Basic Chest
X-ray Interpretation

Overview

Always use a systematic approach. It doesn’t matter what the approach is, just be consistent. Below is one example of a search patter.

  • Assess quality: AP vs. PA; upright vs. supine; patent positioning; Is the whole chest included?
  • Lines/tubes/drains/devices: What lines are present and are they in the expected locations? ET tube, central lines, NG tube/Dobhoff, Pacemaker, valve replacements
  • Airway: Is the trachea midline?
  • Mediastinum: Is it widened (masses, aortic injury, lymphadenopathy)?
  • Cardiac: Is the heart enlarged (cardiothoracic ratio (maximal horizontal cardiac diameter/ maximal horizontal thoracic diameter [inner edge ribs]) on PA CXR should be about 0.4-0.5)
  • Pleural space: Is there a pneumothorax? Pleural effusion?
  • Rest of image: Look for soft tissue changes—foreign bodies, subcutaneous air. Look for bone abnormalities—fractures, masses. Look for abdominal pathology—air under the diaphragm, position of tubes
  • 1,2-10: first rib, posterior aspect of ribs 2 to 10
  • AK: aortic knob
  • APW: aortopulmonary window
  • BS: breast shadow
  • PHB: posterior heart border
  • RHD, LHD: right hemidiaphragm, left hemidiaphragm
  • C, T: carina, tracheal air column
  • CA, GA: colonic air, gastric air
  • CPA: costophrenic angle
  • DA: descending aorta
  • LHB: left heart border (most of which represents the left ventricle, the superior aspect represents the left atrial appendage)
  • RPA: right pulmonary artery
  • S: scapula
  • RA: retrosternal space
  • LPA: left pulmonary artery
  • RC: right clavicle
  • RHB: right heart border (represents the right atrium)
  • RMF: right lung fissure (left major and minor fissures are not always visualized)

Additional resourcees for chest x-ray interpretation

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