Chest x-ray review: everything else

Chest x-ray review is a key competency for medical students, junior doctors and other allied health professionals. Using A, B, C, D, E is a helpful and systematic method for chest x-ray review where E refers to "everything else".

Exposure (everything else)Reference article

At the end of the review, you need to remember to check forThis is a summary article; we do not have a more in-depth reference article.

Summary

• introduction
  • look things that don't fit into the A-D categories and to look at review areas:
    • apices
    • behind the heart
    • below the diaphragm
    • soft tissues abnormalities (e.g. absent breast shadow)

    Apices

    The problem with

• procedure
  • apices is that
    • many people forget to look above the clavicles. When reviewing a film, they start
    • look again at the clavicles and work down, forgetting that they need review the bit of lung above the clavicles. Don't miss a Pancoast tumour because you've failed to look above the clavicles!

      Behind

  • behind the heart

    Altered

    • altered density in the retrocardiac region can fool people into forgetting to review this area thoroughly. I means that it is very easy to miss left lower lobe collapse,be difficult
    • check for basal consolidation or a mass in this region.

      Below

    • fluid-level of hiatus hernia
  • below the diaphragm

    It is worth remembering that the

    • diaphragmatic contour is such that the most inferior portion of the lower lobe is actually below the linedome of the diaphragm on
    • the lungs extend posteriorly below the AP or PA chest x-ray. So, keep a diaphragm
    • look out for massesmass lesions below the diaphragm that are not immediately obvious on the film.

      Soft tissue

  • soft-tissue abnormalities

    There may be

    • gas in the soft tissues (surgical-tissues (surgical emphysema) which can be really easy to miss if you don't
    • look for it specifically. And a missingboth breast shaddowshadows in a patient with previous breast cancer is a really important finding to pick up - it might make you look more carefully for evidence of bone orfemale patients​
• checklist
  • apical lung metastases.tumour
  • left lower lobe collapse
  • hiatus hernia
  • breast shadows