Approach to Chest X-Rays

Evaluate for Right Ventricle Enlargement
Evidence of an enlarged right ventricle can be as follows:

1. Elevation of cardiac apex from the diaphragm
2. Anterior enlargement on lateral view leading to loss of retrosternal airspace or contact of RV with the sternum

Evaluate for Right Atrial (RA) Enlargement
Evidence of right atrial enlargement can be as follows:

1. Increased curvature of the right heart border
2. Enlargement of the superior vena cava (SVC)

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Evaluate for Pericardial Effusion

Evidence of a pericardial effusion can be as follows:

1. A globular heart
2. Loss of the indentations of the left mediastinal border
3. Separation of peri- and epi-cardial fat pads on the lateral film

Evaluate for Left Ventricle (LV) Enlargement
Evidence of an enlarged left ventricle can be as follows:

1. Displacement of cardiac apex inferiorly and posteriorly
2. Boot shaped heart
3. Rigler’s sign (on the lateral film from the junction of the inferior vena cava (IVC) and heart at the level of the diaphragm)

Measure 1.8 cm posteriorly and then 1.8 cm superiorly. If the cardiac shadow extends beyond this point then LV enlargement is suggested.

Evaluate for Left Atrium Enlargement
Evidence of an enlarged left atrium can be as follows:

1. Straightening of the left heart border
2. Increased opacity of the lower right side of a cardiovascular border (double heart border)
3. Elevation of the left main stem bronchus (specifically the upper lobe bronchus on the lateral film)