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Patient Worries After Accessing His Chest X-Ray Report Online

Discussion in 'Radiology' started by Nada El Garhy, Aug 31, 2018.

  1. Nada El Garhy

    Nada El Garhy Golden Member

    May 23, 2016
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    I received an email a few days ago. It has been edited for length and clarity.


    I would like some advice please. I am a 46-year-old male with an off and on cough for 4-5 months. I have never smoked. After my primary care physician examined me, he ordered a chest x ray. A few days later I got a call from the doctor who said my x ray was normal. I was happy to hear that, but I am enrolled with My Chart which allows you to review your results online. Well, I read it and to me it doesn't sound what you would call totally normal, but I have no medical training so I could be wrong. I copied and pasted the report from the radiologist below. What concerns me is the "elevation" he refers to and using the word "fairly" clear lungs. Should I ask for another test or see another doctor for an opinion? If I was your family member would you suggest looking into this more?


    FINDINGS: The frontal view demonstrates fairly clear lungs with slightly increased elevation of the left hemidiaphragm compared with the prior study. This may be at least partially caused by air in the adjacent bowel. No pleural effusion or pneumothorax is noted. The cardiomediastinal silhouette is unremarkable. The lateral view demonstrates fairly stable appearance of the lung bases compared with the previous study.

    IMPRESSION: There is no clear indication of acute cardiopulmonary disease on this exam. Increased elevation of the left hemidiaphragm, possibly due to air in the underlying structure, likely the fundus of the stomach.

    Thanks for your email.

    There is equivocation in almost every sentence. I told the writer not to worry about it and said, “The radiology report says in a roundabout way that your chest X-ray is normal. A normal chest X-ray rules out a number of significant lung diseases.” I wished the gentleman well.

    Rather than go on about this further, I consulted my friend Dr. Saurabh Jha (@RogueRad), Associate Professor of Radiology at the Hospital of the University of Pennsylvania. Here are his thoughts:

    With patients accessing their reports more, it is even more important for radiologists to be clear. But this report is painful to read, introduces unnecessary uncertainty, promises stability when stability is not the issue, tries to be clever with words and phrases. Unfortunately, this is a consequence of reporting culture in which radiologists feel compelled to say everything they see, and qualify everything they see. I dread to think what'll happen when reports start quantifying everything.

    The standardized format doesn't help matters because it forces radiologists to comment on the "cardiomediastinal silhouette” (makes it sound like a ghost) merely to say the "cardiomediastinal silhouette is unremarkable." FFS! Why remark on it?!

    Here's how I'd have written the report, if I thought the elevated hemidiaphragm was clinically irrelevant.

    "Normal lungs—elevated left hemidiaphragm unlikely to be clinically relevant."

    I'd give this report 1/10.

    Awful report, Skeptical. Thanks for raising my blood pressure this morning.


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