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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