page_title: Chest radiograph
section_title: Landmarks
hierarchical_section_title: Chest radiograph / Landmarks
caption_attribution_description: English: Mediastinal structures on a chest radiograph.
context_page_description: A chest radiograph, called a chest X-ray, or chest film, is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are the most common film taken in medicine.
  Like all methods of radiography, chest radiography employs ionizing radiation in the form of X-rays to generate images of the chest. The mean radiation dose to an adult from a chest radiograph is around 0.02 mSv for a front view and 0.08 mSv for a side view. Together, this corresponds to a background radiation equivalent time of about 10 days.
context_section_description: In the average person, the diaphragm should be intersected by the 5th to 7th anterior ribs at the mid-clavicular line, and 9 to 10 posterior ribs should be viewable on a normal PA inspiratory film. An increase in the number of viewable ribs implies hyperinflation, as can occur, for example, with obstructive lung disease or foreign body aspiration. A decrease implies hypoventilation, as can occur with restrictive lung disease, pleural effusions or atelectasis. Underexpansion can also cause interstitial markings due to parenchymal crowding, which can mimic the appearance of interstitial lung disease. Enlargement of the right descending pulmonary artery can indirectly reflect changes of pulmonary hypertension, with a size greater than 16 mm abnormal in men and 15 mm in women.
  Appropriate penetration of the film can be assessed by faint visualization of the thoracic spines and lung markings behind the heart. The right diaphragm is usually higher than the left, with the liver being situated beneath it in the abdomen. The minor fissure can sometimes be seen on the right as a thin horizontal line at the level of the fifth or sixth rib. Splaying of the carina can also suggest a tumor or process in the middle mediastinum or enlargement of the left atrium, with a normal angle of approximately 60 degrees. The right paratracheal stripe is also important to assess, as it can reflect a process in the posterior mediastinum, in particular the spine or paraspinal soft tissues; normally it should measure 3 mm or less. The left paratracheal stripe is more variable and only seen in 25% of normal patients on posteroanterior views.
  Localization of lesions or inflammatory and infectious processes can be difficult to discern on chest radiograph, but can be inferenced by silhouetting and the hilum overlay sign with adjacent structures. If either hemidiaphragm is blurred, for example, this suggests the lesion to be from the corresponding lower lobe. If the right heart border is blurred, than the pathology is likely in the right middle lobe, though a cavum deformity can also blur the right heard border due to indentation of the adjacent sternum. If the left heart border is blurred, this implies a process at the lingula.
caption: Mediastinal structures on a chest radiograph.
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