2 The CXR on the next slide is normal. How would you interpret it? IntroductionMost of the chest x-rays you will see will be normalIn order to recognise abnormality, you need to know what a normal CXR looks likeThe CXR on the next slide is normal. How would you interpret it?
4 General Principles Have a systematic approach Interpret the CXR in conjunction with the clinical findingsAlways compare with previous CXR if available to assess for changeAsk yourself “does my interpretation make sense?”
5 Systematic Approach Name/marker/rotation/ penetration Lines/metal work HeartMediastinumLungsZones (upper/middle/lower)BonesDiaphragmSoft Tissues
6 Systematic Approach Name/marker/rotation/ penetration clavicles equidistant from spinous processes of thoracic spinecan just see lower thoracic spine
7 Systematic Approach Lines/metal work Look for: Sternal wires (implies previous thoracic surgery)Tip of endotracheal tube (2cm above carina)
8 Systematic Approach Lines/metal work Tip of central venous lines at origin of superior vena cava. See tubes and lines presentation.
9 Systematic Approach Heart Occupies up to 50% of the maximum internal thoracic diameter on a standard PA erect viewCannot comment on heart size on AP view because of magnification of heart
10 Systematic Approach Mediastinum Hilar vascular structures should be crisply definedNo widening of mediastinumTrachea should be central
11 Systematic Approach Lungs Compare upper, mid and lower zones upper zoneCompare upper, mid and lower zonesLook between ribs for lung detailRemember to look “behind” the heartmiddle zonelower zone
12 Systematic Approach Bones Look at each rib in turn Clavicles Scapulae and humeri if visibleLower cervical and thoracic spine
13 Systematic Approach Diaphragm Both diaphragms should form a sharp margin with the lateral chest wallBoth diaphragm contours should be clearly visible medially to the spinePosition of stomach gas bubble (not present on this CXR)