Chest X-Ray Clear But Still Have Symptoms

Chest X-rays are often used to workup symptoms that arise from the chest like pain, cough, shortness of breath and abnormal breathing.  Chest X-rays are a great start and allow doctors to make many diagnosis, including life threatening ones.  Chest X-rays however do not identify many important and life threatening conditions in the chest.

Why don’t X-rays show some important diagnosis?

Many conditions simply can not be seen on an X-ray and need a CT.  An example of this would be a dissection of the aorta.  This is when the aorta splits into two.  A pulmonary embolism or clot to the lung can not be seen on X-ray and needs a CT.

The second reason is that X-rays are not as good at showing abnormalities like CT.  The reason for this is because the abnormality on X-ray may be small or hiding behind another structure like the heart.

Sometimes the technique is not great.   Being a large patient may reduce the radiologist’s ability to see an abnormality.

Lack of prior X-rays may limit the ability of the radiologist to provide the best diagnosis.  It is important that the radiologist reading your x ray has all your history and symptoms to get the most accurate diagnosis.

Chest X-ray clear but still have pain?

Chest pain may be a symptom of a serious condition.  Life threatening diagnosis like aortic dissection (tear of aorta into two), pulmonary embolism (clot to the lung) and heart attack will not be seen on X-ray.  even benign conditions like heart burn or muscle pain will not be seen on chest X-ray. Chest X-ray is just one tool used for workup of chest pain.

Even some conditions that X-ray can usually see may not be diagnosed in your particular case.  This may be because the finding is subtle or the technique of the X-ray is limiting.  CT is often much better at detecting many conditions that can cause chest pain.

Chest X-ray clear but still have cough?

Many conditions can cause cough to include infections, medications, asthma, smoking, lung diseases and lung cancer.  While chest X-rays can diagnose many lung diseases, pneumonias and cancers, there are some that can not be seen.  CT is much better at diagnosis of chest conditions that lead to cough.

Chest X-ray clear but still have shortness of breath?

Shortness of breath can be caused by many conditions like pneumonia, heart failure and heart attack, pulmonary emboli, lung diseases, emotional conditions and panic attacks to name a few.  There are many conditions that cause shortness of breath that chest X-ray will not be able to diagnose.

Chest X-ray clear – can you still have pneumonia?

Yes you can.  Some pneumonias are either not visible or difficult to see on chest X-ray.

Chest X-ray clear – can you still have fluid in the lungs?

Yes, you can.  Some pulmonary edema or fluid in the lungs will not be seen well on chest X-ray.  Small amounts of fluid around the lung called pleural effusion may not be seen.

Chest X-ray clear – can you still have cancer?

Yes.  Smaller cancers may not be seen.  Even some bigger tumors can be located in blind spots on a chest X-ray.  A chest CT will see nearly all tumors.

What to do next if the chest X-ray is clear but you still have symptoms?

I think that if you have symptoms referable to your chest, like a chronic cough or chest pain, and your chest x ray is normal, I would not necessarily assume all is truly normal.  I would discuss your symptoms with your provider and see what other testing is appropriate.  This may include a CT scan of the chest.  This test is much better at detecting many problems like infections, cancer, clots, fluid and so on.  So a normal chest x ray, unfortunately, does not exclude many problems of the chest.

Chest X-ray clear but still have symptoms summary

A clear X-ray does not mean that everything is ok.  Workup should continue with further testing like CT given how dangerous and life threatening some conditions can be.  Imaging is just one tool that is used for the workup of symptoms.


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