Chest X-Ray breakdown: how to assess for lung nodules

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A female smoker in her 70s has a Chest X-Ray after presenting to her GP feeling generally presents with breathlessness and has an AP chest X-Ray. What does it show?

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SOLITARY PULMONARY NODULE
👨🏽‍💻This is a very tricky case - it is really important to have a list of review areas to look at when you think a Chest X-Ray is normal

👨🏽‍💻There are several things you may feel are abnormal on this film. There is a small amount of atelectasis at the left lung base, not considered worrying on a subsequent CT. There are two small opacities within both upper zones which are symmetrical and have the appearance of branching vessels. Then there is the genuine worrisome abnormality - a right upper zone lung nodule

👨🏽‍💻It can be easy to overcall this kind of abnormality. I usually invert the film to convince myself if the abnormality is real. In this case the patient is high risk for lung cancer given they are a smoker so it is a little easier to call the abnormality

👨🏽‍💻In this case the abnormality was real and was picked up on the CXR. A CT confirmed a solitary pulmonary nodule which was eventually resected and proven to be a primary lung adenocarcinoma

👨🏽‍💻The differential for a solitary pulmonary nodule is wide and as well as primary lung cancer includes metastasis and benign causes such as hamartoma, AVM and granuloma. Once seen on CT, risk calculators such as the Brock score can give a probability of malignancy and help dictate what happens next

🔻Hopefully this film will help you when assessing the lungs, just try not to overcall!

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