1. Chest Xrays

2. A=trachea, B=carina, C=right atrium, D=aortic knuckle, E=cardiophrenic angle, F=left ventricle, G=clavicle, H=hemidiaphragm, I=gastric air bubble, J=hilar points, K=rib, L=lung, M=costophrenic angle, N=breast shadow, O=thoracic spine

3. Intro
This is a chest radiograph of Mr X who presented with SOB and weight loss
This is an AP/PA chest radiograph…
The radiograph is adequate
Penetrance is… (vertebrae)
Rotation adequate (distance between two clavicles)
Exposure adequate (can see all of patient!)

5. The most obvious abnormality is…
Consolidation, opacity, loss of lung fields, meniscal sign…etc in the ……

6. A - airway
Trachea central?

7. B - Breathing Lung fields visible? Prominent hila?
Lymphoma, sarcoidosis, tb, malignant lymphodenopathy
Lung fields not visible?
Pneumothorax (always – tracheal deviation) Rx attempt aspiration if fails chest drain
Primary causes: CT disorders e.g. Marfan’s, Ehler’s Danlos
Secondary causes: trauma, tumour, infection
Tension pneumothorax (always + tracheal deviation)
Consolidation
Upper lobe pneumonia is tb or carcinoma (usually small cell) until proven otherwise
Mass (tumour, hamartoma, tb abscess, aspergillus)

8. C - Circulation Cardiac silhouette visible? Cardiomegaly if PA?
Check behind heart for tumours
Cardiophrenic angles?

9. D - Diaphragm Costophrenic angles? Pneumoperitoneum
Meniscal sign = effusion
Unilateral effusion is usually exudative i.e. Light’s criteria protein >30g causes incl trauma, tumour, infection
Bilateral effusion usually transudative i.e. Light’s criteria protein <30g, causes are heart failure and hypoalbuminaemia (due to malnutrition, liver failure, nephrotic syndrome)
Pneumoperitoneum

10. E – everything else
No obvious bony abnormalities or sclerotic lesions

11. In summary…
This is a 65yo man who presented with SOB and weight loss. The most obvious abnormality is complete opacity of the right lower zone with obliteration of the costophrenic and cardiophrenic angles and meniscal sign consistent with a diagnosis of pleural effusion.

13. Left lower lobe pneumonias cause loss of L hemidiaphragm and L heart border Right lower lobe pneumonias cause loss of R hemidiaphragm…. Right MIDDLE lobe causes loss of L heart border Easiest to refer to “zones”!