Article · Clinical
Common Chest X-ray Findings — A Field Guide
Common chest X-ray findings reported in routine practice include consolidation (pneumonia), pleural effusion, cardiomegaly, pulmonary nodule, pneumothorax, hyperinflation (COPD), interstitial changes, rib fractures, and mediastinal widening. This guide describes the radiographic features of each.
A field guide to the chest X-ray findings you see every day.
Consolidation
Homogeneous opacity with air bronchograms; obscures the adjacent silhouette. Lobar consolidation → bacterial pneumonia. Patchy/multifocal → atypical or viral pneumonia.
Pleural effusion
Blunting of costophrenic angle on PA, meniscus sign on lateral; large effusions cause mediastinal shift away.
Cardiomegaly, pneumothorax, nodule
Cardiomegaly = cardiothoracic ratio >0.5 on PA. Pneumothorax = visible visceral pleural line with no lung markings peripherally; tension if mediastinal shift away. Solitary pulmonary nodule = rounded opacity <3 cm; >3 cm = mass.
Quick facts
- Air bronchograms point to consolidation
- Blunted costophrenic angle = effusion until proven otherwise
- Tension pneumothorax shifts mediastinum away