What I can see, cautiously

• The films appear to be AP views. In AP films, the heart can look artificially enlarged, so heart size cannot be judged reliably.
• Image quality is somewhat limited by suboptimal inspiration and positioning. This can make the lower lungs look whiter than they truly are.
• There appears to be patchy increased whiteness in the patient’s right mid-to-lower lung, possibly also some central/basal changes on the left. Possible explanations include infection such as pneumonia, partial collapse from shallow breathing (atelectasis), or less commonly fluid-related change. It is not possible to distinguish these safely from these phone photographs alone.
• I do not see an obvious large collapsed lung (pneumothorax) or a large pleural effusion in these photos. That does not rule out smaller abnormalities.
• On the image taken on 18 September, there may be a line/tube projected from the left neck/chest region. If the person has a central venous catheter, its position needs formal confirmation on the original X-ray.

How to interpret a chest X-ray: a repeatable method

1. Start with the technical check: RIPE

• R - Rotation: compare the medial ends of the clavicles with the spine. Unequal distances mean rotation, which can falsely make one lung look denser.
• I - Inspiration: count posterior ribs. Around 9 to 10 visible posterior ribs suggests reasonable inspiration. Low inspiration crowds lung markings and can mimic disease.
• P - Projection: PA is preferred. AP, like these images, magnifies the heart.
• E - Exposure/Penetration: you should just see thoracic vertebrae through the heart. Too white can hide lower-lung disease; too dark can exaggerate markings. The technical adequacy guide describes these checks.

2. Use ABCDE

• A - Airway: Is the trachea central? Are main bronchi visible?
• B - Breathing/lungs: Compare right and left from top to bottom. Look for abnormal white areas (consolidation/collapse), excessive blackness (possible pneumothorax), masses, or loss of normal vascular markings.
• C - Cardiac/mediastinum: Check heart contour, aortic contour, and mediastinal width. Do not call cardiomegaly confidently on an AP film.
• D - Diaphragm: Both hemidiaphragms should be visible. Check costophrenic angles for blunting, which can indicate pleural fluid. Look for free air below the diaphragm.
• E - Everything else: Pleura, bones, soft tissues, and devices such as tubes or central lines.

Important next step