Question: Could you please interpret the following chest X-ray reports for me. There is obviously radiological evidence of heart disease. However, I am more concerned about what the reports suggest regarding the condition of the lungs. (1) Are they more suggestive of pneumionia or pulmonary oedema (or something else), (2) Is there much evidence of pneumonia or pulmonary oedema, and (3) Do the last three reports suggest a worsening or improvement of any lung condition? Throughout all of this time, the WCC and CRP were elevated. Two antibiotics were administered but the last course was completed on 12 January. I appreciate that radiological evidence alone is not definitive. But what, in your opinion, do the radiological reports suggest or indicate?
17 January "Cardiac silhouette is enlarged. There is mid to lower zone pulmonary venous congestion and right pleural effusion. There is thickening of the horizontal fissure. Mild peribronchial airspace changes are noted with reticular opacity seen. There is sparing of the upper lobe. Appearances are consistent with congestive heart failure"
22 January "Quite extensive interstitial opacity is seen on the right compatible with interstitial oedema. Some patchy airspace opacities are seen in the right lower and mid zones. This may present pulmonary oedema or pneumonia. The left lung is clear apart from hyperinflation. There is right pleural effusion. The cardiac shadow is enlarged and the aorta is tortuous"
26 January "Comparison is made with the x-ray on 22 January. Cardiomelagy is present and pulmonary congestion is again noted. There is atelectasis and consolidation in the right mid and lower zones, no change. There are bilateral small pleural effusions, no change."
5 February Patchy consolidation-atelectasis is again noted in the right mid and lower zones. The right pleural effusion has increased in size. There is a small left pleural effusion with left basilar atelectasis. There is mild cardiomegaly present and mild pulmonary congestion"
8 February "There is moderate right pleural effusion with is mostly unchanged as compared to 5 February. Patchy opacification in the right lung mid-zone could relate to airspace consolidation. There is new opacification at the left base which could relate to small effusion and consolidation/collapse"
20 February "The heart is enlarged. There are bilateral effusions. From the right there is mild congestion present. There is no significant change since 8 February"
28 February "The heart is enlarged. There is minimal venous congestion present, bilateral pleural effusions and collapse in both lower lobes. This is less marked than on 20 February"
31 February "The heart is enlarged. There is pulmonary venous congestion and bilateral pleural effusions but these have not changed since the previous examination"

Thank you very much Dr. Bhavsar for your very helpful analysis and advice. May I ask one more question? Could you explain to me your reasons for diagnosing a worsening of the x-ray results? I am certainly not questioning your medical expertise which I greatly value and appreciate. However, I have no training in how to interpret x-ray reports and I would like to get a better understanding of why the reports indicate that there is a deterioration.