CXR

Question 1

CXR interpretation: A (airway) - sequence and things to report?

Answer 1

Sequence:

Start at the top → find the trachea in the midline → trace it down to carina (where the trachea divides to two main bronchi) → right bronchus → return to carina → left main bronchus → angle of carina should be 50-100 degrees

Report:

1. Trachea is midline?
2. There is (or no) airway narrowing
3. The angle at carina is normal (50-100 degrees)

Question 2

CXR interpretation: B (breathing) - sequence (3) and things to report? (7)

Answer 2

Remember:

• whiter areas (increased density) → less gas in lungs
• darker areas (increased lucency) → more gas in lungs

procedure: (basically - volume, density, margins)

• Symmetry
• Check each zone in turn and compare with the other side (apices, UML zones)
  
  • Volume & density - any area of collapse or focal area of increased density?
• check around the lungs/borders comparing each step on both sides
  
  • Lateral margins
  • Costophrenic angles - sharp?
  • Trace hemidiaphragms to spine
  • Cardiac borders - crisp/clear?
• ​check behind the heart - can it be seen clearly?

Report:

1. Both lungs are expanded and similar volume
2. Apices, upper, middle, lower zones are symmetrical
   
   • ​​Areas of reduced volume or increased density
3. Normal (sharp/clear) lateral margins
4. Normal costophrenic angles
5. Normal hemidiaphragms
6. Normal cardiac borders
7. Normal lung behind the heart

Question 3

CXR interpretation: C (circulation) - things to report? (5)

Answer 3

procedure

• assess the position of the heart
  
  • is it on the left and is the apex pointing to the left
• assess the heart size
  
  • PA projection: should be <50% of the chest diameter
  • AP projection: will be artifactually enlarged
• aortic knob
  
  • should be on the left
• upper mediastinal contour
• pulmonary vessels
• hilar structures and the hilar point
  
  • left hilum usually higher than the right

checklist

• cardiac position
• cardiac size
• aortic arch
• upper mediastinum
• hilar vessels

Question 4

CXR interpretation: D (disability) - things to report? (1)

Answer 4

Check for the bones for # or mets.

• trace each of the ribs from posterior to anterior
  
  • #
  • Area of lucency/destructive lesion
• check the clavicles
• check the proximal humeri
• check the scapula
• look at each vertebral body (any loss of height)

Question 5

CXR interpretation: E (everything else) - things to report? (4)

Answer 5

Look for:

1. Lung apices (above clavicles)
2. Behind heart (left lower lobe collapse)
3. Below the diaphragm
4. Soft tissue abnormalities (e.g. surgical emphysema)

Question 6

Report the normal CXR for the long case.

Answer 6

This is AP/PA CXR taken for (…) on (date).

The most pertinent abnormality is (…) - If you can’t see it, skip.

In more detail,

Lines & Tubes: O2 tube, NG, ETT, PICC lines, devices.

A: trachea is in the midline. There is no obvious airway narrowing in the main bronchus with a normal carina angle.

B:

• Both lungs are symmetrical, similar in volume with no obvious areas of collapse (volume).
• There is no obvious area of increased opacity / reticular changes in both lungs
  
  • Comment on behind the heart.
• The lung borders, including lateral margins, CPA, hemidiaphragm, and cardiac border are clear

C:

• Position: heart is on the left with the apex pointing to the left
• Cardio-thoracic ratio is normal (or no cardiomegaly)
• Aortic knob is located on the left with normal upper mediastinal contour
• Pulmonary vessels appear normal
• There is no obvious hilar abnormalities

D & E:

• There are no obvious fractures in ribs, humerus, clavicle or spine
• Any other abnormalities below the diaphragm, soft tissues.

In summary, these findings are suspicious for (…) consistent with my clinical findings.