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Chest Film Search Pattern

David S. Feigin, M.D.

PRELIMINARIES

  • Verify patient information and date on both films and position of LEFT or RIGHT marker on frontal.
  • Note adequacy of penetration and any technical defects.
  • Look briefly at the entirety of both films for obvious abnormalities.

 

FRONTAL

  1. Study the lungs, both up and down and side to side. Include lung volumes and symmetry of markings.
  2. Check periphery of lungs for pneumothorax and effusions.
  3. Evaluate mediastinal contours, edges and shape.
  4. Follow trachea to carina and main bronchi.
  5. Look at both hila for enlargement and abnormal bulges.
  6. Trace periphery of the chest – neck, chest wall, bones, diaphragms. Check the upper abdomen for free air and abnormal air collections

 

LATERAL

  1. Judge the size and shape of the lungs and diaphragms.
  2. Follow the airway from neck to hilum. Note shape of pulmonary arteries.
  3. Note back of heart and darkening toward diaphragm.
  4. Look upward for darkening of anterior mediastinum to the neck.
  5. Follow the spine downward for vertebral bodies and darkening.
  6. Trace periphery – forward through abdomen, up anterior chest wall and down posterior ribs to the costophrenic angles.


REQUIRED STRUCTURES

FRONTAL

A. Lungs

  • Markings (Vessels)
  • Minor Fissure (not always visible but must know location)

B. Mediastinum

  • SVC
  • Right Paratracheal Line
  • Right Atrium
  • Left Ventricle
  • Main Pulmonary Artery (Trunk)
  • Aortic Knob
  • Descending Aorta
  • Left Paratracheal Edge

C. Airways

  • Trachea
  • Carina
  • Main Bronchi

D. Hila – Left and Right Pulmonary Arteries

E. Soft Tissues

  • Neck
  • Chest Walls
  • Breast Shadows
  • Diaphragms
  • Bowel Gas

E. Bones

  • Ribs (Anterior and Posterior)
  • Clavicles
  • Scapulae
  • Humeri
  • Spine
  • Bodies and Disc Spaces
  • Spinous Processes
  • Pedicles


LATERAL

A. Airways

  • Trachea and Main Bronchi
  • Left Bronchus on End

B. Hila – Left and Right Pulmonary Arteries

C. Lungs

  • Markings
  • Fissures – Major, Minor (not always visible but must know location)

D. Heart

  • Left Ventricle
  • IVC

E. Posterior Chest

  • Spine – Bodies and Disc Spaces
  • Ribs

F. Diaphragms, Costophrenic Angles and Bowel Gas

G. Anterior Chest

  • Chest Wall
  • Sternum

 

David S. Feigin, M.D., Professor of Radiology, Johns Hopkins University

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