Shadow on chest X Ray

[jackblue]

My friend has had a chronic cough for 8 weeks which has got slightly better with 2 courses of antibiotics but not gone away. She was initially diagnosed with a chest infection. Before Christmas she was told that there was a shadow on an x ray and is waiting to see doctor again. The cough is quite dry and has got worse since stopping antibiotics. The cough seems to be persistant and comes in spurts and then stops. She has been a smoker but has have not smoked for about 4 years. She is 70.  I am very concerned that the x ray could be showing something bad. The doctor gave her no clue as to what was wrong and said he couldn't tell conclusively from the x ray. This has been very worrying for her. What exactly does an x ray shadow mean?  She appears well but is exhausted from the coughing and the worrying.

[David Tinkelman, M.D.]

The term, X-ray shadow, is a commonly used, but quite non-specific term.  It could be infectious, inflammatory, a clot or a tumor.  An experienced radiologist can often focus in on the most likely causes but, in most instances, further X-ray examination (especially a CT Scan) is indicated.  The doctor owes it to your friend and you to provide as much information about this shadow as possible, including information about what exactly the radiologist said in describing this shadow and its most likely cause.  Her doctor should also do everything possible to quickly establish a definitive diagnosis, so as to not increase your period of high anxiety.  The quickest way to do this would be to seek consultation with a lung specialist (Pulmonologist) to assess your friend’s condition and to make specific recommendations regarding the most prompt and accurate testing to be made to establish the diagnosis with reasonable certainty.

Try not to conclude that the news will necessarily be bad.  The symptoms you describe could all be caused by a mild, but slowly resolving uncomplicated infection, such as pneumonia.  At the same time, do not hesitate to encourage her doctor to proceed with haste, to determine what exactly is going on.

Good luck to you and your friend.

[jackblue]

My friend has had more tests and CT scan and they think she has had pnuemonia which didn't clear up well . She has now been given antibiotics and is being checked for bronchitis. Nothing else has shown up on the scan.