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Pulmonary Hypertension and Chest X-Rays

Posted on March 29, 2022
Medically reviewed by
Steven C. Pugliese, M.D.
Article written by
J. Christy McKibben, LPN

If you’ve experienced symptoms such as shortness of breath or chest pain, your doctor may recommend that you undergo a chest X-ray to help identify the cause. A chest X-ray, also called a chest radiograph, is an imaging test used to create pictures of the airways, lungs, blood vessels, and heart. It also creates an image of the bones of the spine and chest. A chest X-ray is one of several initial tests used to help diagnose pulmonary hypertension (PH).

Here’s what you need to know about chest X-rays for pulmonary hypertension, including what X-rays involve, how they are performed, and what the images can reveal to your health care team.

What Are Chest X-Rays?

Chest X-rays use ray beams of radiation to generate images of the organs and structures in a person’s chest. This imaging procedure is noninvasive, painless, and typically quick. The results of a chest X-ray are often available within one or two days.

Images from X-rays are black and white — they resemble the negatives of a photograph. Because our tissues differ in thickness and density, different components of our bodies allow different amounts of radiation to pass through them.

Solid things, like bones, don’t allow much radiation to pass through them, so they appear opaque (white) on X-rays. Softer elements, such as the lungs and heart, appear more faintly and look gray. Doctors (radiologists) look closely at the structures depicted in an X-ray to spot and identify abnormalities and health conditions.

How Are Chest X-Rays Used for Pulmonary Hypertension?

Chest X-rays are among the first imaging tests that doctors perform if they suspect a person might have pulmonary hypertension. Your doctor “reads” the shading and colors on your chest X-ray to spot abnormalities that may suggest the presence of PH. Two such signs include enlarged pulmonary arteries or an enlarged right ventricle of the heart.

While reviewing a chest X-ray, a radiologist also looks for certain features that may indicate the cause of PH, such as chest wall deformities, interstitial lung disease, emphysema, and left-sided heart disease.

Can a Chest X-Ray Conclusively Diagnose PH?

A chest X-ray is one tool a health care team uses to diagnose PH. However, a definitive diagnosis of PH cannot be made through chest X-rays alone as they cannot detect actual arterial pressure. There are several other routine tests needed to make a PH diagnosis.

Other tests that can be used to diagnose and determine the root of a person’s pulmonary hypertension include:

  • Echocardiogram
  • Electrocardiogram (ECG or EKG)
  • Cardiac catheterization
  • Computerized or computed tomography (CT) scans
  • Magnetic resonance imaging (MRI)

If — after you’ve had an echocardiogram, chest radiograph, and other tests — your health care team believes that their diagnosis of PH may be accurate, you will likely have a right-heart catheterization. Known as the “gold standard” for diagnosing pulmonary hypertension, right-heart catheterization directly measures pulmonary artery pressure (the blood pressure in the pulmonary arteries).

What To Expect the Day of Your Chest X-Ray

Chest radiography is noninvasive, and the procedure is usually completed within minutes.

Preparation for the Chest X-Ray

Chest X-rays don’t require any elaborate or special preparation. You may want to wear loose, comfortable clothing when you attend your appointment, as you may be asked to put on a medical gown. The technician or nurse will ask you to remove your glasses, jewelry, removable dental appliances, hair accessories, and any metal you may be wearing that could interfere with X-ray images. Before you go to your appointment, ask about wearing products like lotions or deodorant. (In most cases, clinicians will ask you to wait to apply them after the X-ray.)

If there is any possibility that you may be pregnant, you must inform the nurse, doctor, and technologist. Some facilities even require a urine sample right before the exam to ensure you’re not pregnant. If you are pregnant and an X-ray is absolutely necessary, the technician can take special precautions to minimize radiation exposure to the fetus.

During the Procedure

The X-ray technologist will ask you to stand against the metal plate of the X-ray machine. They will request that you remain extremely still to prevent blurring the image. Depending on what the doctor orders, you’ll likely be asked to move into different positions. (Your technologist will guide you through these positions. Multiple images from different angles give your doctor a more complete look at your situation.)

The technologist will look at the captured images on their computer after each shifted position to ensure its image is good and that it captured what the doctor requested. The exam itself should only take a few minutes, and it’s painless. The results of the exam usually are available within one to two days.

After Your Chest X-ray

Once your chest X-rays (and the radiologist’s take on what they show) are available, your doctor will let you know and interpret them for you. If your health care team detects any abnormalities or structural changes that may point to PH (or another condition), they may recommend undergoing other diagnostic tests.

Read more about diagnosing PH.

Connect With Those Who Understand

On myPHteam, the social network for people with all types of pulmonary hypertension and their loved ones, more than 43,000 members come together to share support, advice, and stories from their daily lives with others who understand.

Have you undergone a chest X-ray? Share your experience, thoughts, or tips in the comments below or by posting on myPHteam.

All updates must be accompanied by text or a picture.
Steven C. Pugliese, M.D. is affiliated with the Hospital of the University of Pennsylvania in Philadelphia, serving as the director of the pulmonary embolism response team, co-director of the comprehensive pulmonary embolism program, and an assistant professor of clinical medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
J. Christy McKibben, LPN is a freelance writer and licensed practical nurse in North Carolina. Learn more about her here.

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