venous congestion. Some patchy consolidation is seen in the region of right lower zone and there is partial right middle lobe collapse.

O O O O O 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 E B 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


AP erect. There are persistent bilateral pleural effusions, worsening on th left with cardiomegaly and features of LVF.


Supine chest radiograph. No focal consolidation. There is slight increased opacification at the left base most likely due to overlying soft tissue. The trachea is slightly deviated to the right side and the superior mediastinum appears slightly wide, this remains unchanged since the previous examination of 11/04/2012 and is most likely due to retrosternal goitre. If there is any clinical doubt a CT scan or ultrasound would be helpful for further assessment.

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 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 I I I I I I


Patient has been extubated and chest drains removed. RIJ line remains in position. Pericardial calcification is noted. No pneumothorax. There is a little bibasal atelectasis.

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

abnormal_non_clinically_important atelectasis comparison normal object other


There is a borderline sized heart with moderate CCF and bilateral small pleural effusions. The NG tube is in a good position. Midline sternotomy and CABG noted compared to the previous CXR no significant change.

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 E B I I I I I I I


Cardiomegaly with significantly dilated left atrium and CCF of the 2nd degree. There are bilateral small pleural effusions.


AP film. Left IJ line noted in situ with its tip in the left brachiocephalic vein. Median sternotomy suture wires noted in situ. There is evidence of mild pulmonary venous congestion. The lungs are hyperinflated. There is collapse/consolidation in the left lower lobe and a small left basal pleural effusion.

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


Degenerative changes affecting C5/6 and C7 with narrowed disc spaces. Heart is enlarged with pace maker wire bilateral pleural effusions. Lungs clear.

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

cardiomegaly normal object pleural_effusion


Compared to the previous CXR on 17/06/2010, there is no change with pulmonary venous congestion.Right sided rib fractures are not visible on the CXR.

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


MVR noted. Calcification in left lower zone appears more extensive than on 11.3.2014 and is probably a combination of small pleural effusion and rather more extensive overlying consolidation/collapse. There is blunting of the right costophrenic angle. Mild pulmonary venous congestion is noted.

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 I I I I I I I I I I


AP erect. No evidence of pneumothorax. There are bilateral moderate congestive changes. No evidence of consolidation. There are two chest drains on the right. RIJV in a good position. There is right sided small surgical emphysema.

O O O B 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 I I I E B I I


Normal cardiothoracic ratio. Lt. medial basal consolidation seen, with resolution of the Rt. middle lobe ground glass opacity. Other lung fields & CP angles are clear, apart from exaggerated BV markings. Thoracolumbar scoliosis. ETT seen in place.

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

comparison consolidation normal object scoliosis


Previous left upper lobectomy noted. Extensive and patchy consolidation seen within the left upper and middle zones which appears to have progressed slightly since the previous chest radiograph. The right lung is hyperinflated though clear of acute lung pathology. Heart size is normal. Treatment for infection followup advised.

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

comparison consolidation hyperexpanded_lungs normal object recommendation


AP projection. Note is made of mitral valve calcification. No major collapse or consolidation. Pleural spaces are clear.Anthony Hall. Reporting Radiographer - In Health.

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


No focal lung lesion or consolidation noted. The right hila appears dense.?underlying lymph node. This could also be due to technical factors, rotation to left side. Unfolding of arch of aorta is seen. Note is made of pericardial calcification on the right side.

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


Right peripheral basal focal bullae but lungs otherwise are clear. Prominence of the central hilar vessels and cardiomegaly noted. Chest


atelectasis cardiomegaly consolidation interstitial_shadowing object pleural_effusion pneumomediastinum pneumothorax subcutaneous_emphysema

comparison made to recent imaging 19/2/19. oesophagectomy with gastric pull-through. Interval improvement of the bilateral lower lobe consolidation/collapse. previously noted surgical emphysema has also partially resolved. no underlying pneumothorax.Anthony Hall. Reporting Radiographer - In Health.

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atelectasis comparison consolidation normal object subcutaneous_emphysema


Previous imaging has been reviewed 22 August 2018. Kyphosis present. Heart is enlarged and the lungs congested. Appearances are consistent with long-standing heart failure.

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cardiomegaly comparison consolidation paratracheal_hilar_enlargement possible_diagnosis scoliosis


Comparison is made to previous CXR dated 19/11/18. There has been an interval increase in the right pleural effusion and overlying consolidation. Heart is enlarged with increased vascular markings across both lungs. Median sternotomy wires noted. Features are in keeping with heart failure, however an overlying infection cannot be ruled out.

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Left-sided ICD in situ. No pneumothorax. The heart is enlarged and sternotomy wires in situ. Mild lingula atelectasis which likely post-operative in nature. Small hiatus hernia. Old left rib fractures. Baruch Videan. RA67103. Reporting Radiographer (Inhealth). The.

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abnormal_non_clinically_important atelectasis cardiomegaly hernia normal object rib_fracture


Chronic bronchiectasis in the right lung base appears unchanged since June 2017. The heart is enlarged with a cough, congestion. The previously seen small bilateral pleural effusions continue to improve though are not completely resolved. old Right rib fractures. Baruch Videan. RA67103. Reporting Radiographer (Inhealth).

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AP. Despite the projection the heart is enlarged. There is background pulmonary congestion with upper lobe venous diversion. Bilateral pleural effusions; the left-sided pleural effusion has improved though the right-sided pleural effusion has progressed since the previous chest radiograph. Radiographic appearances are more in keeping with cardiac decompensation than infection. Baruch Videan. RA67103. Reporting Radiographer (Inhealth).

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AP semi erect:pacemaker in situ, there is some upper lobe diversion and some congestion of the pulmonary vasculature. No pleural reaction seen and the heart size cannot be properly assessed on this projection.

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Opacification and volume loss in the right hemithorax in keeping with previous lobectomies. The left lung is hyperinflated with background parenchymal changes though no acute lung pathology identified. No significant interval change since previous imaging. Baruch Videan. RA67103. Reporting Radiographer (Inhealth).

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AP supine. Increased bronchovascular markings bilaterally with right upper zone wall thickening. There is a fullness to the right paratracheal region that this is likely to be projectional in nature. Treatment for infection and a repeat PA well centred chest radiograph is advised in the first instance. Baruch Videan. RA67103. Reporting Radiographer (Inhealth).

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Stable appearances to the left apical fibrotic change and cavitation. The remaining lungs are hyperinflated with right apical scarring in keeping with COPD. No acute lung pathology identified. No significant interval change since March 2017. Baruch Videan. RA67103. Reporting Radiographer (Inhealth).

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The most recent chest radiograph dated 08/06/19 is reported. AP. There is new extensive bibasal consolidation with suggestion of a small left pleural effusion. Back pulmonary congestion with upper lobe venous diversion. The heart size cannot be measured. Bilateral calcified pleural plaques again seen. Appearances most in keeping with pulmonary oedema though diffuse infection should be considered.Baruch Videan. RA67103. Reporting Radiographer (Inhealth).

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The heart is enlarged. There are small bilateral pleural effusions. The lungs are congested with upper lobe venous diversion. Appearances in keeping with cardiac decompensation rather than infection. Baruch Videan. RA67103. Reporting Radiographer (Inhealth).

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The heart size is normal. No focal lung lesion demonstrated. The hilar and mediastinal contour appear normal. There is small left paravertebral shadowing below the diaphragm, of bone density, most likely an osteophyte.

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Previous chest x-ray 20 June 2019 and CTPA 05 June 2019 have been reviewed. Heart size cannot be assessed. Right axillary clips noted. There is a moderate left-sided pleural effusion on the background of suspected left lower lobe collapse. Appearances are consistent with progressing infection. Please repeat imaging following appropriate treatment. No evidence of perforation visualised. Elliptical lucency observed below right hemidiaphragm observed on previous chest x-ray 29 April 2019. If there remains clinical concern surgical review advised.

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known non small-cell lung cancer. left hilar/mediastinal mass is again identified. no definitive acute collapse or consolidation. Anthony Hall. Reporting Radiographer - In Health.

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note is made of previous sarcoid. Normal cardiac and mediastinal contours. No focal collapse or consolidation. Pleural spaces are clear. Anthony Hall. Reporting Radiographer - In Health.

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There is a large well defined right-sided mediastinal soft tissue mass. Apeparances are highly suspicious for primary lung malignancy. The remaining lungs appear clear. Heart size is normal. Urgent CT thorax is recommended and referral to MDT. Baruch Videan. RA67103. Reporting Radiographer. Referral to the Lung Cancer MDT advised please email [REDACTED]. 3110. (lc).

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Enlarged and calcified thyroid appears unchanged since previous imaging dating back to 2011. Mild blunting of the costophrenic angles, the remaining lungs appear clear. Heart is enlarged despite projection. Treatment for infection followup advised in the first instance.

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Several chest x-rays have been reviewed. The latest from 7/1/19 date AP erect. Right central line tip overlies the SVC. No pneumothorax. There is severe degenerative changes in both shoulders. Thoracic scoliosis noted. There is cardiomegaly with small right pleural effusion and right mid and bilateral lower zone consolidation. The right chest drain has been removed.

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abnormal_non_clinically_important cardiomegaly comparison consolidation normal object pleural_effusion rib_lesion scoliosis


Comparison is made to the previous film from 30/12/18. AP erect film. New rounded opacity at the right base which appears thin-walled with a more lucent centre. Left lower lobe collapse/consolidation. Bilateral pleural effusions. Degenerative change of both shoulder joints with right superior dislocation and left superior subluxation as on the previous film. The right sided dislocation was present on the film from 30/12/18 but is new since the shoulder film from 2016. Erosion of the lateral clavicles bilaterally. Old left sided rib fracture. Degenerative changes of the spine.

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Known large right necrotic lung mass and lobar collapse. There is Extensive opacification and volume loss in the right hemithorax with slight improvement of the upper zone aeration. The left lung remains clear. Heart size cannot be assessed. No significant interval change since previous imaging. Baruch Videan. RA67103. Reporting Radiographer (InHealth).

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Extensive left pleural calcification and left hilar nodal calcification. No acute lung lesion. CHEST


AP. The lungs are hyperinflated with right apical pleural thickening similar to previous. Since the most recent chest radiograph 625/6/18 there is extensive bibasal consolidation. Small bilateral pleural effusions, more prominent on the right. The heart size cannot be accurately assessed with a left-sided pacemaker. Appearances are most in keeping with bibasal pneumonia though background congestive changes indicate a degree of heart failure. Treatment for infection and followup is advised in the first instance. Baruch Videan. RA67103. Reporting Radiographer (Inhealth).

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Comparison made with the previous chest radiograph from 24 April 2019. AP erect chest x-ray performed. The heart is probably enlarged. There are congestive changes in the lungs and atelectasis at the bases. Recent CT pulmonary angiogram performed 17 May 2019.

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atelectasis cardiomegaly comparison other paratracheal_hilar_enlargement upper_lobe_blood_diversion


Previous radiograph of the same day reviewed. There is reduction in the size of the large right pleural effusion with right upper lobe consolidation which is become more visible as the fluid is now reduced following insertion of a drain. There is a pocket of air likely iatrogenic in the right apex. There is no lateral view but on this single AP view the tip is projected at the base close to the thoracic spine. However I note a subsequent CT has been performed.

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comparison consolidation object other pleural_effusion pneumothorax


There is a right pleural effusion with associated consolidation in the right middle and lower lobes. In addition there is a relatively well defined calcified/bony lesion of the left lower chest laterally. Further assessment with CT is suggested to clarify its aetiology. ? Chest infection

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Comparison made with previous chest radiograph from 4 August 2019. AP erect mobile ITU radiograph. The Vas-Cath has its tip in the SVC. The heart appears enlarged with pulmonary congestion. There are small bilateral pleural effusions.

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cardiomegaly comparison consolidation object pleural_effusion


There is a large right perihilar central mass which is in continuity with the multi compartmental ipsilateral hilar and mediastinal lymphadenopathy. A central bronchial obstruction (bronchus intermedius) is causing near complete collapse of the right middle and lower lobe. It is challenging to differentiate mass from collapse. Interlobular septal thickening at the right lung base is equivocal for a lymphangitis. No concerning right upper lobe or left lung nodules/mass. No pleural effusion. Mild pericardial fluid is noted. The diameter very proximal descending thoracic aorta is 41 mm. No PE. There is low to intermediate density 2 cm nodule in the left adrenal. The aetiology of 1.8 cm left peritoneal nodule adjacent to the spleen is indeterminate, however, in the context is suspicious of peritoneal metastasis. Focal sclerotic lesion in mid thoracic vertebra probably represents a benign bony island. The abdomen has not been imaged.

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CT Thorax &. 2.7 x 3.3 cm lesion is noted just distal to the bronchus intermedius on the right. There is a nodal mass in the infracarinal region on the right measuring 4.1 x 3.7 cm. There is a small pulmonary nodule in the subpleural location in the right lower lobe laterally measuring 4 mm. There is consolidative changes in the right lower lobe. Background emphysematous changes. Moderate right-sided effusion. Prominent mediastinal and upper abdominal para-aortic lymphadenopathy. Widespread hepatic metastases. Normal appearances of the gallbladder, adrenal glands, spleen and both kidneys noted. Sclerotic focus in association with the T8 vertebral body on the right, with further new sclerotic foci within the sternum. Diverticular disease noted in association with the visualised colon without secondary complications.

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