Dear Doc, what did Qatari medics find in my chest x-ray?

I got a chest photographic/film x-ray from a government hospital in Kiambu County and I was declared fit to travel. PHOTO| FILE| NATION MEDIA GROUP

Dr Flo, in 2013, I got a job as waiter in Qatar. They asked for a high-resolution digital chest x-ray report for tuberculosis (scars, lesions, calcified nodes and granuloma).

I got a chest photographic/film x-ray from a government hospital in Kiambu County and I was declared fit to travel. When I got to Qatar, I got another x-ray. Instead of just the back, they added a front, left side and right side (AP, PA, L-side &R-side). After the second x-ray in Qatar, I was declared unfit to work and I was sent back to Kenya.

The following year, I got a job as a waiter in Oman and had another chest photographic/film x-ray done in Kenya. No medical complications were found both in Kenya and in Oman and I worked in Oman for the entire two-year visa period.

In 2016, I got a job in Qatar again, and like the first time, my chest x-ray in Kenya was fine, but the Qatar x-ray report declared me unfit to work and I was sent back home. Doctors in Qatar did not give specific medical reasons why I was declared unfit to work. When I got back, I repeated the x-ray at a renowned private medical facility in Nairobi, and the x-ray report showed that I had no medical condition. I have never had chest problems or tuberculosis.

Doctor, please tell me: Is there a difference between photographic/film x-ray and high-resolution digital x-ray? Which medical conditions can be seen on the former and not on the latter? Which hospitals in Nairobi are best for high-resolution digital chest x-ray for travel purposes? Why might I have been declared unfit to work in Qatar? Which infections should a local radiologist be checking for in people who want to travel to countries like Qatar? George

 

Dear George,

A photographic x-ray film uses a film similar to the photographic film used in old cameras. When exposed to x-rays, an image forms on the film, and once it is developed, the image is visible. Digital imaging uses a digital image detector with sensors to capture the image. The process is faster because there is no need to develop the film. The images can be enhanced and the quality of images is better.

Chest x-rays can be used to diagnose many problems in the lungs, the pleura (lining of the lung), the trachea (windpipe), the mediastinum (the area between the two lungs), the costophrenic angles (where the ribcage meets the diaphragm), the heart, the bones and even the stomach.

The most common view of a chest x-ray worldwide is the PA (postero-anterior) view, meaning the image is taken from the back to the front. The opposite, front to back, is usually done on patients who are unable to stand. The lateral view (plus other possible views) can also be done to clarify something that has been seen in the PA view, or to check structures that are behind the sternum or behind the heart. The views the doctor asks for depend on the protocols in that area or hospital, or on the individual doctor and the illness they may be suspecting.

In Nairobi, most private hospitals and diagnostic centres do high resolution digital x-rays, but the quality may differ depending on the machine the institution uses.

Each country has different immigration health regulations, which also depend on the kind of job one will do. Food handlers and caregivers, especially for children, undergo the highest scrutiny. Most of the time, chest x-rays are used to screen for tuberculosis infection in immigrants, because TB is a public health risk. It is impossible to know exactly what the doctors in Qatar found, because you did not get a medical report.

 

Dr Flo, I feel pain on the right side of my chest every once in a while. The pain lasts two or three days then disappears for weeks or months before it returns. This has gone on for almost nine years. I don’t have any major health issues. What is the problem? James

 

Dear James,

The right side of the chest has several components including the right lung and pleura (lining of the lung), muscle, bones, cartilage, nerves and blood vessels. Pain may signal a problem in any of these tissues.

Lungs and the pleura – inflammation of the lung and/or pleura may be caused by infection or by irritants like chemicals and dust. An infection will cause significant pain, and there may be cough, fast breathing or difficulty in breathing and fever. If you have an untreated infection, symptoms do not disappear on their own; they worsen over time. Inflammation caused by irritants and cold may come and go depending on exposure. Avoiding the trigger will prevent the pain. Medication can also be prescribed to manage the symptoms.

Muscles – there are three layers of muscles, known as the intercostal muscles, in between the ribs, as well as muscles on the front and back of the chest, and along the spine. Any of these muscles could ache, what is called myalgia (muscle pain), either due to recurrent strain, repetitive activity or muscle cramps. Usually after rest, this pain goes away on its own, or you may require painkillers and muscle relaxants.

Nerves – there are many nerves running within and across the chest wall. Any of them could get “trapped” or damaged, leading to chest pain. This is usually more difficult to diagnose, but the treatment is pain medication, and usually the pain goes away with time. If a number of nerves are involved, however, an MRI may be done to determine the exact source of the problem for appropriate intervention.

Bones (and cartilage) – Cartilage connects the ribs and the sternum (breast bone). If there is costochondritis i.e. inflammation between the cartilage and the bone (either the ribs or the sternum), the resultant pain may feel as though the heart has a problem. The pain is usually on the left side of the chest, and it may be sharp, or aching, or feel like pressure, affecting more than one rib. It worsens when you take a deep breath, cough and due to physical activity. It may be triggered by injury, or physical strain, or arthritis. Less likely causes include infection or joint tumours. Treatment includes pain medication, physiotherapy with stretching and nerve stimulation exercises (TENS), hot or cold compresses and rest. It may go away on its own and recur another time.