How to Read a Chest X-Ray

This guide outlines a systematic approach to interpreting a chest x-ray, highlighting key areas of focus and common issues to identify.

Initial Assessment

• Patient Overview:
  • Determine the general condition of the patient.
  • Check if the patient is standing (upright radiograph) or seated.

Lung Apices

• Primary Focus:
  • Rule out pneumothorax.
  • Zoom into lung apices for fine linear pressure or pleural line.
  • Examine lung bases for pleural lines indicating a basilar pneumothorax.

Bones

• Fracture Detection:
  • Start with the right shoulder: inspect right humerus, glenohumeral joint, scapula, and clavicle.
  • Follow and count posterior ribs on both sides.
  • Identify any displaced rib fractures via lateral aspect.
  • Examine the spine for compression fractures.

Cardiomediastinal Silhouette

• Silhouette Review:
  • Follow the right mediastinum and heart border for abnormalities.
  • Check left heart border and aortic knob for lymph nodes or masses.
  • Inspect right and left hilar regions for masses.

Airways and Lungs

• Airway Examination:
  • Trace trachea and main stem bronchi for defects, masses, or foreign bodies.
  • Perform a comparative zigzag review of right and left lungs.

Diaphragm and Gastric Bubble

• Diaphragmatic Evaluation:
  • Scrutinize below the diaphragm for free air.
  • Observe the gastric bubble.

Lateral View (if available)

• Lateral Analysis:
  • View costochondric angles for pleural effusion.
  • Check hemidiaphragms and cardiac silhouette.
  • Examine trachea, esophagus, hilar region, and sternum for fractures.
  • Assess bowel and any possible free air.

Conclusion

• Systematic approach helps ensure no important feature is overlooked.
• Utilize lateral view for problem-solving based on frontal radiograph findings.

---

By following this structured approach, you can efficiently review chest x-rays and potentially identify critical conditions such as pneumothorax, fractures, and abnormalities in the cardiomediastinal silhouette.