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Check the x ray this patient had chest pain
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Reading File
Here is the full radiological analysis for Bhuwan Goswami, 23M, Fortis Hospital (dated 06/07/2026):
Chest X-Ray (PA View) - Image 1
Technical Quality: Good PA projection, adequate inspiration (9-10 posterior ribs visible), minimal rotation, appropriate penetration.
Findings:
| Structure | Finding |
|---|---|
| Lung fields | Bilaterally clear, symmetric aeration - no consolidation, no collapse |
| Pleura | No pneumothorax, no pleural effusion, no thickening |
| Heart size | Cardiothoracic ratio < 50% - normal, no cardiomegaly |
| Cardiac borders | Well-defined and sharp bilaterally |
| Mediastinum | Normal contour, no widening, no adenopathy |
| Trachea | Midline, no deviation |
| Hila | Normal position and size |
| Costophrenic angles | Sharp and clear bilaterally - no blunting |
| Diaphragm | Smooth domes, no subdiaphragmatic free air |
| Ribs/bones | No acute fractures, no lytic/blastic lesions |
Impression: Chest X-ray is NORMAL
Cervical Spine X-Ray (AP + Lateral) - Image 2
| Structure | Finding |
|---|---|
| Cervical lordosis | Mild straightening - likely due to muscle spasm or positioning |
| Vertebral alignment | Anterior, posterior, and spinolaminar lines intact - no anterolisthesis or retrolisthesis |
| Vertebral heights (C2-C7) | Well-preserved, no compression fractures or wedging |
| Disc spaces | Maintained and uniform - no degenerative disc disease |
| Prevertebral soft tissue | Normal thickness, no swelling |
| Posterior elements | Facets and spinous processes intact |
| Trachea (AP view) | Midline, no deviation |
| Cervical ribs | Absent - thoracic outlet syndrome less likely |
Impression: Cervical spine X-ray essentially NORMAL (mild straightening is a non-specific finding)
Clinical Interpretation for Chest Pain
The imaging is reassuringly normal for a 23-year-old male. However, a normal chest X-ray in a patient with chest pain still requires further workup, as the following serious causes cannot be excluded by X-ray alone:
| Diagnosis | Next Step Needed |
|---|---|
| Acute Coronary Syndrome / ACS | 12-lead ECG + Troponin I/T (serial x2) |
| Pulmonary Embolism | D-dimer + CT pulmonary angiography if high clinical suspicion |
| Aortic Dissection | Consider if tearing/tearing pain + BP differential between arms |
| Pericarditis | ECG (saddle-shaped ST elevation), echocardiogram |
| Musculoskeletal | Reproducible on palpation, point tenderness |
| GERD/Esophageal | Burning quality, positional, response to antacids |
Important note: The cervical spine shows mild straightening. If the patient also reports neck/shoulder pain in addition to chest pain, this could suggest a referred pain component from the cervical spine (C4-C5 dermatomes can radiate to the chest/shoulder). However, cardiac and pulmonary causes must be excluded first.
Immediate priorities for this patient:
- 12-lead ECG - most important first step in any chest pain
- Troponin (hs-cTnI or hs-cTnT) at 0h and 1-3h
- SpO2, BP both arms, heart rate, respiratory rate
- Clinical examination for chest wall tenderness
This analysis is for clinical correlation only and does not replace formal radiologist reporting.
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