{"id":712,"date":"2016-08-20T03:28:48","date_gmt":"2016-08-20T03:28:48","guid":{"rendered":"http:\/\/emedsa.org.au\/CoreMed\/?p=712"},"modified":"2016-08-20T03:39:53","modified_gmt":"2016-08-20T03:39:53","slug":"cxr-systematic-interpretation","status":"publish","type":"post","link":"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/20\/cxr-systematic-interpretation\/","title":{"rendered":"CXR  &#8211; Systematic Interpretation"},"content":{"rendered":"<p><a href=\"http:\/\/twitter.com\/share?url=http%3A%2F%2Femedsa.org.au%2FCoreMed%2F2016%2F08%2F20%2Fcxr-systematic-interpretation%2F&amp;count=none&amp;text=CXR  - Systematic Interpretation - CoreMed\" class=\"twitter-share-button\">Tweet<\/a><\/p><p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-720\" src=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/CXRSnowy.jpg\" alt=\"CXRSnowy\" width=\"1275\" height=\"1920\" srcset=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/CXRSnowy.jpg 1275w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/CXRSnowy-199x300.jpg 199w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/CXRSnowy-768x1157.jpg 768w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/CXRSnowy-680x1024.jpg 680w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/CXRSnowy-624x940.jpg 624w\" sizes=\"auto, (max-width: 1275px) 100vw, 1275px\" \/><\/p>\n<p><strong>Introduction<\/strong><\/p>\n<p>This is a commonly ordered investigation by most clinicians.<\/p>\n<p><strong>If you are new to this<\/strong><\/p>\n<ul>\n<li>First get to recognise the structures on the standard <a href=\"http:\/\/radiopaedia.org\/articles\/chest-pa-view\">AP<\/a> and <a href=\"http:\/\/radiopaedia.org\/articles\/chest-lateral-view\">lateral<\/a> views<\/li>\n<li>It is also worthwhile to get to know the structures of the <a href=\"http:\/\/radiopaedia.org\/articles\/normal-contours-of-the-cardiomediastinum-on-chest-radiography\">cardio-medistinal contours<\/a><\/li>\n<li>Have a <em>standard approach<\/em> to the <a href=\"http:\/\/radiopaedia.org\/articles\/chest-x-ray-basic-an-approach\">AP<\/a>\u00a0view<\/li>\n<\/ul>\n<p><strong>Radio-diagnosis<\/strong><\/p>\n<ul>\n<li>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<\/li>\n<li>There is often more than one differential diagnoses for an abnormal appearances<em> e.g. tracheal deviation and lung whiteout could either be due to massive effusion or massive collapse<\/em><\/li>\n<li>Do a careful <em>systematic<\/em> search for other features that support or exclude the\u00a0alternatives<\/li>\n<\/ul>\n<p>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.<\/p>\n<table style=\"width: 623px;\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr style=\"height: 48px;\">\n<td style=\"width: 148px; height: 48px;\" valign=\"middle\"><b>RADIOLOGIC STRUCTURE<\/b><\/td>\n<td style=\"width: 132px; height: 48px;\" valign=\"middle\"><b>ANATOMICAL STRUCTURE<\/b><\/td>\n<td style=\"width: 145px; height: 48px;\" valign=\"middle\"><b>RADIOLOGIC ABNORMALITY<\/b><\/td>\n<td style=\"width: 155px; height: 48px;\" valign=\"middle\"><b>PATHOLOGIES<\/b><\/td>\n<\/tr>\n<tr style=\"height: 152px;\">\n<td style=\"width: 148px; height: 152px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/cardiac-silhouette\"><b>CARDIAC SILHOUETTE<\/b><\/a><\/td>\n<td style=\"width: 132px; height: 152px;\" valign=\"middle\">Cardiac chambers<\/p>\n<p>Pericardium<\/p>\n<p>Left lingula<\/td>\n<td style=\"width: 145px; height: 152px;\" valign=\"middle\">Enlargement<\/p>\n<p>(General\/Localised)<\/p>\n<p>Lingula opacity<\/td>\n<td style=\"width: 155px; height: 152px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/left-ventricular-enlargement\">Chamber hypertrophy<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/pericardial-effusion\">Pericardial effusion\/tamponade<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/silhouette-sign\">Lingula pneumonia<\/a><\/td>\n<\/tr>\n<tr style=\"height: 308px;\">\n<td style=\"width: 148px; height: 308px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/mediastinum\"><b>MEDIASTINUM<\/b><\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/pulmonary-hilum-2\"><b>Hilum<\/b><\/a><\/p>\n<p>&nbsp;<\/td>\n<td style=\"width: 132px; height: 308px;\" valign=\"middle\">Aorta<\/p>\n<p>Hilar nodes<\/p>\n<p>Oesophagus<\/p>\n<p>SVC<\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/typical-thoracic-vertebrae\">Spinal column<\/a><\/p>\n<p>Bronchi<\/td>\n<td style=\"width: 145px; height: 308px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/mediastinal-mass\">Widening<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/pneumomediastinum-basic\">Pneumo-mediastinum<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/spinal-fractures\">Fractures<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/vertebral-metastases\">Bone lytic\/sclerotic lesions<\/a><\/td>\n<td style=\"width: 155px; height: 308px;\" valign=\"middle\">&nbsp;<\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/bilateral-hilar-lymph-node-enlargement\">Lymphadenopathy<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/thoracic-aortic-aneurysm\">Aneurysm<br \/>\n<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/coarctation-of-the-aorta\">Coarctation of aorta<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/thoracic-aortic-injury\">Ruptured aorta<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/boerhaave-syndrome\">Ruptured oesophagus<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/pneumothorax\">Pneumothorax<\/a><\/p>\n<p>Fractures<\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/thymic-sail-sign\">Thymus<\/a><\/td>\n<\/tr>\n<tr style=\"height: 176px;\">\n<td style=\"width: 148px; height: 176px;\" valign=\"middle\"><b>AIR COLUMN<\/b><\/td>\n<td style=\"width: 132px; height: 176px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/trachea\">Trachea<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/oesophagus\">Oesophagus<\/a><\/td>\n<td style=\"width: 145px; height: 176px;\" valign=\"middle\">Tracheal deviation<\/p>\n<p>Tracheal compression<\/p>\n<p>Opacity<\/td>\n<td style=\"width: 155px; height: 176px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/tension-pneumothorax\">Tension pneumothorax<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/hemithorax-white-out\">Massive collapse\/effusion<\/a><\/p>\n<p>Tumour \/ Abscess<\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/airway-foreign-bodies-in-children\">Airway Foreign body<\/a><\/td>\n<\/tr>\n<tr style=\"height: 308px;\">\n<td style=\"width: 148px; height: 308px;\" valign=\"middle\"><b>LUNG FIELDS<\/b><\/td>\n<td style=\"width: 132px; height: 308px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/lung\">Lung<\/a><\/p>\n<p>Pulmonary vessels<\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/lung-fissures\">Lobar fissures<\/a><\/p>\n<p>&nbsp;<\/td>\n<td style=\"width: 145px; height: 308px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/pulmonary-opacification\">Opacities<\/a> (read first!)<\/p>\n<p>Air\/fluid levels<\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/pulmonary-alveolaroedema\">Alveolar oedema<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/upper-lobe-pulmonary-venous-diversion\">Vesser diversion<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/kerley-lines-in-the-exam\">Kerley B, C lines<\/a><\/p>\n<p>Oligaemia<\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/westermark-sign\">Westermark&#8217;s sign<\/a><\/td>\n<td style=\"width: 155px; height: 308px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/consolidation-basic\">Consolidation<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/pneumonia\">Pneumonia<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/lobar-collapse-basic\">Collapse<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/pulmonary-oedema\">Pulmonary oedema<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/westermark-sign\">Pulmonary embolus<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/cannonball-metastases-1\">Tumour\/Metastases<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/lung-abscess\">Abscesses<\/a><\/td>\n<\/tr>\n<tr style=\"height: 220px;\">\n<td style=\"width: 148px; height: 220px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/pleura\"><b>PLEURA<\/b><\/a><\/td>\n<td style=\"width: 132px; height: 220px;\" valign=\"middle\">Pleura<\/p>\n<p>Pleural cavity<\/td>\n<td style=\"width: 145px; height: 220px;\" valign=\"middle\">Effusion<\/p>\n<p>Pneumothorax<\/p>\n<p>Pleural opacity<\/td>\n<td style=\"width: 155px; height: 220px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/pleural-effusion\">Pleural effusion<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/haemothorax\">Haemo-thorax<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/thoracic-empyema-1\">Empyema<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/pneumothorax\">Pneumothorax<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/asbestosis\">Asbestosis<\/a><\/td>\n<\/tr>\n<tr style=\"height: 264px;\">\n<td style=\"width: 148px; height: 264px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/normal-position-of-diaphragms-on-chest-radiography\"><b>Diaphragm<\/b><\/a><\/td>\n<td style=\"width: 132px; height: 264px;\" valign=\"middle\">Diaphragm<\/p>\n<p>Liver<\/p>\n<p>Stomach<\/p>\n<p>Peritoneal cavity<\/p>\n<p>Colon<\/td>\n<td style=\"width: 145px; height: 264px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/elevated-hemidiaphragm\">Elevation<\/a><\/p>\n<p>Flattening<\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/subdiaphragmatic-free-gas\">Free gas<\/a><\/td>\n<td style=\"width: 155px; height: 264px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/phrenic-nerve-palsy\">Phrenic nerve palsy<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/copd-basic\">COAD\/Asthma<\/a><\/p>\n<p>Hepatomegaly<\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/hiatus-hernia\">Hiatus hernia<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/diaphragmatic-hernia\">Diaphragmatic hernia<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/pneumoperitoneum-summary\">Rupture viscus<\/a><\/td>\n<\/tr>\n<tr style=\"height: 176px;\">\n<td style=\"width: 148px; height: 176px;\" valign=\"middle\"><b>CHEST WALL<\/b><\/td>\n<td style=\"width: 132px; height: 176px;\" valign=\"middle\">Soft tissues<\/p>\n<p>Ribs<\/td>\n<td style=\"width: 145px; height: 176px;\" valign=\"middle\"><a href=\"http:\/\/radiopaedia.org\/articles\/subcutaneous-emphysema\">Subcutaneous emphysema<\/a><\/p>\n<p>Fractures<\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/lytic-rib-lesion-mnemonic\">Sclerotic\/lytic bone lesions<\/a><\/td>\n<td style=\"width: 155px; height: 176px;\" valign=\"middle\">Trauma<\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/pneumothorax\">Pnemo-thorax<\/a><\/p>\n<p><a href=\"http:\/\/radiopaedia.org\/articles\/rib-fractures\">Fractures<\/a><\/p>\n<p>Metastases<\/td>\n<\/tr>\n<tr style=\"height: 128px;\">\n<td style=\"width: 148px; height: 128px;\" valign=\"middle\"><b>UPPER LIMB OSTEOLOGY<\/b><\/p>\n<p><b>CERVICAL SPINE OSTEOLOGY<\/b><\/td>\n<td style=\"width: 132px; height: 128px;\" valign=\"middle\">Bones<\/td>\n<td style=\"width: 145px; height: 128px;\" valign=\"middle\">Fractures<\/p>\n<p>Sclerotic\/lytic bone lesions<\/td>\n<td style=\"width: 155px; height: 128px;\" valign=\"middle\">Fractures<\/p>\n<p>Metastases<\/td>\n<\/tr>\n<tr style=\"height: 132px;\">\n<td style=\"width: 148px; height: 132px;\" valign=\"middle\"><b>NECK SOFT TISSUES<\/b><\/td>\n<td style=\"width: 132px; height: 132px;\" valign=\"middle\">Skin, muscle<\/p>\n<p>Neck vessels<\/td>\n<td style=\"width: 145px; height: 132px;\" valign=\"middle\">Swelling<\/p>\n<p>Subcutaneous air<\/td>\n<td style=\"width: 155px; height: 132px;\" valign=\"middle\">Infection<\/p>\n<p>Trauma<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><em>Acknowledgements to Radiopaedia, a popular Australian moderated website in the #FOAMed community now with international contribution<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tweet 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&#8230; <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/20\/cxr-systematic-interpretation\/\">Read more &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":720,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"episode_type":"","audio_file":"","cover_image":"","cover_image_id":"","duration":"","filesize":"","date_recorded":"","explicit":"","block":"","filesize_raw":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-712","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/712","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/comments?post=712"}],"version-history":[{"count":9,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/712\/revisions"}],"predecessor-version":[{"id":722,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/712\/revisions\/722"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/media\/720"}],"wp:attachment":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/media?parent=712"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/categories?post=712"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/tags?post=712"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}