Practice Lesson of the Week

Chest radiographs in pregnancy

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b4057 (Published 09 October 2009) Cite this as: BMJ 2009;339:b4057
  1. S J O’Connor, specialist registrar respiratory medicine1,
  2. H Verma, specialist registrar radiology2,
  3. S Grubnic, consultant radiologist2,
  4. C F J Rayner, consultant respiratory physician2
  1. 1Mayday University Hospital, Croydon, Surrey CR7 7YE
  2. 2St George’s Hospital, London
  1. sallyjeanoconnor{at}yahoo.co.uk
  • Accepted 17 February 2009

Do not hesitate to perform chest radiography in pregnant patients if they fulfil the criteria

The misconception that a pregnant patient should not undergo a chest radiograph is common. Risk to a fetus during chest radiography is minimal, but reluctance to image pregnant patients can delay diagnosis and affect outcomes. We describe two cases illustrating use of this investigation when clinically indicated.

Case 1

A 38 year old woman was referred to the chest clinic by her general practitioner. She was 31 weeks pregnant and reported an eight week history of fever, dry cough, and left sided chest pain. Despite repeated courses of oral antibiotics her symptoms had slowly worsened, resulting in a referral for specialist review. On examination she had decreased breath sounds at the left lung apex, left basal crackles, and soft expiratory wheeze. A chest radiograph showed a mass at the left hilum and left upper lobe collapse (fig 1). Urgent bronchoscopy revealed a large vascular tumour obstructing the left upper lobe. A computed tomography (CT) scan confirmed a hypervascular lesion centred on the left upper lobe bronchus, which was most consistent with a carcinoid tumour, and several lymph nodes in the prevascular space.

She had an elective caesarean section at 35 weeks followed by a left …

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