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This article aims to illustrate the challenges in interpreting chest X-rays and the potential for misdiagnosis.

May 28, 2026Open Access

Images in medicine: The misleading chest X-ray

Key Points

This article aims to illustrate the challenges in interpreting chest X-rays and the potential for misdiagnosis.
Case report of a 40-year-old female with respiratory symptoms and elevated biomarkers.
Evaluation of chest X-ray findings with subsequent CT pulmonary angiogram.
Discussion on the importance of hidden areas in chest X-ray readings.
Chest X-ray showed no obvious consolidation but raised concerns for lung cancer due to prominent left hilum.
CT pulmonary angiogram revealed significant consolidation in the left lower lobe.
Elevated d-dimer and C-reactive protein suggest underlying pathology despite normal blood counts.

Abstract

This article discusses the case of a 40-year-old female presenting with chest pain, cough, and shortness of breath. She is a nonsmoker with her bloods showing a normal full blood count, as well as normal urea and creatinine. Her C-reactive protein was significantly elevated along with her D-dimer. The chest-X ray (CXR) showed no obvious consolidation, but a prominent left hilum raised the concerns of a possible lung cancer. Subsequently, she had computerized tomography pulmonary angiogram, which showed no pulmonary embolism, but significant consolidation in the left lower lobe behind the heart. This emphasizes the difficulty in reading CXR due to hidden areas in CXR. We discussed the importance of these hidden areas in the interpretations of CXR.

Images in medicine: The misleading chest X-ray

Key Points

Abstract

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