Clinical Evaluation

• Clinical Evaluation:

  • Airway
  • Bones & soft tissues
  • Cardiac shadow, mediastinum & hilum
  • Diaphragm and lung fields
• Airway:

  • trachea: should be central with spinous process, filled with air, same width whole way down, potential presence of endotracheal tube
  • carina: where trachea bifurcates into 2 main bronchi, just below level of aortic arch
• Bones:

  • lots of bones can be seen in chest x-ray
  • check for rib fractures (usually occur laterally)
  • check for osteoporosis (should be seen as black due to a loss of bone density)
  • Soft tissue: fat, muscle and skin around chest wall
  • should be white
  • there should be no air in soft tissue so check for black
• Cardiac:

  • check orientation (1/3 to right 2/3 to left) of heart
  • check for aortic arch
  • check for clear border of heart
  • Hilum: patients pulmonary artery and pulmonary veins and lymph nodes - seen as white on both sides of heart
  • check if widest part of heart fits into one half chest, if its larger its an enlarged heart
• Diaphragm:

  • dome shaped
  • gastric bubble under left diaphragm
  • cardiophrenic angle: between heart and hemidiaphragm - 90 degrees
  • costalphrenic angle: between ribs and hemidiaphragm - more acute angle
  • lung markings - white seen in lungs is the blood vessels, absences of these could show lung disease