Review areas

These review areas are sites where pathology is commonly missed and warrant a second look before any chest X-ray is reported as normal:

■ Breasts (symmetry/mastectomy).

■ Below the diaphragm, do not forget that the lungs extend below the diaphragms, also look at the upper abdomen for surgical clips/ calcification/pneumoperitoneum.

The 'normal' chest X-ray in examination vivas

Behind the heart (hiatus hernia/lung nodules/left lower lobe collapse).

Thoracic spine and paraspinal lines (trauma).

Clavicle (nodule behind medial end and eroded lateral end).

Shoulder (dislocation).

Apices (pancoast tumour).

Hila (assess position, size and density).

Lung parenchyma.

Bones, especially ribs (look for metastases or fractures).

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