The Chest X-Ray Database
The Chest X-Ray Database
This radiograph demonstrates a hazy right paramedian opacity with an indistinct right heart border. This is a typical radiographic appearance of pectus excavatum. A lateral radiograph or a prior CT (if available) could be used to confirm. The primary differential consideration would be a right middle lobe pneumonia or potentially a mediastinal mass if the sternal depression is severe enough to cause deformation of the mediastinal contours (not seen in this case).
This radiograph demonstrates a left upper extremity peripherally inserted central catheter (PICC) with tip terminating in a persistent left SVC. The presence of a persistent left SVC was confirmed on review of prior cross sectional imaging. A PICC in the internal thoracic vein can have a similar appearance on AP/PA radiographs, however a lateral radiograph easily distinguishes the two as a persistent left SVC will course centrally and the internal thoracic vein will course anteriorly.
The radiograph is otherwise unremarkable.
This case demonstrates bilateral eventration of the diaphragm. Eventration is the result of localized atrophy of the diaphragmatic muscle or localized replacement with fibroelastic tissue, which gives the diaphragm an irregular contour on imaging. It can be part of normal aging, as in this case, congenital, or post-traumatic. The study is otherwise unremarkable.
This radiograph demonstrates an incidentally discovered right aortic arch in an asymptomatic patient. The exam is otherwise unremarkable for the patient’s age.
This radiograph demonstrates true dextrocardia, which was confirmed by reviewing multiple past radiographs. If no prior radiographs are present, discussion with the technologist to ensure that the image was not inadvertently mirrored would be appropriate. The study is otherwise unremarkable.
This radiograph demonstrates a skin fold projecting over the right hemithorax that could be easily mistaken for a pneumothorax. Skin folds are frequently identified as such because they cross anatomic boundaries such as the mediastinum or lateral chest wall. The lack of clinical symptoms such as shortness of breath can be reassuring, but not definitive. In this case, the only imaging finding that distinguishes the skin fold from a pneumothorax is the minor fissure which remains intact across the pseudo-pleural separation. A repeat chest radiograph was obtained with instruction to the technologist to smooth the patient’s skin and clothing prior to acquisition and the finding was no longer present. A left lateral decubitus radiograph would have also been an appropriate next step.