From the Guidelines
A chest X-ray PA view report for suspected pulmonary hypertension should include assessment of central pulmonary arteries, right heart chamber enlargement, and lung fields, as these are key findings in pulmonary hypertension, as noted in the study by Miniati et al 1. When evaluating a chest X-ray PA view for suspected pulmonary hypertension, several key features should be assessed, including:
- Cardiac size and contour, with particular attention to right heart chamber enlargement
- Pulmonary vascularity, including the size of the central pulmonary arteries, such as the main pulmonary artery (MPA) and the right descending pulmonary artery
- Lung fields, for evidence of diffuse lung diseases such as interstitial fibrosis or emphysema, which can be associated with pulmonary hypertension
- Pleural spaces, diaphragm, bony structures, and soft tissues, to rule out other potential causes of symptoms. A sample report might read: "Chest X-ray PA view shows an enlarged main pulmonary artery (MPA) measuring 40mm from midline to left lateral border, suggestive of pulmonary hypertension, as supported by the study by Schmidt et al, which found that an MPA diameter of >35mm is indicative of PH 1. The right descending pulmonary artery is also enlarged, measuring 18mm at the hilum. The lung fields are clear, but there is evidence of right heart chamber enlargement. No pleural effusion or pneumothorax is identified. Impression: Chest X-ray findings suggestive of pulmonary hypertension, with enlarged central pulmonary arteries and right heart chamber enlargement, consistent with the findings of Miniati et al 1." It is essential to note that while chest radiography can be useful in detecting moderate to severe pulmonary hypertension, it may not be sensitive enough to detect mild cases, and further imaging evaluation should be pursued if there are persistent unexplained symptoms, as recommended by the study 1.
From the Research
Sample Report of a Chest X-Ray PA View
A chest X-ray PA (posteroanterior) view is a standard radiographic projection used to evaluate the lungs, heart, and chest cavity. The following is a sample report of a chest X-ray PA view:
- The chest X-ray PA view is taken with the patient standing upright and the X-ray beam passing from back to front (posteroanterior).
- The report typically includes information about the patient's identification, the date and time of the examination, and the type of examination performed.
- The radiologist's interpretation of the image is also included, which may describe any abnormalities or findings, such as pulmonary nodules, lung masses, or cardiomegaly.
Pulmonary Nodules on Chest X-Ray
Pulmonary nodules are common findings on chest X-rays and computed tomography (CT) scans 2, 3.
- They are typically defined as rounded opacities less than 3 cm in diameter.
- The probability of malignancy depends on the size and characteristics of the nodule, as well as the patient's risk factors and clinical history 2, 4.
- Small solid nodules (<8 mm) are more likely to be benign, while larger nodules (≥8 mm) have a higher probability of malignancy 2.
- Subsolid nodules, which are divided into ground-glass and part-solid nodules, have a higher risk of cancer and should be followed with surveillance imaging for longer 2, 3.
Management of Pulmonary Nodules
The management of pulmonary nodules depends on the estimated probability of malignancy, patient comorbidities, and patient preferences 2, 4.
- Small solid nodules (<6 mm) may be followed with surveillance imaging, while larger nodules (≥8 mm) may require further evaluation with positron emission tomography (PET)-CT, nonsurgical biopsy, or surgical resection 2, 4.
- Part-solid nodules are managed according to the size of the solid component, with larger solid components associated with a higher risk of malignancy 2.
- Ground-glass nodules have a probability of malignancy of 10% to 50% when they persist beyond 3 months and are larger than 10 mm in diameter 2.