This document provides guidance on interpreting chest x-rays (CXRs) through a systematic ABCDE method. It reviews basic thoracic anatomy and common findings seen on CXRs in inpatient settings. Examples are given of CXR interpretations for various clinical scenarios, including correctly and incorrectly placed feeding tubes and central lines. Key points on interpreting lobar consolidation, pulmonary edema, pleural effusions, and possible COVID-19 are also summarized.

1. CHEST XRS
GENERAL INTERPRETATION
SARAH LAWRENCE
ID/GIM ST4

2. LEARNING
OBJECTIVES
Revise basic thoracic anatomy in relation to
CXRs
Develop a systematic method of interpreting
CXRs
Recognise presentations on CXR commonly
encountered in an inpatient setting
Learn how to correctly interpret NGT and PICC
line placement

3. A QUICK REFRESHER
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4. ABC OF CXR
INTERPRETATION
A- Airway
B- Breathing
C- Circulation
D- Duh!
-Artefacts
-Devices
E- Everything else
-Soft tissue
-Bone
-Review areas
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5. 67 year old man undergoes
open total gastrectomy. 2
days post-op, he develops a
productive cough and
spikes a temperature
Atelectasis
NOW FOR SOME
PRACTICE

6. 25 year old woman
presents to A&E unwell
with RUQ pain. She has
deranged LFTs on her
bloods.
Atypical pneumonia (R
lower lobe)
NOW FOR SOME
PRACTICE

7. Consolidation will appear as
a similar density to
adjacent soft tissue.
To determine where
consolidation is, look at
which border is lost:
diaphragm or heart.
RLL = Diaphragm border lost
RML = Heart border lost
LOBAR CONSOLIDATION

8. NOW FOR SOME
PRACTICE
78 year old woman
presents with worsening
breathlessness and a long
history of fatigue.
LL collapse and upper
mediastinal mass

9. 81 year old man with COPD
presents with increased
SOB.
Pulmonary oedema
-Alveolar shadowing
-Kerley B lines
-Cardiomegaly
-Upper lobe Diversion
-Pleural Effusion
NOW FOR SOME
PRACTICE

10. A 52 year old man with
laryngeal surgery presents
with aspiration pneumonia.
A NGT is passed.
Incorrectly placed NGT
NOW FOR SOME
PRACTICE

11. NGT CXR
INTREPRETATION
Bisects the carina/main bronchus
Descends in the midline
Tip visible below the diaphragm, ideally within the stomach
bubble
Pitfalls: NGT in the oesophagus, bendy oesophagi, below the
diaphragm but in the lower lobe

13. A 52 year old man with
laryngeal surgery presents
with aspiration pneumonia.
A NGT is passed.
Correctly placed NGT
NOW FOR SOME
PRACTICE

14. 64 year old IFU patient has
a PICC inserted for TPN.
Correctly placed PICC
NOW FOR SOME
PRACTICE

15. PICC CXR
INTERPRETATION
Distal tip should be in the lower 1/3
of the SVC, just above the cavoatrial
junction
The carina can be used as a guide

16. 59 year old woman with a
previous history of breast
cancer presents with 3
weeks of increasing SOB
and R pleuritic chest pain
Bilateral pleural effusions
R>>L (?metastatic)
NOW FOR SOME
PRACTICE

17. 70 year old man with IHD is
admitted with 7 days of
fever, dry cough and SOB
Bilateral patchy mainly
peripheral consolidation
(suggestive of Covid-19)
NOW FOR SOME
PRACTICE

18. drsarahlawrence@gmail.com
THANK YOU