Chest X-ray is a common test ordered to evaluate chest pain. Chest pain can be caused by many benign and life threatening conditions. Chest pain can be caused by conditions arising from the heart, lungs, chest wall, esophagus, upper abdomen, and blood vessels of the chest.
What diagnosis can be made on chest X-ray to explain chest pain?
Some of the conditions that can cause chest pain can be diagnosed on chest X-ray. Some of these include conditions in the lungs. Several common ones include a pneumonia or infection of the lungs. A collapsed lung or pneumothorax is also often seen on chest X-ray. Fluid around the pleura or covering of the lung can be diagnosed.
Most conditions can’t be diagnosed on chest X-ray
Diseases of the aorta such as dissection can rarely be suggested from a chest x ray. This is when a tear of the inner lining of the aorta splits the aorta into two lumens. Aneurysms can sometimes be seen as masses arising adjacent to the aorta. Aortic disease is best diagnosed with CT.
Diseases of the esophagus that cause chest pain can not be diagnosed with chest X-ray. One notable exception is an esophageal foreign body. Some foreign bodies can be seen on chest X-ray along the course of the esophagus. A rupture of the esophagus may show some air along the esophagus.
Other conditions such as reflux, inflamed esophagus, and spasms can not be seen. We don’t see the esophagus on a chest X-ray because it blends in with the other soft tissues next to it. An X-ray exam with barium or endoscopy are the best tests to look for esophageal disease.
Chest X-ray is not good for heart disease
Disease of the heart that cause chest pain can not be diagnosed for the most part on chest X-ray. Heart attack, angina, valve disease, inflammation of the heart can not be seen. Fluid around the heart called pericardial effusion can sometimes be offered as a possibility when the heart becomes enlarged compared to a prior chest X-ray. Echocardiograms and MRI are the best tests to image the heart.
Diseases of the chest wall can cause chest pain. Most notably, broken ribs can be seen on a chest x ray. Costochondritis is an inflammation of the cartilage of the rib near the breast bone. This can cause chest pain but can not be seen on a chest X-ray. Spread of cancer to the chest wall can cause pain and can sometimes be seen on chest x ray.
Conditions of the upper abdomen such as inflammation of the gallbladder or pancreas can not be seen. Perforation of a peptic ulcer can be seen as free air in the abdomen. Some psychiatric conditions like chest pain can cause chest pain and will not be diagnosed on a chest x ray.
Chest X-ray for chest pain is a quick and inexpensive start to evaluating chest pain. Unfortunately, most conditions that cause chest pain can not be diagnosed with a chest X-ray. A good clinical history by your doctor, lab testing and other imaging tests are needed. A negative chest X-ray does not mean that there is no cause for your chest pain.