SET T0038 -
Chest Radiographs only

Observations:

The right heart border is obscured. The anterior aspects of the ribs show a fairly steep angulation.

Two possibilities: middle lobe collapse (or consolidation); alternatively, the lungs are normal and the appearance is explained by a depressed sternum. The somewhat steep angulation of the anterior aspects of the ribs would favour the latter explanation for the appearance of the right side of the heart.

See the CT section:

This shows the pectus very well indeed. The mediastinum is squeezed between the depressed sternum and the spine. The reason why we see a seemingly "blurred" right border of the heart on the CXR is because the right border lies over the spine.

Incidentally: (a) the lungs were entirely clear; (b) the CT section shows breast implants.

Observations:

The main finding is an obscured right border of the heart. No good evidence of a depressed sternum.

Three other appearances are somewhat less definite: (1) right lung is arguably slightly smaller than the left lung; (2) the right lung is somewhat more hypertransradiant than the left lung; (3) the vessel count in the right lung is also - arguably - " fewer " than in the left lung.

Conclusion:

Middle lobe disease. Either consolidation or collapse.

The somewhat softer observations (ie 1, 2, & 3 above) suggest that there is significant volume loss in the middle lobe.

See the CT section - coronal reconstruction: collapse of the middle lobe with bronchiectasis. This is a long standing abnormality and explains the patient's symptoms.

Collapse of the middle lobe . . .  See : The Chest X-Ray : A Survival Guide : Pages 62-63

Possible cardiac enlargement.

The lungs are clear.

The dense area over, and adjacent to, the anterior aspect of the right first rib could cause concern. But . . . it is very dense and there is a similar but less gross appearance overlying the left first rib.

Comment: dense calcification in the cartilage at the costo-chondral junction of the first ribs is a fairly common finding. It can be misread as a lung mass. Sometimes the amount and size of the calcification is similar on the two sides; more often, on one side the calcification is larger/denser/more prominent.

This "lesion" is dense costo-chondral calcification.

Scattered and ill defined low density shadows projected over both lungs. Otherwise - normal appearances.

No other abnormal finding. The bones are nomal.

Comment: Given the history of being a carpenter - these islands of low density and low definition raise the strong probability of these lesions being asbestos related pleural plaques.

Pleural plaques . . . See : The Chest X-Ray : A Survival Guide : Page 90