Common Chest X-ray Abnormalities in Respiratory Medicine

Chest X-ray Abnormalities

• Consolidation can be caused by infection, infarction, inflammation, or rarely, bronchoalveolar cell carcinoma
• Lobar collapse can be caused by mucus plugging, tumour, compression by lymph nodes
• Solitary nodule is a common chest X-ray abnormality
• Multiple nodules can be caused by miliary tuberculosis (TB), dust inhalation, metastatic malignancy, healed varicella pneumonia, or rheumatoid disease
• Ring shadows, tramlines, and tubular shadows are indicative of bronchiectasis
• Cavitating lesions can be caused by tumour, abscess, infarct, pneumonia (Staphylococcus/Klebsiella), or granulomatosis with polyangiitis (GPA)
• Reticular, nodular, and reticulonodular shadows are indicative of diffuse parenchymal lung disease or infection
• Pleural abnormalities can include fluid, plaques, or tumour
• Increased translucency, bullae, and pneumothorax can also be observed

Magnetic Resonance Imaging (MRI)

• Conventional MRI of lung parenchyma is not commonly used, but is being explored for distinguishing benign from malignant pleural disease and tumour invasion of chest wall or diaphragm
• Hyperpolarized He MRI is a developing method for assessing ventilation distribution within the lung

Ultrasound

• Transthoracic ultrasound is a point-of-care investigation for assessing pleural space
• It can distinguish pleural fluid from pleural thickening, identify pneumothorax, and guide pleural aspiration, biopsy, and intercostal chest drain insertion
• It can also be used to guide needle biopsy of superficial lymph node or chest wall masses and provides information on diaphragm shape and movement

Endoscopic Examination

• Laryngoscopy can be used to inspect the larynx directly with a fibreoptic laryngoscope in cases of suspected intermittent laryngeal obstruction (ILO)
• It can identify paradoxical movement of the vocal cords, mimicking asthma
• Left-sided lung tumours can involve the left recurrent laryngeal nerve, paralysing the left vocal cord and leading to a hoarse voice and a 'bovine' cough
• Continuous laryngoscopy during exercise tests can identify exercise-induced ILO
• Bronchoscopy can inspect the trachea and the first 3-4 generations of bronchi using a flexible fibreoptic bronchoscope

Test your knowledge on common chest X-ray abnormalities in respiratory medicine, including pulmonary and pleural shadowing, consolidation, lobar collapse, solitary nodules, multiple nodules, and cavitating lesions. Learn about different patterns seen in chest X-rays and their possible underlying causes.