Imaging Case of the Week 124

The chest x-rays are from a 50 year old chronic smoker presenting with chest pain and cough. What can be seen?


Frontal chest x-rayLateral chest x-ray


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The frontal chest x-ray shows a 2cm nodule in the right mid-zone which is also visible on the lateral view. The right hilum is bulky. The left lung field is clear. These x-ray features are suggestive of a bronchogenic carcinoma.

pulmonary nodule

The patient had a CT scan of his chest for further characterisation of the nodule and it confirmed a primary lung malignancy.

A parenchymal lung opacity, based on the size, is divided into 4 categories:

  • Miliary -> less than 2 mm (miliary tuberculosis)
  • Micro-nodule -> 2 to 7 mm (acute hypersensitivity pneumonitis)
  • Nodule -> 7 to 30 mm (granuloma, metastatic disease)
  • Mass -> more than 30mm (bronchogenic carcinoma)

Reference: Fundamentals of Diagnostic Radiology by Brant and Helms, 4th edition