FRCR 2B Rapid Reporting : CXR cases

The rapid reporting cases when we sometimes miss the finding include:

• Subtle pneumothorax (especially Apical and Supine PT).
• Apical pulmonary nodule / mass.
• Lytic lesion rib.
• Mastectomy.

Other less subtle ones include : Rib fracture, distal clavicular fracture, Left Upper Lobe collapse, Right middle lobe pneumonia, RLL/LLL collapse.

Patterns of pulmonary edema, SPN, Hilar lymphadenopathy, lobar consolidation are usually the obvious 'abnormal's in the exam, which should not pose any problems.

Ill-defined air-space opacification in right mid-zone, with poor definition of right cardiac margin (loss of silhouette), consistent with a right middle lobe pneumonia.  Unless careful, can pass this as normal. 

Case courtesy of Dr Jan Frank Gerstenmaier, Radiopaedia.org. From the case rID: 25805

The above case is a case of D10 ivory vertebra due to sclerotic metastasis from breast Ca.
However for the RR purpose, see the left mastectomy, with increased transradiancy of left hemithorax.
In addition there are few surgical clips seen in the lateral chest wall on left side.

The above image shows how to follow a checklist in each CXR case. The importance to follow a checklist for each region cannot be discounted in any case. This image also shows how subtle rib lytic lesions can be.

Click here for the Chest Radiograph RR Checklist

Good web resources for RR:

1. Radiology Masterclass

2. Radiopaedia ( Now have 6 packets of RR free).

3. Norwich Image Interpretation Course.

4. FRCR Academy (Paid Membership, ~30 RR packets).

5. Dr. Sameer Shamshuddin's Website : This site has numerous other resources and links for FRCR.
6. Dr. Gaurav Shankar's FRCR 2B Tips.