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How to read a

Chest X-RayDr. Felix AcostaWest Medical Review

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Initial ChecksMake sure you have the right patientNae! "urnae

Age#atient $istory

Date o% the radiography

&ptii'e roo lighting

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Verify Technique&rientation

Inspiration

Rotation

#enetration

(xposure

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&rientation#A

A#

)ateral"upine)ow *uality

Decu+itus

)aying on yourside

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When do you use an #A,-old "tandard

I% patient can stand up

-ravity pulls a+doen downetter view o% chest

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When do you use an A#,When patient is +ed ridden

Distorts heart and ediastinu

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When do you use a

lateral,When you need to locali'ea lesion

"ee parts o% the lung norally covered

ehind the heart! and +ases /covered +ydiaphra0

Fluids! +ut decu+itus is +etter

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When do you use supine,Alost never

&nly i% patient is really deteriorated in +ed

and can1t +e oved)ow *uality

A+doen copresses all chest structures

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When do you use

decu+itus,2o look at3Fluids

Air&+struction

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Inspiration or (xpirationAde*uacy o% inspirationNine pairs o% ri+s should +e seen posteriorly

(xpiration#neuothorax

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RotationDistance %ro the edial end o% each clavicle

to the spinous process o% the verte+ra at thesae level! should +e e*ual

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#enetration&ne should +arely see the thoracic verte+rae

+ehind the heart

Noral

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(xposure /tie +ased0&ne needs to +e a+le to identi%y +oth

costophrenic angles and lung apices

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Radiological checklistAirway

ones

CardiacDiaphra

(4usions

Fields /)ung Fields0

-astric Air +u++le

$ilu

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Airway /2rachea0#ushed away#leural e4usion!

2ension #neuothorax

#ulled towardsAtelectasis /collapsed lung0

2u+es or %oreign +odies

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2ension #neuothorax

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Atelectasis /)oss o% lungvolue0

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onesCheck %or %ractures dislocation! su+luxation!

osteo+lastic or osteolytic lesions in clavicles!ri+s! thoracic

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CardiacCheck heart si'e

Cardiothoracic ratio)ess than 5.6

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Cardioegaly

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DiaphraRight heidiaphrag"hould +e higher than the le%t

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(4usions)ook %or +lunting o% the costophrenic angle

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FieldsCheck %or in7ltrates

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-astric Air +u++leeware o% hiatal hernia

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$ilu(nlarged lyph nodes

Calci7ed nodules

Mass lesions

#ulonary arteries! i% greater than 8.6cthink a+out possi+le causes o% enlargeent

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C2 "can

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Case scenario3 2

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$elical /"piral0 C2 "can2hink

pulonarye+olis

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Common Chest X-Raysfor USMLE)o+ar pneuonia

ronchopneuoniaInterstitial pneuonia

"arcoidosis

CD

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)o+ar #neuonia

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9pper lo+e pneuonia

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Middlelo+e pneuonia

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)ower lo+e #neuonia

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ronchopneuonia

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Interstitial pneuonia

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"arcoidosisilateral hiliar

lyphadenopathy

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CD&verexpanded:hyperin;atedlungs

Flatteneddiaphrag

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CD /ephysea0arrel chest

Flattening o% thediaphra

Increased

retrosternalairspace

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Noral vs CD

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#neuothorax /low yield0