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 B refers to breathing and the assessment of the lungs and pleural spaces.
Summary
-
introduction
- large number of processes that cause lung abnormality
- aeration of the lungs is often altered by pathology
- whiter areas (increased density)
- less gas in the lungs
- darker areas (increased lucency)
- more gas in the lungs
- whiter areas (increased density)
-
procedure
- check for symmetry (allowing for mediastinum)
- check each zone in turn and compare with the other side
- apices, upper, middle and lower zones
- check volume and density
- look for any focal areas of increased density
- check around the lungs comparing each step on both sides
- start at the apex and trace down the edges of the lungs
- check the costophrenic angles are sharp
- trace the hemidiaphragms to the spine
- check the cardiac borders are crisp and clear
- check the hilar structures can be seen clearly
-
checklist
- both lungs are expanded and similar in volume
- apices, upper, middle and lower zones are symmetrical
- normal lateral margins
- normal CPAs
- normal hemidiaphragms
- normal cardiac borders
- normal lung behind the heart