Systemic Review of a CXR, CXR, PA Projection

Systemic Review of a CXR

• general review – is the film well penetrated and symmetrical. Are breast shadows (if present) equal? Are nipple shadows (if present) equal? Are there artefacts such as wire sutures after cardiac surgery?
• is the image centred? – inner clavicles should be the same distance from the midline
• is the trachea central?
• follow the mediastinal outline downwards. Are their any bumps that shouldn’t be there? What might they be?
• does the lowest part of the heart shadow meet the diaphragm at a sharply defined angle? If not why not?
• does the dome of the diaphragm have a normal sweep? Why not?
• is the heart width less than twice the chest width (cardiothoracic ratio over 50% is abnormal e.g. in heart failure)
• does the outer edge of the diaphragm meet the pleura at a sharp acute angle? If not why not?
• is the sweep from the cardiophrenic angle to the lung apex symmetrical and equal? If not, why not?
• do the lung markings go from the mediastinum to all areas of the lung normally?
• check the skeleton. Fractured ribs are difficult to see but there may be signs of old fractures. They may be at different stages or places suggesting previous trauma. Bony metastases or osteoporotic signs may be seen.

10. Al-Jabbar: The Overpowering Lord Whoever recites Ya Jabbaru will not be subjected to coercion, and will not be exposed to violence, severity or harshness.