This a technically inadequate AP chest x-ray. The costophrenic angles are not visible. The x-ray is under penetrated.

There is sclerosis of T7 vertebral body. This turned out to be metastasis from prostatic carcinoma.

The lung fields are clear. Heart size cannot be commented on as it is an AP projection. There is a right para tracheal opacity.

Conditions to look for on a chest x-ray in a patient with syncope are:

• Hypoxia related – pneumonia, large pleural effusion, pneumothorax.
• Pulmonary embolism (oligaemic lung fields, enlarged pulmonary arteries, Hampton’s hump)
• Thoracic aortic dissection (widened mediastinum)
• A large heart – large pericardial effusion
• CCF

The above patient had advanced imaging and PE was ruled out as a cause of syncope.