Shadowing on a chest X-ray is a finding that can represent many different conditions, from infection and fluid to inflammatory lung disease and, in some cases, malignancy, and the consultation is the process of working out which. I begin with a detailed clinical history: how long any symptoms have been present, the pattern of breathlessness or cough, any fever or weight loss, smoking history, occupational exposures, and any relevant past medical history including previous TB. I then review all available imaging, perform spirometry, and decide which further investigation is most likely to provide the diagnosis most efficiently. Often this means a CT scan; sometimes it means a bronchoscopy. I will explain the plan clearly and the reason for each investigation before anything is ordered.
Written by Dr. Subhajit Sen, MBBS, MD (Pulmonology/Respiratory Medicine), Consultant Pulmonologist, West Bengal. 12 years of clinical experience. Phone: +91 8282857661.
