Presenting a CXR: ABCDE

Question 1

How could you present a CXR? ABCDE

Answer 1

-Airway: trachea, carina, bronchi and hilar structures.

-Breathing: lungs and pleura.

-Cardiac: heart size and borders.

-Diaphragm: including assessment of costophrenic angles.

-Everything else: mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas.

Question 2

Airways: what will you look for?

Answer 2

Is the trachea central or deviated to one side? Look at the carina, bronchi and hilar region.

If it is PE or Pneumothorax, it exerts a mass effect and pushes it away from the side with an anomaly.
A collapse in the lung/lobe pulls it towards it.

Question 3

Breathing: what will you look for?

Answer 3

Look at the lungs

Look at the pleura - should not normally be seen on a CXR. Just check that the lung markings extend throughout the edges lung fields.

Question 4

Cardiac: what will you look for?

Answer 4

Heart size and borders

The heart should be less than 50% of the size of the thoracic window.

Remember, AP X-rays exaggerate the heart size.

Question 5

Diaphragm: what will you look for?

Answer 5

Look at the costophrenic angle - the anlge at which the diaphragm meets the ribs. They should be acute and well-defined. If it is lost or bigger, then this is known as costophrenic blunting. This is usually due to fluid or hyperinflation of the lungs.

The diaphragm is usually higher on the right side due to the liver. The left diaphragm to look for some gastric fundus which may show gas or fluid.

Question 6

Everything else: what will you look for?

Answer 6

Mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas.