After a systematic look at the whole chest X-ray, it is worth re-checking areas that may conceal important pathology.
It is always worth double checking for pneumothorax or pneumoperitoneum. In an OSCE/viva this is seen as good practice, and a mark may be granted for mentioning the absence of these entities.
A pneumothorax is most easily seen at the apices on a Posterior-Anterior (PA) X-ray. Pneumoperitoneum (free gas below the diaphragm) is only seen on a chest X-ray if acquired when the patient is positioned erect.
Other review areas include the soft-tissues and bones, the area behind the heart, and the edges of the image.
The area behind the heart is too dense (red ring) and the left hemidiaphragm is not well-defined to the midline. This is evidence of consolidation affecting the left lower lobe.
Well done if you noticed the small left pleural effusion (arrow).
Did you spot the missing right humerus?
This patient had a history of a previous malignant bone lesion of the right humerus which had been resected (red area). Note the surgical clips (white).
