Chest X-ray

Heart right border

Right atrium

Superior vena cava entering superiorly

Inferior vena cava often seen at its lower margin

Heart left border

Left ventricle and left atrial appendage

The pulmonary artery

Aortopulmonary window

Aortic notch extend superiorly.

What view

PA (lower diapjragm, full lungs/large, horizontally oriented clavicales, scapula not displaced)

what view

AP (higher diapjragm, smaller lungs, obliquely oriented clavicales, scapula displaced, falsely enlarged heart and medastinum)

Overexposed (can be confused with COPD patients)

underexposed

underexposed

trachea divaiated to the right due to rotation.

distance between clavical and spinuss process not equal on both sides. rotated to the left.

Left hilum higher than right (NL)

AP chest X-ray (critically ill patient and intubated)

tracheal intubation (above the carnia. if lower it will inter right main stem bronchous→leads ti left lung collaps)

NG tube

Central line (into SVC)

left main stem bronchous showing radio-opacity and patent bronchioles→Air broncho-grams (if localised→indicates infectious process)

Bilateral diffuse lung opacities on both lung fields (slightly more on left side)

Ddx: ARDs, decomensated heart failure, aspiration

Air bronchograms

AP chest X-ray

chest tube

tracheal tube

NG tube

PA chest X-ray

Opacity on right side

Miniscus sign (indicates pleural effusion in PA view)

AP chest X-ray

Opacity on right side

Grading sign (indicates pleural effusion in AP view)

PA chest X ray

left lung lucency

veceral pleural line visible on left side

no tracheal divation and centralised mediastinum →so left sided simple pneumothorax

CP angle obliterated on left and no miniscus sign→air fluid leveling→pleural effusion on left side.

Left sided hydropneumothorax

radio-opacity on right upper lung zone

right hilum lifted upward

trachea divated to ipsilateral side (to the right)

Ddx: atelectasis/lung collapse, lung fibrosis, iatrogenic (lobectomy)

sharp line of demarcation of right upper lobe opacity (everything below is normal)→right upper LOBE collapse

causes of collapse→anything obstructing rught upper lobe bronchous; tumor, mucus blood.

tinted right hemidiaphragm (can also be seen in upper lobe collapse)

right side peunothorax

tracheal deviation to left

compresed/shifted heart

absent vasculature on right

Rught lung abcess (apperse well defined radio-opaque with air fluid level)

Right middle lobe pneumonia

pulmonary infeltrat

radio-opacity (air bronchograms)

Silhouette sign→loss of sharp border of the heart (on the right for this picture)

Right lower lobe pneumonia

Silhouette sign with right diaphragm (loss of sgarm border of right diaphragm)

dextrocardia

important to look at past patient imaging and rest of organs to check for dextro totalis

Lung mets (RCC mc cause)

variable in size, well defined, radio-opacities, diffuse, bilateral

Canonball appearance

Peds patient

Sail sign (indicates thymus gland)

COPD patient

diaphragm flat

barrel chest on lateral view (AP diameter increase)

widened intercostal spaces

lungs hypper enflated→globular heart

Hidden area showing hiatal hernia

RTA patient with multiple rib fractures

discontinuity in ribs

multiple right sided rib fracture

subtle simple apical pneumothorax on right side

hemothrax in CP angle on right side

(rib fracture can be complicated by pneumothorax or hemothorax so always check)

cardiomegaly

AP chest X ray and yet heart is still grossly enlarged

subcutaneous emphysema

radio-lucency in subcutanous planes showing/enhancing the pectoralis major fibers