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What to look for in the apparently normal radiograph

Authoring team

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

  1. Kelly B. The chest radiograph. Ulster Med J. 2012 Sep;81(3):143–148.
  2. 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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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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