interpret CXRs :

1. Dim room lighting

2. Check patient information - name, age, sex, date of radiograph
3. Identify radiographic technique - AP/PA film, exposure, rotation,
patient position (supine, sitting or erect)
4. Identify and check position of lines, tubes and other invasive devices
5. Soft tissues foreign bodies (metal), thickness, contours, presence
of gas, masses, mastectomy
6. Lungs (parenchyma)- look for abnormal densities (opacity or
lucency) or Pneumothorax
-

Look at lung volumes (hyperinflated in COPD)

Look at each lobe and compare (esp. apices)

Linear atelectasis

If shadowing: look for air bronchograms

7. Hila - position, masses or lymphadenopathy

8. Heart - size and shape
9. Pulmonary vessels - artery or vein enlargement (follow outwards)
10.

Bones density, lesions or fractures. Clavicle, scapula, ribs.

11.

Pleura - thickening, calcification, effusion or Pneumothorax

12.

Trachea - midline or deviated, wall, lumen diameter

13.

Mediastinum - width and contour, discreet masses

14.

Check review areas - apices, especially right upper lobe,

retrocardiac area, the peripheral lung margins, posterior

costophrenic sulci, and the diaphragm.
CXR signs of heart failure:
1. Alveolar oedema

2.
3.
4.
5.

Kerley B lines
Cardiology
Distended upper lobe vessels
Pleural effusions

Causes of consolidation: infection, pulmonary oedema, sarcoidosis, neoplasm,

infarction (following PE), haemorrhage.

Silhouette signs
Anatomical relationships:
Right heart boarder and RML
Ascending aorta and RUL
Left heart border and lingula
Left anterior diaphragm and heart
Aortic knob and LUL
Right posterior diaphragm and RLL
Left posterior diaphragm and LLL
Lobar collapse

Occurs due to proximal occlusion of a bronchus, causing a loss of

aeration. The remaining air is gradually absorbed, and the lung loses
volume. Causes:

1. Proximal stenosing bronchogenic carcinoma, which occludes a bronchus.

Patients are middle aged or elderly, and almost always smokers.
2. Asthma: In a young adult or older child . Collapse occurs secondary to
mucous plugging of the major airways.
3. In an infant consider an inhaled foreign body, such as a peanut.
4. Retention of secretions is a frequent cause of post operative collapse.
Features of collapse on CXR:
Tracheal displacement towards the side of the collapse.
Mediastinal shift towards the side of the collapse.
Elevation of the hemidiaphragm.
Reduced vessel count on the side of the collapse.
Herniation of the opposite lung across the midline.
A hilar mass, which also suggests carcinoma as the cause.
Other evidence of malignant disease (eg. rib metastases, lymphangitis,
effusion)
The presence of a foreign body; however these are rarely easy to see.
The presence of an endotracheal tube; is it sited too low?
Pleural effusions
Meniscus sign
Subpulmonic pleural effusion: effusion trapped between lung and
diaphragm (resembles elevated diaphragm)
Large effusions can cause the mediastinum to shift to opposite side
Free flowing pleural effusion: use lateral decubitus views to identify

Loculated pleural effusion: doesnt shift with a change in position, absence

of air bronchogram, convex border
pseudotumor is fluid trapped in a fissure
Kerley lines: 2-3 cm long pleural perpendicular to lateral chest, represent
thickened interlobular septa and edematous lymphatics