What’s wrong with this picture? (This is a real-life case from my work from a few days ago.)

(Click on the image for a larger view.)

This is a chest x-ray from an otherwise healthy 25-year old man who came into the emergency room complaining of sudden onset of chest pain and shortness of breath. He hurts on his right side. There was no recent injury or unusual preceding event.

For non-physicians, the film is oriented as if the patient were looking at you. His right side is on the left side of the image and his left side is on the image right.

The heart is the whiter area in the center and the two lungs are the darker regions on either side.

The bones (such as the ribs and collar bones) are white. The backwards “L” in the upper right of the image is a film marker placed by the x-ray tech to indicate the patient’s left side (“L”).

This is classic teaching case for 3rd year medical students just starting their hospital rotations on medicine, surgery, or the ER — some might get it and some might not.

The average 1st-year radiology resident (i.e., someone who had finished 4 years of medical school and one year of internship) should make this diagnosis in about 2-3 seconds.

The radiologist’s next step would then be to call the ER physician ASAP to alert him to this diagnosis.

The answer will be posted on Monday.