The chest radiograph in primary liver cell carcinoma

In a prospective study, 38 consecutive cases of primary liver cell carcinoma were seen over one year (1988) at the liver unit of the University College Hospital, Nigeria. An analysis of the chest X-ray findings was made. Normal chest X-rays were found in 23.7% of cases. Abnormal findings included elevated diaphragm (63.2%), pulmonary metastases (18.4%), and pleural effusion (18.4%), perhaps the highest ever so reported. It may be concluded that, in a middle-aged man with a hard irregular hepatomegaly, the findings of the triad of elevated diaphragm, pulmonary metastasis and pleural effusion on chest X-ray should make one very suspicious of liver cancer. The differential diagnoses of these radiological findings are briefly discussed.