What to look for in the apparently normal radiograph
If the chest radiograph appears normal then the following should be checked for: (1,2)
- a mastectomy
- a small apical pneumothorax
- a fluid level below the heart, due to a hiatus hernia
- collapse of the right middle lobe and loss of clarity of the right heart border
- absence of the outline of the left diaphragm behind the heart (sail sign) as a result of left lower lobe collapse
- deviation of the trachea
- paratracheal lymphadenopathy
- air beneath the diaphragm
- dextrocardia with the film reversed
- always check the apices, hila, behind the heart and the costophrenic angles
Reference
- Kelly B. The chest radiograph. Ulster Med J. 2012 Sep;81(3):143–148.
- Hodler J et al. Diseases of the Chest, Breast, Heart and Vessels 2019-2022: Diagnostic and Interventional Imaging [Internet]. A Systematic Approach to Chest Radiographic Analysis. Published online: February 20, 2019.
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