Imaging Case of the Week 500 Answer

The following chest x-ray request reads ’70 year old with central chest pain. Consolidation? Widened mediastinum’.

What can you observe on the x-ray?

The chest x-ray shows:

There is no consolidation of the lung fields and the mediastinum is not widened (which was the clinical question raised by the treating doctor). A large hiatus hernia was noted by the reporting specialist.

The above patient actually presented with a sudden onset of epigastric and lower chest pain followed by numerous episodes of vomiting. This important clinical information was not conveyed on the radiology request form.

A CT scan of the chest later on confirmed gastric volvulus and the patient underwent emergency surgery.

It is important to provide an accurate summary of the clinical situation while requesting imaging. This will enable the specialist to respond to the clinical question raised in the radiology request.