The forgotten view: Chest X-ray - Lateral view

Abstract

With CT (computed tomography) chest gaining more importance as a diagnostic tool, chest X-ray especially the lateral view is taken less commonly nowadays. Besides CT chest is also proven to be superior to chest X-ray in patients with major blunt trauma. We are presenting a 68-year old male who was partially treated from outside for a left sided pneumonia. He came to our hospital because of persisting chest pain. Chest X-ray, frontal view (postero-anterior) was almost normal except for a mild opacity in the left lower zone. CT scan of the chest revealed a fluid collection posteriorly enclosed within enhancing pleura. Chest X-ray, left lateral view showed a corresponding posterior pleural based opacity. We are presenting this case to highlight the importance of the lateral view of the chest X-ray. In selected cases there is still a role for the lateral view. With the three dimensional visualization provided by the CT, the lateral view of the chest may be easier to understand. Consequent to the initial diagnosis by CT further follow up can be done with the chest X-ray. In a limited way this mitigates unnecessary expenditure and more importantly prevents the patient from exposure to harmful radiation in the form of repeated CT.

Keywords: Chest X-ray; Computed tomography; Lateral view.

Fig. 1

A). Chest X-ray with a mild opacity in the left lower zone. B) & C). CT scan of chest, axial view and sagittal view showing fluid collection posteriorly enclosed within enhancing pleura. D). Chest X-ray, left lateral view showing a corresponding posterior pleural based opacity, 10 × 5 cm projecting into the lung and and blunting of the posterior costo-phrenic recess.

Fig. 2

Chest X-ray, left lateral view showing almost complete resolution of the opacity.