How to Read a Chest X-Ray: The ABCDE Approach
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Chest X-Ray Interpretation: ABCDE
Reading and interpreting chest x-rays is a useful skill to have, no matter what type of specialty you practice.
Chest x-rays are common, as they are often ordered for patients with chest pain, shortness of breath, respiratory symptoms, concerns for pneumonia, etc.
Therefore, having the skillset to read and interpret normal versus abnormal chest x-rays on your own is convenient.
But what is the best approach to reading chest x-rays, especially if you don’t have much experience?
Fortunately, this lecture will give you a simple memory trick and mnemonic using the ABCDE approach!
The ABCDE mnemonic helps make reading chest x-rays easier.
We will walk through the ABCDE method step-by-step, and you will quickly realize how simple this approach is to incorporate in your practice.
So if you want to learn how to read a chest x-ray with ease, then you have come to the right spot!
Let’s get started with the ABCDE mnemonic!
A - Airway
As mentioned above, the ABCDE mnemonic is a great method for reading and interpreting chest x-rays.
It provides a systematic approach to ensure that you don’t forget to look at something.
You’ll first start with “A”, which stands for “Airway”.
This is when you will interpret the parts of the airway visible on the chest x-ray.
This typically includes the trachea, the right main bronchus, the left main bronchus, as well as any portions of the airway distal to that.
Look for signs of tracheal deviation, filling defects, mass effect, or a foreign body that may have been aspirated.
B - Breathing
After assessing the airway, proceed to “B”.
“B” stands for “Breathing”.
This is when you will interpret both lungs.
Begin by looking at the lung borders, making sure that there are lung markings visualized out to the chest wall.
You are looking for any signs of pneumothorax, also known as a collapsed lung, in which there is an abnormal collection of air between the visceral and parietal pleura.
The presence of a pleural line on chest x-ray could indicate a pneumothorax.
After assessing the lung borders, compare and contrast both lungs in a “zig-zag” approach for any abnormalities.
Example abnormalities may include signs of pleural effusion, mass, or an opacity that could suggest pneumonia to name a few.
Lastly, make sure to observe any portions of lung visible below the hemidiaphragm on chest x-ray.
C - Cardiovascular/Circulation
After assessing the airway and lungs (breathing), move on to “C”.
The “C” stands for “Circulation or Cardiovascular”.
This is when you will assess the cardiomediastinal silhouette.
First, look at the right and left mediastinal borders, assessing the width of the mediastinum.
A widened mediastinum could potentially suggest an aortic dissection.
You are also looking for signs of pneumomediastinum, the presence of air in the mediastinum secondary to air escaping the lungs, airways, or bowel.
Next, assess the rest of the heart border.
You are looking to see if any portion of the heart border is obscured by an opacity, which could suggest pneumonia or other causes.
Assess the overall size of the heart as well for any signs of cardiomegaly.
Lastly, observe the right and left hilar regions as masses can present there.
D - Disability
Next, proceed to “D” which stands for “Disability”.
This is when you will assess the bones for fractures, dislocations, or any other abnormalities.
First, assess the proximal portion of the humerus available on x-ray, as well as the glenohumeral joint and scapula bilaterally.
Next, assess the right and left clavicle.
Third, assess each rib starting at the posterior aspect, follow it along the lateral border, and then assess any anterior portions available.
Lastly, take a look at the vertebral bodies. You can potentially pick up compression fractures or other abnormalities.
E - Everything Else
Lastly, “E” stands for “Everything Else” to help pick up the other aspects of the x-ray that have not yet been observed.
There are a few components to interpret here.
First, assess below the diaphragm (as well as the diaphragm itself) for any signs of free air. Observe the gastric bubble as well.
Next, look for any signs of subcutaneous air or emphysema.
Lastly, check for any tubes or lines in place such as an endotracheal tube, a central line, a nasogastric tube, etc.
Summary
Hopefully the ABCDE approach will give you a simple way to remember how to read and interpret chest x-rays.
Just remember the following:
A - Airway
B - Breathing
C - Circulation/Cardiovascular
D - Disability
E - Everything Else
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