Radiology, Reading a Chest X-Ray

Question 1

Mnemonic for reading chest x-rays:

Answer 1

Are there many lung lesions?

ATMLL:
Abdomen
Thorax and soft tissue
Mediastinum
Lung, unilateral
Lung, bilateral

Question 2

Abdomen, what to look for, how to read

Answer 2

Start from patient’s right side, left side of x-ray. Scan across the upper abdomen several times.

Normal gas-containing structures are the stomach and the splenic flexure of the colon. The liver is always visible. The hepatic flexure and the spleen may be visible.

Splenic flexure - The bend of the colon near the spleen; the junction of the transverse and descending colon. The splenic fixture is suspended from the diaphragm by the phrenocolic ligament, which passes over the lower part of the left kidney.

Hepatic flexure - The bend of the colon under the liver; the junction of the ascending and transverse colon. SYN: right colic flexure

Question 3

Mediastinum, how to read x-ray

Answer 3

Because there are multiple overlapping structures, an organized approach is needed.

Start with a global look for contour abnormalities (i.e., focal or diffuse widening).

Look for the:
Trachea and carina
Aorta and the heart
Hilum (left is higher than the right)

The following should be visible: trachea, carina, aortic arch or knob, descending and ascending aorta, heart, the left and right hilum.

Diaphragms: right is normally higher than the left, just the opposite of the hill.

Question 4

Thorax, how to read chest x-ray

Answer 4

Starting at the right lung base, look at the soft tissues of the chest wall (i.e., muscles, breast), the ribs, and the shoulder girdle in sequence. Finish by reviewing the left side in reverse order.

Check the heads of the clavicles to confirm that position is correct.

Question 5

Posterior ribs tend to be ____, while anterior ribs ____ from ___ to ___.

Answer 5

Posterior ribs tend to be horizontal.

Anterior ribs descend from lateral to medial.

Question 6

Lungs, how to evaluate

Answer 6

Lungs are evaluated last and are examined twice, once individually and then bilaterally.

Start with the right costophrenic angle, examine the right and then the left lung.

Finish with a side by side comparison, sweeping from the patient’s right to the left.

Question 7

A posteroanterior (PA) or an anteroposterior (AP) x-ray is always viewed as if your are facing the patient from

Answer 7

The front