CHAPTER 11 The hidden abnormality
11.1 Pancoast’s tumour
A number of abnormalities can be easily missed. Before deciding an X-ray is normal:
1. Look carefully at the apices of both lungs. This is a common site for lung pathology, for example a Pancoast’s tumour or chronic fibrosis. Lesions here can be easily missed because the apex of the lung is hidden by ribs and clavicles.
2. Look carefully at the heart shadow. Lesions behind the heart are often missed because they are obscured by the whiteness of the heart. Look carefully for any parts of the heart shadow that look whiter than the rest. Look also for the triangular shadow of left lower lobe collapse and other subtle changes such as consolidation behind the heart.
