Chest X-ray - Scenario 3
Scenario discussion

Scenario discussion

Poor candidate

  • Spends too long considering patient rotation
  • Does not diagnose a pneumothorax or calls it 'collapse'
  • Guesses heart size

Average candidate

  • Describes all X-ray features succinctly and accurately with a systematic approach and states that heart size cannot be accurately assessed

Good candidate

  • Comments on possible mediastinal shift but acknowledges difficulty in assessment due to patient rotation (image 1)
  • Explains all physical signs and symptoms
  • Requests the post drain insertion chest X-ray, notices the chest drain and diagnoses pneumothorax with residual effusion - hydropneumothorax
  • Answers questions correctly and succinctly


  • If you are unable to diagnose a pneumothorax at finals you cannot expect to pass. Some candidates fail because they use incorrect terminology such as 'lung collapse.'

Descriptive terms

  • It does not take long to describe a pleural effusion. Homogeneous density with lack of air bronchogram, and a 'meniscus' are characteristic features. Image 2 gives you a chance to show you know that effusions have a horizontal surface when directly in contact with air - a hydropneumothorax.

Page author: Salisbury NHS Foundation Trust UK (Read bio)

Last reviewed: February 2016