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| RADIOLOGICAL QUIZ |
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| Year : 2022 | Volume
: 5
| Issue : 3 | Page : 132-133 |
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Chest X ray: A systematic approach
K Kalaiyarasan, R Sridhar, Gadusatla Shivani
Department of Respiratory Medicine, Sri Venkateshwara Medical College Hospital and Research Centre, Puducherry, India
| Date of Submission | 13-Feb-2023 |
| Date of Acceptance | 14-Feb-2023 |
| Date of Web Publication | 01-Mar-2023 |
Correspondence Address:
Dr. Gadusatla Shivani
Department of Respiratory Medicine, Sri Venkateshwara Medical College Hospital and Research Centre, Puducherry
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/japt.japt_6_23
How to cite this article:
Kalaiyarasan K, Sridhar R, Shivani G. Chest X ray: A systematic approach. J Assoc Pulmonologist Tamilnadu 2022;5:132-3 |
A 56-year-old male, nonsmoker with a past history of treated pulmonary tuberculosis (PTB) presented with complaints of breathlessness, cough with sputum for 1 year, and aggravated for 1 week. On examination, the patient was not tachypenic at rest, on auscultation bilateral biphasic coarse crackles heard over the right and left lower interscapular area and infrascapular area. A chest X-ray posterio anterior view (PA view) was taken. What are the radiological findings seen in this chest X-ray [Figure 1]?
| Discussion | |  |
On chest X-ray, the most striking radiological finding is bilateral ectatic changes seen over right mid zone, lower zone, and left lower zone suggestive of bronchiectasis which coincides with patient clinical history probably PTB sequalae.
In our practice, always better to approach any radiological image in systematic way. Many ways of approach to chest X-ray have been described in the literature. One way of approach of chest X-ray is ABCDE approach which is the simple way to interpret the chest X-ray.[1]
- A: Airways
- B: Bone and soft tissues
- C: Cardiac
- D: Diaphragm
- E: Everything else (lung fields).
After checking the technical qualities, when we interpreted this patient chest X-ray by ABCDE approach, we noted that the trachea was pushed to the left side by a mass lesion with no airway compromise [Figure 2]. We also reviewed patient's old computed tomography (CT) thorax films done few months ago in some other hospital which showed well-defined mass pushing trachea to the left side which was not mentioned in the CT report [Figure 3]. | Figure 2: Chest X-ray - Tracheal deviation (red oval indicates mass pushes the tracheal)
Click here to view |
 | Figure 3: CT thorax (red arrow indicates mass on the right of the trachea). CT = Computed tomography
Click here to view |
Common causes of tracheal deviation:[2]
- Deviated toward diseased side
- Atelectasis
- Agenesis of the lung
- Pneumonectomy
- Pleural fibrosis.
- Deviated away from diseased side
- Pneumothorax
- Pleural effusion
- Large mass
- Mediastinal mass.
Subsequently, ultrasonography (USG) of the neck was performed which showed a thyroid mass of size 3.4 cm × 3.1 cm. A USG-guided fine-needle aspiration was performed, and the cytology revealed a follicular neoplasm. The patient was referred to the general surgery department for further evaluation. A total thyroidectomy was performed, and the histopathology report revealed it to be a follicular carcinoma.
| Conclusion | | |
When interpreting any radiological image, rather than getting distracted by the most striking finding, it is better to follow a systematic approach, which will be more informative and beneficial. Remember to always look at the radiology film or video and not just the available report. This case study emphasizes the importance of a systematic approach in the clinical practice.
Acknowledgment
Thanks to the Department of Respiratory Medicine, Radiology, Sri Venkateshwara Medical College Hospital and Research Center, Puducherry.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | De Lacey G, Morley S, Berman L. The chest X-ray: A survival guide. Elsevier Health Sciences; 2012.  |
| 2. | Querney J, Singh SI, Sebbag I. Tracheal deviation with phrenic nerve palsy after brachial plexus block. Anaesth Rep 2021;9:41-3. |
[Figure 1], [Figure 2], [Figure 3]
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