Assessment of bones and soft tissue on chest x-ray

Described below are points to consider on assessment of bones and soft tissue on chest x-ray. 

• ribs
  • rib fractures
  • lesions (most commonly metastases): may appear as lucent and/or sclerotic; inverting contrast may help in identification
  • previous surgery, e.g. thoracotomy with rib resection
• vertebrae
  • fractures: compression are common traumatic fracture can be difficult to identify
  • lesions: commonly incidental benign (e.g. haemangioma) and less commonly skeletal metastases
• pectoral girdle: fractures, distal clavicular erosion, sclerosis
• soft tissue
  • asymmetric soft tissue may indicate a mastectomy (common), soft tissue mass or Poland syndrome
  • surgical clips, e.g. lobectomy, pneumonectomy, mastectomy, axillary clearance, thyroidectomy
  • subcutaneous emphysema and soft tissue injuries