Thorax PA projection, L83, Thorax, Atlas of Radiologic Anatomy, Lothar Wicke

Thorax PA projection - How to read 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?
• The film is well penetrated and symmetrical
• The breast shadows are present and equal
• No Nipple Shadows
• No artifacts present
• is the image centred? – inner clavicles should be the same distance from the midline
• The Image is centered
• is the trachea central?
• The trachea is central
• Carina - Bifurcation of trachea
• follow the mediastinal outline downwards. Are their any bumps that shouldn’t be there? What might they be?
• Left
• Aortic arch
• Pulmonary Vein
• Left Auricle
• Left Ventricle
• Right
• Superior Vena Cava - T3
• Right Atrium
• Inferior Vena Cava
• does the lowest part of the heart shadow meet the diaphragm at a sharply defined angle? If not why not?
• Yes
• does the dome of the diaphragm have a normal sweep? Why not?
• Yes
• is the heart width less than twice the chest width (cardiothoracic ratio over 50% is abnormal e.g. in heart failure)
• Yes
• does the outer edge of the diaphragm meet the pleura at a sharp acute angle? If not why not?
• Yes
• Costodiaphragmatic recess sharp
• is the sweep from the cardiophrenic angle to the lung apex symmetrical and equal? If not, why not?
• Yes
• do the lung markings go from the mediastinum to all areas of the lung normally?
• Yes
• Left Primary Bronchus
• Pulmonary Vein
• 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.
• No fractures
• Medial Margin of the Scapula
• Superior Angle of the Scapula
• Clavicles
• 1st Rib

Other

• Fundus of Stomach

The main regions where a chest X-ray may identify problems may be summarized as ABCDEF by their first letters:^[3]

• Airways, including hilar adenopathy or enlargement
• Breast shadows
• Bones, e.g. rib fractures and lytic bone lesions
• Cardiac silhoutte, detecting cardiac enlargement
• Costophrenic angles, including pleural effusions
• Diaphragm, e.g. evidence of free air
• Edges, e.g. apices for fibrosis, pneumothorax, pleural thickening or plaques
• Extrathoracic tissues
• Fields (lung parenchyma), being evidence of alveolar filling
• Failure, e.g. alveolar air space disease with prominent vascularity with or without pleural effusions