Are the cardiomediastinal (cardiac and mediastinal) contours and lung fields normal, with no evidence of consolidation, pleural effusion, or acute intrapulmonary abnormality?

From the Guidelines

The patient's chest X-ray shows normal findings, indicating no acute intrathoracic abnormalities, and suggests that further evaluation with chest radiography may not be necessary at this time, as the diagnostic performance of chest radiography varies among the reviewed literature, with a high negative predictive value reported in some studies 1.

The chest X-ray reveals a normal heart and mediastinum size, properly inflated lungs, and intact osseous structures, which is consistent with the impression of no acute intrathoracic findings.

• The lungs appear normally inflated, with no signs of consolidation, pleural effusion, or other acute intrapulmonary abnormalities.
• The osseous structures are intact, indicating no fractures or other bone issues.
• The cardiopulmonary function appears normal from an imaging perspective, but clinical correlation with the patient's symptoms and physical examination is still important for complete assessment. According to the American College of Radiology, chest radiography is recommended for the evaluation of chronic cough, although the exact timing of imaging has varied between groups 1.
• A study by Kastelik et al. found that initial evaluation with posteroanterior chest radiography was included as part of a standardized clinical protocol for chronic cough, and abnormal radiography was positively associated with underlying primary pulmonary pathology other than asthma 1.
• Another study by Ojoo et al. prospectively evaluated patients with chronic cough and found that 7 radiographs (6.3%) were reported contributory to the final diagnosis, with diagnosis achieved in 82% of patients 1. However, the diagnostic performance of chest radiography varies among the reviewed literature, with a high negative predictive value reported in some studies, but limited sensitivity for airway abnormalities and other patterns of lung disease 1.
• A retrospective analysis by Altenburg et al. reported that up to 34% of chest radiographs were reported unremarkable in patients with CT-proven bronchiectasis 1.
• A study by Park et al. showed that chest radiographs were normal in 49 out of 166 confirmed cases on LDCT, and chest radiography was more often normal when LDCT identified ground-glass opacity, bronchial wall thickening, centrilobular nodules, and small and dependent consolidations 1.

From the Research

Radiographic Findings

• The cardiomediastinal contours are normal for size
• Lungs appear normally inflated
• No consolidation, pleural effusion or acute intrapulmonary abnormality is visualized radiographically
• The osseous structures appear intact

Impression

• No acute intrathoracic findings

Relevant Studies

• There are no direct studies related to the given radiographic findings 2, 3, 4, 5, 6
• However, studies have been conducted on the effectiveness of various treatments for asthma and chronic obstructive pulmonary disease (COPD), such as budesonide/formoterol therapy 2 and beta-blockers 3, 5
• Other studies have examined the use of salbutamol inhalation in patients with coronary artery disease and asthma or COPD 4, and the comparative effectiveness of albuterol inhalers with and without integrated dose counters for patients with asthma or COPD 6