The Importance of Chest X-Rays


One of the most important things I learned as a pediatric resident at Los Angeles Children's Hospital was to order a chest X-ray, if I was puzzled about a diagnosis.

I wish more doctors knew this, because I constantly wonder why it often takes patients so long to get a diagnosis when they have shortness of breath, chest pain, coughing, flu-like symptoms or a child with a fever who is not feeling well.

I remember being at a friend's house in another city when she told me about a neighbor's child who had been ill for five days with quite an elevated fever. The child's doctor didn't seem to be worried about the elevated temperature and told the mother he was sure the child would be fine. I said if I was the parent, I would insist on a urinalysis, blood count, and chest X-ray. Fortunately, the mother listened to me and took the little girl back to the doctor. He didn't want to bother with the tests, but the mother insisted and it turned out that the child had quite a severe pneumonia. She responded well to antibiotics and the parents were very grateful for my help. (I hope they changed pediatricians!)

I had a favorite set of twins when I was in practice and was concerned to hear one of the twins was ill, when I returned from a two week vacation. Walking into the examining room, I saw the little girl grunting and said to the mother, "Maggie has pneumonia." The mother replied that the doctor who had been taking my practice while I was gone said he didn't hear anything abnormal  in the chest. I insisted that Maggie have an immediate chest  X-ray and yes, she did have a lobar pneumonia. Pneumonia can be very silent when you listen with a stethoscope. 

I saw another child who had had a croupy cough for several weeks and had been seen by three doctors. Each one had ordered an antibiotic that didn't help the bad cough. I ordered a chest X-ray and asked to have the neck included. The little boy had a safety pin stuck in his  trachea that had to be removed surgically.

A good friend in his fifties was a long-time smoker and refused to get a chest-X-ray even though I was sure he was in trouble. He didn't see doctors very often, but finally after I kept urging him to see a doctor and insist on a chest-X-ray, he did. The man had quite extensive cancer of the lung and didn't live for just a few months after that. If he had had an earlier chest-X-ray, or even a yearly chest-X-ray, I am sure he would have had many more years to live. It was a tragic loss of life.

Image copyright: Newtown grafitti, flickr, CC-BY

Article last time updated on 27.09.2016.

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It was my understanding that a spiral CT was best to detect very early lung cancer? My father, a long time smoker, had many chest X-rays over the years. He was lulled into a false sense of security, when they were "negative". However, one year it showed two small lesions in two different lobes. He had non-small cell lung cancer. He died about 18 months later.
#1 at 27.09.2016 from ANP Jo Nell Costello (Other)
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