How to read chest X-Ray?

          HOW TO READ CHEST X-RAY

Reading a chest X-ray (CXR) is a core skill in radiology and clinical practice. Here's a structured, step-by-step approach to reading and interpreting a chest X-ray like a professional:

✅ 1. Patient and Image Details

  • Check patient info: Name, age, sex, and date of the X-ray.
  • Projection type: PA (posteroanterior) vs. AP (anteroposterior) vs. lateral.
  • Image quality:
    • Position: Patient should be straight (check clavicles and spinous processes).
    • Inspiration: Should see at least 6 anterior or 10 posterior ribs.
    • Exposure: Spine just visible behind the heart.


🔍 2. Systematic Review – Use an ABCDE Approach

A – Airways

  • Trachea: Is it central or deviated?
  • Carina: Sharp angle (around 60°).
  • Main bronchi: Any obstruction, collapse, or foreign body?

B – Breathing (Lungs & Pleura)

  • Compare lung fields side-by-side.
  • Look for:
    • Opacities (e.g., consolidation, collapse, mass)
    • Hyperlucency (e.g., pneumothorax, emphysema)
    • Lung volume changes
  • Pleura: Any thickening, effusion, or pneumothorax?
    • Pneumothorax: Look for absence of lung markings at periphery.

C – Cardiac Silhouette & Mediastinum

  • Heart size: <50% thoracic width in PA view is normal.
  • Borders: Right = RA, Left = LV.
  • Aorta and mediastinum: Widening may suggest aneurysm or mass.

D – Diaphragm

  • Right is normally slightly higher than the left.
  • Costophrenic angles: Should be sharp—blunting = pleural effusion.
  • Free air under diaphragm = perforated hollow viscus.

E – Everything else

  • Bones: Ribs, clavicles, scapulae, vertebrae for fractures or lesions.
  • Soft tissues: Swelling, subcutaneous emphysema.
  • Tubes/lines: Check position of central lines, ET tubes, NG tubes, pacemakers, etc.


🔁 Compare

  • With previous X-rays if available.
  • Look for interval changes (improvement, worsening, or new findings).

⚠️ Common Abnormalities

Finding Possible Diagnosis
Consolidation    Pneumonia
Cavitation TB, abscess
Effusion CHF, malignancy, infection
Collapse Obstruction, mucus plug
Pneumothorax Trauma, COPD
Cardiomegaly Heart failure
Kerley B lines Pulmonary edema

🧠 Tips

  • Always correlate with clinical findings.
  • If unsure, describe what you see using radiologic terms (e.g., "right lower zone opacity with air bronchograms").


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