Chest x-ray review: circulation

Last revised by Dr Jeremy Jones on 14 Aug 2021

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 C refers to circulation and assessment of the heart and cardiomediastinal contour.

Summary

  • introduction
    • assessment of the mediastinum
    • predominantly about the heart
    • remember the other structures in the mediastinum
  • 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 knuckle
      • 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 and upper mediastinum
    • hilar vessels

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Cases and figures

  • Chest x-ray - circulation
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