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Preoperative chest radiograph
  1. Mahan Salehi,
  2. Benjamin Rea
  1. Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Dr Mahan Salehi, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; mahan93{at}

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Clinical introduction

A man in his 60s who had recently moved to the area attended a preoperative appointment for a cholecystectomy. He reported to be asymptomatic. He had a past medical history of hypertension and took Amlodipine and had no known allergies. A chest X-ray was performed as part of the workup (figure 1).

Figure 1

Preoperative chest X-ray

What is the cause of abnormalities seen on the image?

  1. Prominent pericardial fat pad only

  2. Bilateral healed rib fractures

  3. Pneumoperitoneum

  4. Aortic coarctation

  5. Lung cancer

Answer: D

The correct answer is D, as there is evidence of bilateral inferior rib notching (online supplemental figure 1—white chevron) as well as an absent aortic knuckle (online supplemental figure 1 …

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  • Contributors MS and BR came up with the concept and prepared the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.