Chest X-ray - Scenario 6
Answers to scenario questions

Answers to scenario questions

Question 1

Can you link the clinical history to the X-ray findings?

• The clinical features point to the possibility of lung cancer (smoker, worsening shortness of breath, weight loss), but pneumonia also seems likely (productive cough and raised inflammatory markers).
• In this clinical setting you would be expected to suggest that the X-ray findings likely relate either to cancer or infection, or more likely to both.
• (Read more on the discussion page)

Question 2

What clinical examination findings would you expect?

• There are many possible examination findings. Start by mentioning what you might see at the bedside, for example a sputum pot, and general findings such as cachexia or nicotine stained fingers. Concentrate on findings that relate directly to the X-ray image such as stony dullness at the right lung base (pleural effusion) and bronchial breathing in the right mid-zone (consolidation).

Question 3

How do you explain the blood test results?

• The raised inflammatory markers suggest infection. In this setting it is likely the right mid-zone shadowing represents pneumonia.
• The abnormal liver function tests raise the concern of liver metastases.

Question 4

Which imaging examination would you suggest doing next and why?

• In the context of suspected lung cancer seen on a chest X-ray, the next imaging test is usually a CT of the chest and upper abdomen with intravenous contrast. This is done for staging purposes.
• The normal renal function means that intravenous contrast can be given for the CT (so long as there is no other contraindication such as a history of previous allergic reaction to contrast material).