Definition

A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.

Figures

Alternative Names

Chest radiography; Serial chest x-ray; X-ray - chest

How the test is performed

You stand in front of the x-ray machine. You will be told to hold your breath when the x-ray is taken.

Two images are usually taken. You will need to stand against the machine, and then sideways.

How to prepare for the test

Tell the health care provider if you are pregnant. Chest x-rays are generally not done during the first 6 months of pregnancy.

How the test will feel

There is no discomfort. The film plate may feel cold.

Why the test is performed

Your doctor may order a chest x-ray if you have any of the following symptoms:

• A persistent cough
• Chest injury
• Chest pain
• Coughing up blood
• Difficulty breathing

It may also be done if you have signs of tuberculosis, lung cancer, or other chest or lung disease.

A serial chest x-ray is one that is repeated. It may be done to look at or monitor changes found on a previous chest x-ray.

What abnormal results mean

Abnormal results may be due to many things, including:

In the lungs:

• Collapsed lung
• Collection of fluid around the lung
• Lung cancer
• Lung tumor
• Malformation of the blood vessels
• Pneumonia
• Scarring of lung tissue
• Tuberculosis

In the heart:

• Problems with the size or shape of the heart
• Problems with the position and shape of the large arteries

In the bones:

• Fractures of ribs and spine
• Osteoporosis
• Other problems with the ribs or spine

Abnormal results may also be due to:

• Achalasia
• Acute bronchitis
• Acute MI
• Acute mountain sickness
• Acute pulmonary eosinophilia (Loeffler syndrome)
• Adult Still’s disease
• Alcoholic cardiomyopathy
• Alpha-1 antitrypsin deficiency
• Anthrax
• Aortic dissection
• Aortic insufficiency
• Aortic stenosis
• ARDS (adult respiratory distress syndrome)
• Asbestosis
• Aspergillosis
• Aspiration pneumonia
• Atelectasis
• Atrial myxoma
• Atrial septal defect
• Atypical mycobacterial infection
• Atypical pneumonia
• Blastomycosis
• Breast cancer
• Bronchial adenoma
• Bronchial asthma
• Bronchiectasis
• Bronchiolitis
• Bronchopulmonary dysplasia
• Byssinosis (cotton dust lung disease)
• Caplan syndrome
• Cardiac tamponade
• Cerebral abscess
• Chronic bronchitis
• Chronic glomerulonephritis
• CMV pneumonitis
• Coal workers pneumoconiosis
• Coarctation of the aorta
• Coccidioidomycosis
• Diaphragmatic hernia
• Diffuse interstitial pulmonary fibrosis
• Dilated cardiomyopathy
• Disseminated tuberculosis (infectious)
• Drug-induced lupus erythematosus
• Drug-induced pulmonary disease
• Echinococcus
• Emphysema
• Empyema
• Goodpasture syndrome
• Heart failure
• Histoplasmosis; acute (primary) pulmonary
• Histoplasmosis
• Hodgkin’s lymphoma
• Hospital-acquired pneumonia
• Hypersensitivity pneumonitis
• Hypertensive heart disease
• Hypertrophic cardiomyopathy
• Hypothyroidism
• Idiopathic cardiomyopathy
• Idiopathic diffuse interstitial pulmonary fibrosis
• Industrial bronchitis
• Infective endocarditis
• Inhalation anthrax
• Ischemic cardiomyopathy
• Left-sided heart failure
• Legionnaire’s disease
• Lyme disease
• Malignant hypertension (arteriolar nephrosclerosis)
• Meningitis
• Mesothelioma (benign-fibrous)
• Mesothelioma (malignant)
• Metastatic brain tumor
• Metastatic cancer to the lung
• Metastatic pleural tumor
• Mitral regurgitation  
• Mitral stenosis
• Mitral valve prolapse
• Mycoplasma pneumonia
• Myocarditis
• Necrotizing vasculitis
• Neuroblastoma
• Neurosarcoidosis
• Non-Hodgkin’s lymphoma
• Occupational asthma
• Patent ductus arteriosus
• Pericarditis
• Peripartum cardiomyopathy
• Pneumocystis jiroveci pneumonia
• Pneumonia in immunocompromised host
• Pneumonia with lung abscess
• Premature infant
• Primary alveolar hypoventilation
• Primary pulmonary hypertension
• Pulmonary actinomycosis
• Pulmonary alveolar proteinosis
• Pulmonary aspergilloma (mycetoma)
• Pulmonary edema
• Pulmonary embolus
• Pulmonary histiocytosis X (eosinophilic granuloma)
• Pulmonary nocardiosis
• Pulmonary valve stenosis
• Pulmonary tuberculosis
• Pulmonary veno-occlusive disease
• Q fever  
• Renal cell carcinoma
• Respiratory distress syndrome (infants)
• Respiratory syncytial virus (RSV)
• Restrictive cardiomyopathy
• Rheumatoid lung disease
• Right-sided heart failure
• Sarcoidosis
• Senile cardiac amyloid
• Silicosis
• Skin lesion of histoplasmosis
• Solitary pulmonary nodule (benign)
• Spontaneous pneumothorax
• SVC obstruction
• Systemic lupus erythematosus
• Systemic sclerosis (scleroderma)
• Tension pneumothorax
• Testicular cancer
• Tetralogy of Fallot
• Transient ischemic attack (TIA)
• Transposition of the great vessels
• Traumatic pneumothorax
• Ventricular septal defect
• Viral pneumonia
• Wegener’s granulomatosis
• Wilms tumor

What the risks are

There is low radiation exposure. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is very low compared with the benefits.Pregnant women and childrens are more sensitive to the risks of x-rays.

References

Gotway MB, Elicker BM. Radiographic techniques. In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 19.

Stark P. Imaging in pulmonary disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 84.

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