Abnormal chest X-ray



  1. What is an abnormal chest x-ray?
  2. Why does a doctor order a chest x-ray?
  3. What causes an abnormal chest x-ray?
  4. What does an abnormal chest x-ray look like?
  5. What's the next step?



What is an abnormal chest x-ray?

A chest X-ray is an imaging test that utilises low doses of radiation in short blasts to create images of the inside of a patient’s chest. In this way, doctors can examine the heart, lungs, bones, and blood vessels.

If the X-ray images show abnormalities, this means that there is something unusual on the image of the chest. This is usually indicative of a problem, and could be immediately obvious, such as a broken or fractured rib, or could simply be a shadow that needs further investigation.

Some doctors specialise in dealing with abnormalities in chest X-ray results, and may order follow-up tests to determine the cause.


Why does a doctor order a chest x-ray?

A doctor may order a chest x-ray if a patient is presenting with symptoms such as:

  • persistent coughing
  • difficulty breathing
  • wheezing
  • coughing up blood
  • chest pain
  • chest injury
  • fever
  • shortness of breath

Other reasons a chest x-ray may be ordered is to reveal:

  • fractures
  • heart-related problems
  • problems with blood vessels
  • changes after having an operation
  • lung conditions
  • outline and size of the heart
  • position of pacemaker, defibrillator, or catheter


What causes an abnormal chest X-ray?

An abnormal chest X-ray can be caused by a number of conditions.


  • pneumonia (unusual white or hazy shadow on the normally dark lungs on the X-ray can indicate this)
  • abscesses
  • pulmonary oedema (fluid build-up in the lungs)
  • lung cancer and other masses in the lungs
  • cavities in the lungs or cavitary lesions (caused by diseases like tuberculosis and sarcoidosis)
  • bronchitis
  • asthma


  • an enlarged heart (cardiomegaly), which can, in turn, be caused by various conditions, such as hypertension or coronary artery disease.
  • heart failure
  • fluid around the heart




What does an abnormal chest x-ray look like?

Lungs: the whiter the lungs appear on the scan, the more dense they will be; the darker they are, the less dense. A doctor will assess which side of the lungs or if both sides are abnormal based on key surrounding features.

Heart: the heart blocks radiation so will appear lightly in the scan. Any abnormalities with the heart or surrounding it will appear as lighter or darker areas.

Bones: bones are the densest natural structure seen in a chest x-ray. Fractures will be quickly and easily seen in the scan as dark lines through the bone.

A radiologist will look for clues indicating there is an abnormality and will report with the doctor who ordered the chest x-ray.


If the doctor is concerned by an abnormal chest X-ray, but doesn’t have enough information to make a diagnosis, they may order further tests, including a chest CT scan or a PET scan. By analysing the results of all these tests, the problem can be identified, and the doctor can plan a course of action with the patient to treat the condition.

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