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Nov 30, 2021 · Chest. 1997 Mar;111(3):537-43 Ullman E, Brady WJ, Perron AD, Chan T, Mattu A. Electrocardiographic manifestations of pulmonary embolism. Am J Emerg Med. 2001 Oct;19(6):514-9 Kosuge M, Kimura K, Ishikawa T, Ebina T, Hibi K, Kusama I, Nakachi T, Endo M, Komura N, Umemura S. Electrocardiographic differentiation between acute pulmonary embolism and acute coronary syndromes on the basis of negative ...
The chest x-ray is the most frequently requested radiologic examination. In fact every radiologst should be an expert in chest film reading. The interpretation of a chest film requires the understanding of basic principles. In this article we will focus on: Normal anatomy and variants.
- Confirm Details
- Abcde Approach
- Airway
- Breathing
- Cardiac
- Diaphragm
- Everything Else
- Review Areas
- References
Begin chest X-ray interpretation by checking the following details: 1. Patient details: name, date of birth and unique identification number. 2. Date and time the film was taken 3. Previous imaging: useful for comparison.
The ABCDE approach can be used to carry out a structured interpretation of a chest X-ray: 1. Airway: trachea, carina, bronchi and hilar structures. 2. Breathing: lungs and pleura. 3. Cardiac: heart size and borders. 4. Diaphragm: including assessment of costophrenic angles. 5. Everything else: mediastinal contours, bones, soft tissues, tubes, valve...
Trachea
Inspect the trachea for evidence of deviation: 1. The trachea is normally located centrally or deviating very slightly to the right. 2. If the trachea appears significantly deviated, inspect for anything that could be pushing or pulling the trachea. Make sure to inspect for any paratracheal masses and/or lymphadenopathy.
Carina and bronchi
The carina is cartilage situated at the point at which the trachea divides into the left and right main bronchus. On appropriately exposed chest X-ray, this division should be clearly visible. The carina is an important landmark when assessing nasogastric (NG) tube placement, as the NG tube should bisect the carina if it is correctly placed in the gastrointestinal tract. Theright main bronchus is generally wider, shorter and more vertical than the left main bronchus. As a result of this diffe...
Hilar structures
The hilar consist of the main pulmonary vasculature and the major bronchi. Each hilar also has a collection of lymph nodes whicharen’t usually visiblein healthy individuals. The left hilum is often positioned slightly higher than the right, but there is a wide degree of variability between individuals. The hilar are usually the same size, so asymmetry should raise suspicion of pathology. The hilar point is also a very important landmark; anatomically it is where the descending pulmonary arter...
Lungs
Inspect the lungs for abnormalities: 1. When interpreting a chest X-ray you should divide each of the lungs into three zones, each occupying one-third of the height of the lung. 2. These zones do not equate to lung lobes (e.g. the left lung has three zones but only two lobes). 3. Inspect the lung zones ensuring that lung markings are present throughout. 4. Compare each zone between lungs, noting any asymmetry (some asymmetry is normal and caused by the presence of various anatomical structure...
Pleura
Inspect the pleura forabnormalities: 1. The pleura are not usually visible in healthy individuals. If the pleura are visible it indicates the presence of pleural thickening which is typically associated with mesothelioma. 2. Inspect the borders of each lung to ensure lung markings extend all the way to the edges of the lung fields (the absence of lung markings is suggestive of pneumothorax). 3. Fluid (hydrothorax) or blood (haemothorax) can accumulate in the pleural space, resulting in an are...
Assess heart size
In a healthy individual, the heart should occupy no more than 50% of the thoracic width(e.g. a cardiothoracic ratio of less than 0.5). This rule only applies to PA chest X-rays(as AP films exaggerate heart size), so you should not draw any conclusions about heart size from an AP film. Cardiomegaly is said to be present if the heart occupies more than 50% of the thoracic width on a PA chest X-ray. Cardiomegaly can develop for a wide variety of reasons including valvular heart disease, cardiomy...
Assess the heart’s borders
Inspect the borders of the heartwhich should be well defined in healthy individuals: 1. The right atrium makes up most of the right heart border. 2. The left ventricle makes up most of the left heart border. The heart borders may become difficult to distinguish from the lung fields as a result of pathology which increases the opacity of overlying lung tissue: 1. Reduced definition of the right heart border is typically associated with right middle lobe consolidation. 2. Reduced definition of...
The right hemidiaphragm is, in most cases, higher than the leftin healthy individuals (due to the presence of the liver). The stomach underlies the left hemidiaphragm and is best identified by the gastric bubble located within it. The diaphragm should be indistinguishable from the underlying liver in healthy individuals on an erect chest X-ray, how...
Mediastinal contours
The mediastinum contains the heart, great vessels, lymphoid tissue and a number of potential spaceswhere pathology can develop. The exact boundaries of the mediastinum aren’t particularly visible on a chest X-ray, however, there are some important structures that you should assess.
Bones
Inspect the visible skeletal structureslooking for abnormalities (e.g. fractures, lytic lesions).
Soft tissues
Inspect the soft tissuesfor obvious abnormalities (e.g. large haematoma).
Finally, before completing your assessment of a chest X-ray, make sure you’ve looked at the ‘review areas’ where pathology is often missed. These areas include: 1. the lung apices 2. the retrocardiac region 3. behind the diaphragm 4. the peripheral region of the lungs 5. the hilar regions This ensures you’ve comprehensively assessed the X-ray and r...
James Heilman, MD. Right-sided pneumonia. Licence: CC BY-SA 3.0.James Heilman, MD. Cardiomegaly. Licence: CC BY-SA 3.0.Hellhoff. Pneumoperitoneum. Licence:CC BY-SA 3.0.Steven Fruitsmaak. Chilaiditi syndrome. Licence:CC BY-SA 3.0.Feb 1, 2014 · The chest x-ray shows diffuse consolidation with 'white out' of the left lung with an air-bronchogram. This patient had a chronic disease with progressive consolidation. The disease started as a persitent consolidation in the left lung and finally spread to the right lung. Final diagnosis: bronchoalveolar carcinoma.
a. Section 1.4.2. Defining Chest Pain includes 2 recommendations and Figure 2. Index of Suspicion that Chest “Pain” is Ischemic in Origin Based on Commonly Used Descriptors b. Section 2.1. History includes 1 recommendation and Figure 3. Top 10 Causes of Chest Pain in Emergency Department Based on Age (Weighted Percent) and Table 3. Chest ...
Jun 25, 2024 · The total effective dose of a chest X-ray (in PA and lateral views) ranges from 0.06 to 0.25 mSv, depending on the voltage of the system used and type of system (film-screen or digital radiography). Meanwhile, PA view accounts for 25% of the total effective dose of a chest X-ray while lateral view accounts for 75% of the total effective dose 6 .
Investigations. ECG. Bloods. FBC, U&E, LFT, D-dimer (if considering PE and low Wells score), troponin if suspected IHD. ABG if patient acutely unwell or sats under 95%. CXR. Portable CXR if the patient is severely ill. Standard CXR if they can go to department. Echo/ CT if large proximal PE or aortic root dissection suspected.
