CXR – Systematic Interpretation

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CXRSnowy

Introduction

This is a commonly ordered investigation by most clinicians.

If you are new to this

  • First get to recognise the structures on the standard AP and lateral views
  • It is also worthwhile to get to know the structures of the cardio-medistinal contours
  • Have a standard approach to the AP¬†view

Radio-diagnosis

  • Although the clinician often has the advantage of a greater appreciation of the clinical context, first describe the abnormal findings before launching into a definitive diagnosis
  • There is often more than one differential diagnoses for an abnormal appearances e.g. tracheal deviation and lung whiteout could either be due to massive effusion or massive collapse
  • Do a careful systematic search for other features that support or exclude the¬†alternatives

Following is a table using common terms and conditions breaking down the components of the CXR into abnormal findings, their differentials and some important pathologies.

RADIOLOGIC STRUCTURE ANATOMICAL STRUCTURE RADIOLOGIC ABNORMALITY PATHOLOGIES
CARDIAC SILHOUETTE Cardiac chambers

Pericardium

Left lingula

Enlargement

(General/Localised)

Lingula opacity

Chamber hypertrophy

Pericardial effusion/tamponade

Lingula pneumonia

MEDIASTINUM

Hilum

 

Aorta

Hilar nodes

Oesophagus

SVC

Spinal column

Bronchi

Widening

Pneumo-mediastinum

Fractures

Bone lytic/sclerotic lesions

 

Lymphadenopathy

Aneurysm

Coarctation of aorta

Ruptured aorta

Ruptured oesophagus

Pneumothorax

Fractures

Thymus

AIR COLUMN Trachea

Oesophagus

Tracheal deviation

Tracheal compression

Opacity

Tension pneumothorax

Massive collapse/effusion

Tumour / Abscess

Airway Foreign body

LUNG FIELDS Lung

Pulmonary vessels

Lobar fissures

 

Opacities (read first!)

Air/fluid levels

Alveolar oedema

Vesser diversion

Kerley B, C lines

Oligaemia

Westermark’s sign

Consolidation

Pneumonia

Collapse

Pulmonary oedema

Pulmonary embolus

Tumour/Metastases

Abscesses

PLEURA Pleura

Pleural cavity

Effusion

Pneumothorax

Pleural opacity

Pleural effusion

Haemo-thorax

Empyema

Pneumothorax

Asbestosis

Diaphragm Diaphragm

Liver

Stomach

Peritoneal cavity

Colon

Elevation

Flattening

Free gas

Phrenic nerve palsy

COAD/Asthma

Hepatomegaly

Hiatus hernia

Diaphragmatic hernia

Rupture viscus

CHEST WALL Soft tissues

Ribs

Subcutaneous emphysema

Fractures

Sclerotic/lytic bone lesions

Trauma

Pnemo-thorax

Fractures

Metastases

UPPER LIMB OSTEOLOGY

CERVICAL SPINE OSTEOLOGY

Bones Fractures

Sclerotic/lytic bone lesions

Fractures

Metastases

NECK SOFT TISSUES Skin, muscle

Neck vessels

Swelling

Subcutaneous air

Infection

Trauma

 

Acknowledgements to Radiopaedia, a popular Australian moderated website in the #FOAMed community now with international contribution

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