Chest X-Ray | How to Interpret A Chest X-Ray

Chest X-Ray | A Short Review on X-Ray Chest. The chest X-Ray (CXR) is performed to evaluate the lungs, heart and chest wall. Normal CXR is taken with the patient in an upright position. Routine Chest X-Ray is taken in a frontal view which is referred to as posterior-anterior or PA view. The other views of CXR include lateral view, apical view and lateral decubitus views.

How to Interpret A Chest X-Ray

“Normal Chest X-Ray”

First look at the trachea whether it is shifted or not.

A well-centred x-ray. Medial ends of clavicles are equidistant from the spinous process

Divide The Lung Field into Three Zones

Assessment of the position of the Diaphragm

Normally  anterior end of 6th rib touches the diaphragm and posterior end of 10th rib touches the diaphragm. The Diaphragm will be told low if  7th rib touches the anterior end and 11th rib touches posterior end.

Carefully examine each diaphragm

Assessment of Heart Size

Some Easy Clue to Reach the Diagnosis by Reading the Chest X-Ray

If you see in x-ray major  portion of one side is White then it mostly likely pleural effusion . but exclude the consolidation

Pleural effusion:

·         milky and bright white than that of consolidation.

·         Now look angle (costo and cardio phrenic ) it will be obliterate . This two are the more important point of  pleural effusion .

·         Now look at upper border it will concave upward.

·         If trachea shifted 100% chance of pleural effusion. remember in p.E. trachea may not shift until massive 

In case  of consolidation

·         hazy white / less white than PE

·         Usually angle are clear unless it in lower ZONE

·         Upper border usually  irregular 

·         Trachea never shift

If in an x-ray u show one side is more black and another side is normal then maybe it is  pneumothorax

·         Pneumothorax


·         Now carefully look vascular marker with comparing the opposite u will see that it absent.

·         If look medially to that pneumothorax side  will see a small white things at near hilum it is collapsed lung

If u see in X-ray at one side upper half is black and lower portion is white as pleural effusion and these are separated by clear-cut horizontal line (fluid level )


If see any things like white egg (dim) in a X-ray. or rounded or circumscribed and margin may be irregular then it is

Mass lesion


Look carefully rib destruction present or not

If you  see anything like  white egg (dim ) in that egg that mean rounded lesion air fluid level

Lung abscess


Air fluid level (in that rounded lesion upper portion will be black and lower portion will b

White and separated by horizontal line )

If you see multiple egg (dim ) of variable size then it will

Secondaries in the lung


In a x-ray u may show both side more black than usual x-ray . to u this Xray seems to larger than as usual


It emphysema or COPD

Confirm it by counting that costophrenic end of diaphragm below the ant.end 6 rib or post end of 10 rib

If you see in x-ray that there is multiple dots of 1-2 mm are in both lung field 

Milliary TB


Skull  it may be haemolytic  or multiple myeloma

If u see multiple black dot of variable size no doubt it is MM

 If black dot absent  then it is haemolytic anemia . if u look upper border of skull  u will see think double borders (hair on appearance)

If you see any X-ray of hand it will

Rheumatoid hand in your level

If you see any X-ray LS spine then the it may be

Pott’s or ankylosing spondylitis

First exclude ankylosing  where your got

·         White thick vertical line along mid vertebral body (calcification of ant longitudinal ligament )

·         All the or most vertebral body are fused with each other laterally (syndesmophyte )

·         X-ray film is contain lumber and sacral vertebra mainly

If not find  these two then it pott,s . now find out the number of collapsed vertebra . at that vertebra level you don’t find and intervertebral disc

It mainly contain thoracic and lumbar vertebra


If  see any X-ray where hear is pear or guava  ) shape then it is pericardial effusion IN your level

Pericardial effusion


Pear shape , lung is olgemic (slightly black and vascular marker are less prominent )

Multiple valvular heart disease


If lung is not olgemic rather plethoric (vascular marker are more prominent )  u have not remember this

If you show and patchy (soft 3-4 cm) over lungs usually upper or lower zone then it is

Pulmonary TB




Dr. Shahidullah Shamol (FCPS in Medicine)

Assistant Professor, Department of Medicine

Mymensingh Medical College/tr (syndesmophyte )

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