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Chest x-ray review: everything else

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 E refers to "everything else".

Summary

  • introduction
    • look at things that do not fit into the A-D categories and review areas
      • apices
      • behind the heart
      • below the diaphragm
      • soft tissues abnormalities (e.g. absent breast shadow)
  • procedure
    • apices
      • many people forget to look above the clavicles
      • look again at the lung above the clavicles
    • behind the heart
      • altered density in the retrocardiac region can be difficult
      • check for basal consolidation or a mass in this region
      • fluid-level of hiatus hernia
    • below the diaphragm
      • diaphragmatic contour is the dome of the diaphragm
      • the lungs extend posteriorly below the diaphragm
      • look out for mass lesions below the diaphragm
    • soft-tissue abnormalities
      • gas in the soft-tissues (surgical emphysema)
      • look for both breast shadows in female patients​
  • checklist
    • apical lung tumor
    • left lower lobe collapse
    • hiatus hernia
    • breast shadows

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