Chest and Cardiothoracic Imaging
Core concepts
Master the systematic reading of a chest radiograph: technical adequacy (rotation, inspiration, penetration), then lines and tubes, mediastinal contours, lungs, pleura, and bones. Understand the silhouette sign and air bronchograms. Learn the patterns of lung disease: consolidation, ground-glass, reticulation, honeycombing, nodules, and cavitation. Know the HRCT features of usual interstitial pneumonia (UIP) and the differential of diffuse lung disease. Understand pulmonary embolism imaging (CTPA), the Wells score, and the role of ventilation-perfusion scanning. Learn cardiac imaging basics: coronary CTA, calcium scoring, and the anatomy of the cardiac chambers and great vessels. Understand pleural disease: effusion, pneumothorax, and mesothelioma. Know the staging of lung cancer (TNM) and the significance of mediastinal lymphadenopathy.
Traps
A normal chest radiograph does not exclude early disease. The silhouette sign localizes to the adjacent structure, but loss of the right heart border means middle lobe or medial lower lobe, not the whole right lung. Distinguish cardiomegaly from pericardial effusion. Do not confuse the azygos fissure with a lung lesion. Remember that CTPA requires adequate contrast timing and that subsegmental PE management is controversial.
Rule of thumb
Use the ABCDE approach (Airway, Bones, Cardiac, Diaphragm, Everything else) for every chest radiograph. For a solitary pulmonary nodule, size and stability on prior imaging drive management more than morphology alone.