Chest Radiograph - Problems Identified

Problems Identified

Chest radiographs are used to diagnose many conditions involving the chest wall, bones of the thorax, and structures contained within the thoracic cavity including the lungs, heart, and great vessels. Pneumonia and congestive heart failure are very commonly diagnosed by chest radiograph. Chest radiographs are used to screen for job-related lung disease in industries such as mining where workers are exposed to dust.

For some conditions of the chest, radiography is good for screening but poor for diagnosis. When a condition is suspected based on chest radiography, additional imaging of the chest can be obtained to definitively diagnose the condition or to provide evidence in favor of the diagnosis suggested by initial chest radiography. Unless a fractured rib is suspected of being displaced, and therefore likely to cause damage to the lungs and other tissue structures, x-ray of the chest is not necessary as it will not alter patient management.

The main regions where a chest X-ray may identify problems may be summarized as ABCDEF by their first letters:

• Airways, including hilar adenopathy or enlargement
• Breast shadows
• Bones, e.g. rib fractures and lytic bone lesions
• Cardiac silhoutte, detecting cardiac enlargement
• Costophrenic angles, including pleural effusions
• Diaphragm, e.g. evidence of free air, indicative of perforation of an abdominal viscus
• Edges, e.g. apices for fibrosis, pneumothorax, pleural thickening or plaques
• Extrathoracic tissues
• Fields (lung parenchyma), being evidence of alveolar filling
• Failure, e.g. alveolar air space disease with prominent vascularity with or without pleural effusions