Chest X rays

Posteroanterior (PA) projection.

When a patient is too unwell or unable to stand for a PA radiograph, often using a portable machine.

The heart may appear magnified, the scapulae may overlap the lung fields, and the clavicles may appear more horizontal.

Black, because air absorbs very little X-ray radiation.

White, because they absorb or attenuate more X-ray radiation.

Rotation, Inspiration, Projection, and Exposure.

To assess the technical quality of a chest X-ray before interpreting abnormalities.

The spinous processes should lie midway between the medial ends of the clavicles, with the clavicles approximately symmetrical.

Approximately 5–7 anterior ribs or 8–10 posterior ribs above the diaphragm.

Too white, with insufficient detail visible behind the heart.

Too dark, with excessive visibility of structures behind the heart and potentially reduced visibility of lung markings.

Examples include ECG leads, pacemakers, central venous catheters, nasogastric tubes, and other monitoring or medical devices.

The chest X-ray is often normal or shows nonspecific abnormalities; the embolus itself is usually not visible.

Airway, Breathing, Cardiac, Diaphragm, and Everything else.

Tracheal position and alignment, including any deviation, as well as the main bronchi where visible.

Tension pneumothorax, major lung collapse, a large pleural effusion, pneumonectomy, or a large mass. The direction of deviation depends on the cause.

It can push the trachea away from the affected side, particularly when under pressure.

It can pull the trachea towards the affected side due to volume loss.

It can push the trachea away from the affected side if sufficiently large.

It can pull the trachea towards the side of the removed lung due to volume loss.

Lung fields and markings, consolidation, masses, pneumothorax, pleural effusions, costophrenic angles, and hilar size and appearance.

Most commonly a pleural effusion, although pleural thickening can also cause blunting.

Hilar lymphadenopathy, a central mass, or enlarged pulmonary vessels.

Heart size, cardiac contours, mediastinal width, and the position of the cardiac silhouette.

The cardiothoracic ratio is greater than 50%, although projection and image quality must be considered.

AP projection magnifies the heart, potentially making it appear enlarged even when its true size is normal.

The position and contour of both hemidiaphragms, their relative heights, and the costophrenic angles; look for free air beneath the diaphragm.

The right hemidiaphragm is usually slightly higher than the left.

Phrenic nerve palsy, lung volume loss, diaphragmatic eventration, or subdiaphragmatic causes.

Bones, soft tissues, visible upper abdomen, medical devices, and other abnormalities not covered by the preceding steps.

Rib or clavicle fractures, vertebral abnormalities, destructive bone lesions, and other skeletal injuries.

COPD
Notice the hyperinflation of the lungs due to the trapped air in the alveoli

AP

PA

Underexposed

Overexposed

Tension Pneumothorax

Pmeumonia

Pleural Effusion
Notice the meniscus

Pneumonectomy - removal of the whole lung

Cardiomegaly