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 |
MEDIASTINUM
|
Aorta
Hilar nodes Oesophagus SVC Bronchi |
Widening |
Fractures |
AIR COLUMN | Trachea | Tracheal deviation
Tracheal compression Opacity |
Tension pneumothorax
Tumour / Abscess |
LUNG FIELDS | Lung
Pulmonary vessels
|
Opacities (read first!)
Air/fluid levels Oligaemia |
Consolidation |
PLEURA | Pleura
Pleural cavity |
Effusion
Pneumothorax Pleural opacity |
Pleural effusion |
Diaphragm | Diaphragm
Liver Stomach Peritoneal cavity Colon |
Elevation
Flattening |
Phrenic nerve palsy
Hepatomegaly |
CHEST WALL | Soft tissues
Ribs |
Subcutaneous emphysema
Fractures |
Trauma
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