Differences in PA versus AP projection on a chest radiograph

Case contributed by Yi-Jin Kuok
Diagnosis not applicable

Presentation

Motor bike accident

Patient Data

Age: 30
Gender: Male

The superior mediastinum appears widened due to AP magnification.

The heart appears enlarged - a combination of AP magnification and underinflation

There appears to be a bilateral interstitial infiltrate/airways thickening - probably also due to underinflation.

Same patient, repeat CXR the next day (PA projection this time) - normal inferring that the “abnormalities” seen the previous day were likely spurious

Case Discussion

Projection and degree on inspiration are important to note when interpreting chest x-rays. 

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