-2 :: Topic - 6043 :: :: ::
Medical Image Database, Atlas, and Teaching File
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This is a concise, yet comprehensive review for the MS 2 Oral Exam for the Chest X-Ray Search Pattern and Required Structures. See references below for supportive information.

Note: the oral exam will start with the NORMAL ANATOMY - REQUIRED STRUCTURES (below), then the search pattern.

» PRELIMINARIES (search pattern)

1. Verify patient information and date on both films and position of LEFT or RIGHT marker on frontal.

2. Note adequacy of penetration and any technical defects.
(Should be able to see intervertebral disc space through the heart shadow. Vertebral spinous process should be midway between medial heads of both clavicles.)

3. Look briefly at the entirety of both films for obvious abnormalities.

» FRONTAL VIEW

4. Study the lungs, both up and down and side to side.
Include lung volumes and symmetry of markings.

5.Check periphery of lungs for pneumothorax and effusions.

6. Evaluate mediastinal contours, edges and shape.

7. Follow trachea to carina and main bronchi.

8. Look at both hila for enlargement and abnormal bulges.

9. Trace periphery of the chest - neck, chest wall, bones, diaphragms. Check the upper abdomen for free air and abnormal air collections

» LATERAL VIEW

10. Judge the size and shape of the lungs and diaphragms.

11. Follow the airway from neck to hilum.
Note size and shape of pulmonary arteries.

12. Note back of heart and darkening toward diaphragm.

13. Look upward for darkening of anterior mediastinum to the neck.

14. Follow the spine downward for vertebral bodies and darkening.

15. Evaluate diaphragms, then trace periphery of images - forward through abdomen, up anterior chest wall and down posterior ribs to the costophrenic angles.

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» NORMAL ANATOMY - REQUIRED STRUCTURES for MS-2 Students

Note: The examiner will point to structures and ask the student to name, then the examiner will name structures and ask the student to point to.

» FRONTAL VIEW

A.Lungs
Markings (Vessels should branch and taper from central to peripheral. Make sure lung markings reach the chest wall to r/o pneumothorax, fluid, and pleural disease)
Minor Fissure (not always visible but must know location)

B.Mediastinum
SVC - Superior Vena Cava
Right Paratracheal Line
Right Atrium
Azygoesophageal edge (recess)
Left Ventricle
Aortic Knob
Main Pulmonary Trunk
Heart - Left Ventricle
Descending Aorta
Left Paratracheal Stripe (or edge)

C.Airways
Trachea
Carina
R& L Main Bronchi

D.Hila - Left and Right Pulmonary Arteries

E.Soft Tissues
Neck
Chest Walls
Breast Shadows
Diaphragms
Costophrenic angles (CPA)
Bowel Gas, Stomach bubble (if present)

E.Bones
Ribs (Anterior and Posterior)
Clavicles
Scapulae (Acromion, Glenoid, Coracoid)
Humeri (Greater Tuberosity and Head)
Spine
   Bodies and Disc Spaces
   Spinous Processes
   Transverse process
   Pedicles


» LATERAL VIEW

A.Airways
Trachea and Main Bronchi
Left Bronchus on End

B.Hila - Left and Right Pulmonary Arteries
RPA (oval and anterior to airway)
LPA ("comma" shaped and behind airway)

C.Lungs
Markings
Fissures - Major (oblique) and Minor (horizontal)
(Not always visible - but must know location.)

D.Heart
Left Ventricle
IVC
Anterior/Superior Lucency

E.Posterior Chest
Spine - Bodies and Disc Spaces
Ribs

F.Diaphragms, Costophrenic Angles and Bowel Gas

G.Anterior Chest
Chest Wall
Sternum   

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Chest Review - Anatomy with Popup Labels: Click for HyperLink

Chest Review - Anatomy Text: Click for HyperLink