Chest X-Ray Interpretation
Systematic CXR interpretation: use the mnemonic 'ABCDE' — Airways, Bones, Cardiac, Diaphragm/Drains/Devices, Everything else (lungs/pleura).
Key findings: - Consolidation: airspace opacity with air bronchograms → pneumonia, lung contusion, pulmonary edema - Atelectasis: volume loss, shift toward opacified area, elevated hemidiaphragm - Pneumothorax: visceral pleural line, absence of lung markings, mediastinal shift away (tension) - Pleural effusion: blunting of costophrenic angles, meniscus sign, >200 mL to see on PA CXR - Cardiomegaly: cardiothoracic ratio >0.5 on PA film - Pulmonary edema: bat-wing pattern, Kerley B lines, cephalization of vessels, increased cardiac silhouette
- Consolidation with air bronchograms = pneumonia or pulmonary edema
- Tension pneumothorax: tracheal deviation AWAY from affected side
- Pleural effusion: costophrenic blunting (>175–200 mL required to see on upright PA)
- Kerley B lines: horizontal lines at lung bases = interstitial pulmonary edema
- ET tube tip: should be at T4 level, 2–4 cm above carina
In tension pneumothorax, DO NOT wait for CXR if patient is hemodynamically compromised — decompress immediately with 14–16g needle in 2nd ICS midclavicular line.