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Chest x-ray

Definition

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

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:

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:

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:

Abnormal results may also be due to:

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 children 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.

Aortic rupture, chest X-ray
Aortic rupture (a tear in the aorta, which is the major artery coming from the heart) can be seen on a chest x-ray. In this case, it was caused by a traumatic perforation of the thoracic aorta. This is how the x-ray appears when the chest is full of blood (right-sided hemothorax) seen here as cloudiness on the left side of the picture.
Lung cancer, frontal chest X-ray
A CXR in a patient with central cancer of the right lung. Notice the white mass in the middle portion of the right lung (seen on the left side of the picture).
Adenocarcinoma - chest X-ray
This chest x-ray shows adenocarcinoma of the lung. There is a rounded light spot in the right upper lung (left side of the picture) at the level of the second rib. The light spot has irregular and poorly defined borders and is not uniform in density. Diseases that may cause this type of x-ray result would be tuberculous or fungal granuloma, and malignant or benign tumors.
Coal worker
This chest x-ray shows coal worker's lungs. There are diffuse, small, light areas on both sides (1 to 3 mm) in all parts of the lungs. Diseases that may result in an x-ray like this include: simple coal workers pneumoconiosis (CWP) - stage I, simple silicosis, miliary tuberculosis, histiocytosis X (eosinophilic granuloma), and other diffuse infiltrate pulmonary diseases.
Coccidioidomycosis - chest X-ray
This chest x-ray shows the affects of a fungal infection, coccidioidomycosis. In the middle of the left lung (seen on the right side of the picture) there are multiple, thin-walled cavities (seen as light areas) with a diameter of 2 to 4 centimeters. To the side of these light areas are patchy light areas with irregular and poorly defined borders.Other diseases that may explain these x-ray findings include lung abscesses, chronic pulmonary tuberculosis, chronic pulmonary histoplasmosis, and others.
Coal workers pneumoconiosis - stage II
This chest x-ray shows stage II coal worker's pneumoconiosis (CWP). There are diffuse, small light areas on both sides of the lungs. Other diseases that may explain these x-ray findings include simple silicosis, disseminated tuberculosis, metastatic lung cancer, and other diffuse, infiltrative pulmonary diseases.
Coal workers pneumoconiosis - stage II #2
This chest X-ray shows coal workers pneumoconiosis - stage II. There are diffuse, small (2 to 4 mm each), light areas throughout both lungs. In the right upper lung (seen on the left side of the picture), there is a light area (measuring approximately 2 cm by 4 cm) with poorly defined borders, representing coalescence (merging together) of previously distinct light areas. Diseases which may explain these X-ray findings include simple coal workers pneumoconiosis (CWP) - stage II, silico-tuberculosis, disseminated tuberculosis, metastatic lung cancer, and other diffuse infiltrative pulmonary diseases.
Coal workers pneumoconiosis, complicated
This picture shows complicated coal workers pneumoconiosis. There are diffuse, small, light areas (3 to 5 mm) in all areas on both sides of the lungs. There are large light areas which run together with poorly defined borders in the upper areas on both sides of the lungs. Diseases which may explain these X-ray findings include complicated coal workers pneumoconiosis (CWP), silico-tuberculosis, disseminated tuberculosis, metastatic lung cancer, and other diffuse infiltrative pulmonary diseases.
Coal workers pneumoconiosis, complicated #2
This picture shows complicated coal workers pneumoconiosis. There are diffuse, massive light areas that run together in the upper and middle parts of both lungs. These are superimposed on a background of small and poorly distinguishable light areas that are diffuse and located in both lungs. Diseases which may explain these X-ray findings include, but are not limited to: complicated coal workers pneumoconiosis (CWP), silico-tuberculosis, and metastatic lung cancer.
Tuberculosis, advanced - chest X-rays
Tuberculosis is an infectious disease that causes inflammation, the formation of tubercules and other growths within tissue, and can cause tissue death. These chest x-rays show advanced pulmonary tuberculosis. There are multiple light areas (opacities) of varying size that run together (coalesce). Arrows indicate the location of cavities within these light areas. The x-ray on the left clearly shows that the opacities are located in the upper area of the lungs toward the back. The appearance is typical for chronic pulmonary tuberculosis but may also occur with chronic pulmonary histiocytosis and chronic pulmonary coccidioidomycosis. Pulmonary tuberculosis is making a comeback with new resistant strains that are difficult to treat. Pulmonary tuberculosis is the most common form of the disease, but other organs can be infected.
Pulmonary nodule - front view chest X-ray
This x-ray shows a single lesion (pulmonary nodule) in the upper right lung (seen as a light area on the left side of the picture). The nodule has distinct borders (well-defined) and is uniform in density. Tuberculosis (TB) and other diseases can cause this type of lesion.
Sarcoid, stage II - chest X-ray
Sarcoid causes damage to the lung tissue that heals by scarring. The film shows a diffuse milky and granular appearance in the normally dark lung areas. This individual has marked decrease in lung function.
Sarcoid, stage IV - chest X-ray
This film shows advanced sarcoid, scarring of the lungs (the light streaking), and cavity formation (the dark areas in the upper right side of the picture).
Pulmonary mass - side view chest X-ray
This individual has a mass in the upper part of the lung. Although the cause of the mass can be suspected, based on this person's history, there are many diseases that can produce lung lesions.
Bronchial cancer - chest X-ray
This is a chest x-ray of a person with bronchial cancer. This is a front view. The lungs are the two dark areas. The heart and other structures are white areas visible in the middle of the chest. The light areas that appear as subtle branches extending from the center into the lungs are cancerous.
Lung nodule, right middle lobe - chest X-ray
This is a chest x-ray (CXR) of a nodule in the right lung.
Lung mass, right upper lung - chest X-ray
This picture is a chest x-ray of a person with a lung mass. This is a front view, where the lungs are the two dark areas and the heart and other structures are visible in the middle of the chest. The x-ray shows a mass in the right upper lung, indicated with the arrow (seen on the left side of the picture).
Lung nodule - front view chest X-ray
This is a chest x-ray showing a mass in the right lower lung near heart (seen on the left side of the picture).

Review Date: 9/1/2012
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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