INDICATIONS

The chest radiograph (CXR) is the most commonly ordered plain film in emergency medicine and has correspondingly broad indications. It is ordered to evaluate patients with chest pain, breathing complaints, thorax trauma, fevers, and altered mental status. Patients who complain of chest pain have a broad differential diagnosis, and CXR is one of the first screening tests to be applied in chest pain complaints. This study is relevant when cardiac or pulmonary processes are suspected. CXR should be obtained when patients are suspected of having an occult infectious process, presenting with fever, altered mental status, or hypotension. A screening CXR helps initially evaluate patients for thoracic injury after thoracoabdominal trauma.

DIAGNOSTIC CAPABILITIES

CXR is useful to diagnose or identify primary cardiac and pulmonary pathology, abnormal pleural processes, thoracic aortic dilation, aspirated foreign bodies, and thoracic trauma. In cardiac disease, the CXR reveals pulmonary edema, moderate to large pericardial effusion, and cardiomegaly. CXR shows multiple primary pulmonary processes. It reveals infectious processes, such as lobar pneumonia, tuberculosis, atypical pneumonia, empyema, and lung abscess. Pulmonary processes such as pneumonitis, hyperaeration due to chronic obstructive pulmonary disease (COPD) and asthma, and lung masses are evident on CXR. Pleural processes such as pleural thickening, pneumothorax, hemothorax, and pleural effusions are also evident on CXR.