Chest x-ray review: circulation

Last revised by 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.


  • 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

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Chest x-ray - circulation
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.