Clinical Case Database / Category: Teaching and Training

Interpretation of the chest X-ray in patients presenting with chest pain

Publication details

Dr Caroline Rubin MB BS, MRCP, FRCR, MA(Ed).
Foundation Years Journal, volume 7, issue 9, p.46 (123Doc Education, London, October 2013)

Abstract

The chest x-ray is the most frequently requested imaging examination with chest pain as one of the most frequent indications, but it is one of the most difficult to interpret. The importance of a strategy for interpreting the chest x-ray findings of adult patients presenting with ‘chest pain’ is highlighted by the two cases presented. The reporting radiologist often does not have the benefit of any additional information to tailor the diagnosis. Viewing the image with an open mind can be advantageous, preventing too narrow a focus on a single area with the potential to miss significant findings. However additional clinical information on the imaging request can improve the reporting radiologist’s understanding of the clinical context, enhance the quality of the report and thus impact on patient care.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Authors

Dr Caroline Rubin MB BS, MRCP, FRCR, MA(Ed).

Department of Radiology
Southampton General Hospital
Tremona Road
Shirley
Southampton
Hampshire
SO16 6YD

References

1.http://radiologymasterclass.co.uk/tutorials/chest/chest_quality/chest_ xray_quality_start.html (accessed 14.4.2013)
2. Von Kodolitsch Y, Nienaber C, Dieckmann C, Schwartz A, Hofmann T, Brekenfeld C, Nicolas V, Berger J, Meinertz T. Chest radiography for the diagnosis of acute aortic syndrome. Am J Med 2004, 116 (2): 73–7.
3. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL et al. International Registry of Acute Aortic Dissection (IRAD): new insights from an old disease. JAMA. 2000; 283: 897–903
4. Braverman A C. Acute aortic dissection: clinician update. Circulation 2010, 122: 184-188
5. LeMaire SA, Russell L. Epidemiology of thoracic dissection. Nat Rev Cardiol. 2011 Feb, 8(2) 103-13
6. Faisal Al-Mufarrej, Jehangir Badar, Farid Gharagozloo, Barbara Tempesta, Eric Strother, Marc Margolis. Spontaneous pneumomediastinum: diagnostic and therapeutic interventions. Journal of Cardiothoracic Surgery 2008, 3:59 (http://www.cardiothoracicsurgery.org/content/3/1/59) accessed 21.4.2013
7. Introduction to Chest Radiography. http://www.med-ed.virginia.edu/ courses/rad/cxr/index.html (accessed April 2013)
8. Worsley D, Alavi A, Aronchick J, Chen J, Greenspan R, Ravin C, Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology,1993; 189 (1): 133–6.
9. Haap MM, Gatidis S, Horger M, Riessen R, Lehnert H, Haas CS. Computed tomography angiography in patients with suspected pulmonary embolism – too often considered? Am J Emerg Med. 2012 Feb; 30(2):325-30.
10. Dath R, Nashi M, Sharma Y, Muddu B N, Case Report: Pneumothorax complicating isolated clavicle fracture. Emerg Med J 2004; 21:395-396
11. Alazzawi S, De Rover WS, Morris-Stiff G, Lewis MH. Erect chest radiography in the setting of the acute abdomen: essential tool or an unnecessary waste of resources? Ann R Coll Surg Engl. 2010 Nov; 92(8):697-9.
12. Desai PC, Ataga KI. The acute chest syndrome of sickle cell disease. Expert Opin Pharmacother.2013 Mar 28. [Epub ahead of print]
13. Ander DS, Vallee PA. Diagnostic evaluation for infectious etiology of sickle cell pain crisis. Am J Emerg Med. 1997 May; 15(3):290-2.

Disclaimers

Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.