So you want to know how to read a chest next, right? Do you? I think I didn't teach you a thing or two. Let's go! Alright guys, so today we are going to be discussing how to read a chest x-ray. Again, this is my search pattern. It is not necessarily the best search pattern. This is just what I have adopted over the last few years. So let's get started. The first thing I do always is, do an overall look at the patient. I want to know if the patient is really sick. Are they an outpatient? Like this one is, when they can stand up. As you notice, this is an upright radiograph. I guess they could be sitting down, but this patient looks well enough that they could be probably standing during this one. So the next thing I do is go straight to the long apesies. I'm trying to rule out a pneumothorax, is that is one of the most important things you can see on an x-ray. So what I do is, I zoom in real closely to the long apesies. I make sure there's no fine linear plural line up here that would indicate a pneumothorax. There isn't on this patient. So then what I do is, I go down to the long bases, because sometimes you can have a nice linear plural line down here, which would indicate a bazzle component of a pneumothorax or even a lock-related bazzle or pneumothorax down here. Sometimes if I'm having trouble deciding if there's a pneumothorax or not, I can switch to the inverted windows, which can sometimes give you a nice contrast between the plura and the adjacent ribs or whatnot. All right, so the next thing I do is go straight to the bones. And I know it's weird, but I've seen so many missed fractures on a chest x-ray, and I don't want to miss those, so I just straight to the bones to make sure I know that I look at them. So what I do is, I start up at the right shoulder, so I take a look at the right humerus, on into the glenohymeral joint, follow down the scapula, take a look at the distal right clavicle, down to the sternopelicular junction, follow it on to the left clavicle, down distally, take a look at the scapula, and to the glenohymeral joint on the left, and any portion of the visualized proximal left humerus. Then what I do is, I start at the right first posterer rib, and I count each posterer rib on down. I do this quickly with my eyes, but for the sake of this video, you'll see me follow each posterer rib. Then what I do is, I come over on the left, follow all the posterer ribs up, so sometimes you can see a nice posterer rib fracture on these right ear graphs. After I've cleared the posterer portion of the rib, I will take a look at the lateral aspect of the rib, or the posterer lateral rib. For this, I usually like to zoom up a little bit. You'll be able to see a nice displaced rib fracture out here, which you often are able to pick up. Again, I follow this up on the right, and once I've cleared that, I go to my spine. Sometimes you can window really hard to take a look at your vertebral bodies, and make sure you're not missing any compression fracture. Once I've cleared the bones, I start with my cardio-media-stinal silhouette. What I do is, I follow the right side of the medium-stinal silhouette down, making sure there's no medius-stinal widening. Follow this on down through my right heart-forward, make sure it's not obscured, or silhouetteed out by some consolidated opacity, like in pneumonia. Again, I come down lower, and I go to the heart-forwarder, really pay attention to this AP window here, just below the aorta knob, because you can have nice little enlarged left nodes or masses that like to live in this region. Same dose for the right-hiler, and left-hiler region as well. You can find a nice mass in there that'll bow this out subtly. Then what I do is, I follow my medius-stinal border on up as well. Next, what I finally do, I lifted the airways and the lungs. So what I do is, I follow down my traitia onto the right main stem broncus, and left main stem broncus, making sure there's no filling defects, or mass within the traitia, or foreign body, which would be aspirated. I then take a look at my lungs. I do an overall feel for what the lungs look like, like to right and left. Then what I do is, I compare each side in a zigzag sort of manner, and over here, and then what I do is, the opposite zigzag on the way back, comparing right and left, right and left, right and left. Really paying attention to any opacity that will catch my eye. Once I do that, I window really hard below the diaphragm, because as you notice, there's a lot of longlets just below this diaphragm, and you can see through the diaphragm to see it. Then what I do is, I take a look to make sure I'm not missing any free air, especially on an upright radiodraft. And then I look at my gastro-tubul. So after I've cleared the frontal portion of the radiodraft, I go to the lateral view, if there is one. The lateral view is great for problem solving. If I see something on the frontal radiodraft, I can always use the lateral view to kind of pinpoint where exactly it is. For instance, if I see something in this long region, and I look on lateral, and it's down here, I would know it's in the left lower lobe. So how I approach the lateral view is, I usually just take an overall outline of the lateral long view, and I look at my cost-efernic angles down here, to make sure there's no layer in fluid, which would mean there's a plural fusion. I follow my right hemidire frame up, followed by my left hemidire frame. Take a look at the overall view of the cardiac silhouette. I should see a nice retro-stern-off-fear space, which I do. I follow my lateral view of the trade-key down, and a softness, if you can see it. And I take a look at my highly-region as well. Next, what I do is I window really hard to take a look at the osteostructures, making sure I'm not missing any obvious compression fracture, or rib fracture. I usually zoom in a little bit, so you can see how you would be able to catch a nice post-ear rib fracture back here, or even a compression fracture as well. While I'm over here, I usually take a look at my sternum. You can sometimes catch a nice, displaced sternum fracture over here as well. Then I go underneath the diaphragm, making sure there's no obvious free air, which I may have missed on, a frontal radiodraft, and I take a look at the bowel. And that is pretty much it. So that, ladies and gentlemen, is how I read a chest x-ray. I hope you enjoyed it, and I hope you learned something. If you liked the video, as always, make sure you like and subscribe, and I will see you on the next video.