What Can A Chest X-Ray Diagnose?

Chest X-rays are one of the most common tests done in radiology.  Chest X-rays are often the starting point for workup of many conditions of the chest.  Chest X-rays are performed by technologists and interpreted by radiology doctors who specialize in medical imaging.

What do you see on a chest X-ray?

Chest X-rays show us both lungs, the mediastinum, the chest wall, the upper abdomen, and spine.  Chest X-rays can identify many abnormalities of the chest ranging from benign abnormalities all the way to deadly conditions like cancer.

Lung abnormalities on chest X-ray

Lung abnormalities are well seen on chest X-rays.  We can see infections and pneumonias.  These will appear most commonly as hazy or white areas in the lungs.

We can see fluid in or around the lungs.  Fluid in the lungs is called edema and can be caused by many conditions, but are commonly seen with heart failure.  Fluid around the lungs is called an effusion.

Cancer is another abnormality we can see.  This will appear as a nodule or mass.  A round white spot in the dark lungs or a larger area more then 3 cm is called a mass.  Many nodules seen in the lungs can be from spread of cancer.

Many other lung diseases like scarring, allergic reactions, drug reactions, other injuries and inflammatory diseases can be seen.

What can a chest X-ray diagnose in the lungs: infections, cancer, fluid, and many other lung diseases.

Mediastinal abnormalities on chest X-ray

The mediastinum is the part of the chest between the lungs.  This includes the heart, the large vessels that enter or leave the heart, the esophagus, lymph nodes, thymus and nerves.

Chest X-rays do not show us much detail of the mediastinum.  CT is much better.  Chest X-rays can show us masses of the mediastinum.  These can be cancerous, enlarged lymph nodes, aneurysms, cysts and other benign masses. We can also sometimes see widening of the mediastinum from traumatic changes such as that from bleeding.

What can a chest X-ray diagnose in the mediastinum: tumors, enlarged lymph nodes, cysts, aneurysms, traumatic changes

Chest wall abnormalities on chest X-ray

The chest wall is the ribs, the muscles and other soft tissues around the lungs.   We can diagnose abnormalities of the ribs like breaks and bone lesions.  We can sometimes see cancerous masses such as that from spread of a cancer elsewhere.

What can a chest X-ray diagnose in the chest wall: abnormalities of ribs such as fractures, bone lesions and masses.

Pleural abnormalities on chest X-ray

The pleura is the covering of the lungs.  There can be fluid in the pleura called an effusion.  A pneumothorax is when air gets into the pleura and causes the lung to collapse.  Masses and spread of cancer can involve the pleura.  There can be infections called an empyema in the pleura.

What can a chest X-ray diagnose in the pleura: fluid, lung collapse from pneumothorax, infections, masses and cancers

Heart abnormalities on chest X-ray

The heart is seen on every chest X-ray.  Unfortunately we don’t get to see many details about the heart on a chest X-ray.   We can mostly see the size of the heart and any calcifications.  We can’t see the coronary arteries, valves, or how it functions.

We can see some heart problems on chest X-ray. For example, we can see enlargement which can be from many causes.  A few common ones are heart failure and fluid around the heart called a pericardial effusion.  We can sometimes see enlarged chambers of the heart.  We can see calcified valves.

What can a chest X-ray diagnose in the heart: heart enlargement, chamber enlargement, calcifications.

Abdominal abnormalities on chest X-ray

Chest X-rays show the upper abdomen.  We can sometimes see abnormalities like dilated bowel loops which can mean a blocked or obstructed bowel.  We can see gall stones and other calcifications at times.   Air in the abdomen which can mean perforated bowel and can be life threatening.  Organ enlargement can sometimes be seen as a big liver or spleen.

What can a chest X-ray diagnose in the abdomen: dilated bowel, gallstones, organ enlargement, perforated bowel and air in the abdomen.

Spinal abnormalities on chest X-ray

We can see the thoracic spine on chest X-rays.  This is better seen on the lateral or view taken from the side of the patient. We can see abnormalities of the vertebra like fractures, bone lesions and arthritis.  We can’t see the cord or nerve roots on an X-ray.

What can a chest X-ray diagnose in the spine: fractures, bone lesions, and arthritis 

What can a chest X-ray diagnose: summary

Chest X-rays are quick inexpensive and allow many diagnosis to be made in the chest. They are often the starting point for the workup of many chest conditions.   Chest X-rays do not show all abnormalities and many symptoms and findings on chest X-rays will need further testing with chest CT.