Airway lesions presenting with a normal chest X-ray.

From August 1980 to December 1987, 2,020 patients were proved by bronchoscopy to have endobronchial lesions at Chang Gung Memorial Hospital, Taipei. The chest roentgenograms, reviewed by 2 thoracic physicians and 1 radiologist, were reported to be normal in 31 of these patients. The incidence of airway lesions with a normal chest X-ray was 1.5% (31 out of 2,020 cases). These 31 patients included 18 males and 13 females, and their ages ranged from 7 months to 75 years with a mean of 40.3 years. The leading diseases in these cases were tracheal cancer (8 cases), tracheal and/or bronchial tuberculosis (6 cases), bronchogenic carcinoma (5 cases), tracheal schwannoma (2 cases), tracheal cyst (1 case) and bronchial adenoma (1 case). The trachea and main bronchi were the two most frequent sites of radiologically occult endobronchial lesions. Although the majority of the lesions occupied more than 50% of the diameter of the airway lumen, they were not well demonstrated in the routine chest radiological studies. Location, size and nature of the lesions were the major consideration that contributed to the normal-looking appearance of the chest X-ray. Alertness to the symptoms, physical signs and clinical history led to further investigation and the final diagnosis. The conclusion is that some airway lesions may present with a normal chest X-ray and delay the diagnosis. Careful history taking and observation of clinical symptoms and signs are important in the final diagnosis of these patients.