Chest X-ray - Scenario 4
Answers to scenario questions

Answers to scenario questions

Question 1

How is hyperexpansion determined on a chest radiograph?

• Greater than 7 anterior ribs visible above the diaphragm in the mid-clavicular line
• AND/OR
• Flattening of the diaphragm

Question 2

What does hyperexpansion tell you about underlying lung disease?

• There is obstructive airways/pulmonary disease

Question 3

What could be the cause of the chest wall pain and tenderness?

• There are multiple partially healed rib fractures

Question 4

How is the history of steroid treatment relevant?

• Steroid use has led to generalised loss of bone mineral density resulting in weakness of bone, with fractures secondary to minor trauma - coughing

Question 5

How is osteoporosis formally diagnosed?

• X-ray can show reduction of bone mineral density, but cannot formally diagnose osteoporosis
• A DEXA (Dual Energy X-ray Absorptiometry) scan is required