Chest and Cardiovascular Radiology
Approach
Read every chest radiograph in the same order: technical adequacy (rotation, inspiration, penetration), then lines, tubes and devices, then lungs, pleura, mediastinum, hila, bones and soft tissues. Most missed findings sit at the apices, behind the heart, below the diaphragm and in the soft tissues.
Key patterns
Loss of a border localises disease to the adjacent structure: loss of the right heart border implicates the right middle lobe, loss of the right hemidiaphragm the right lower lobe, loss of the left heart border the lingula. Only structures of similar radiographic density silhouette, so ground-glass opacity does not obscure vessels. Air bronchograms within consolidation confirm airspace disease rather than collapse.
On high-resolution CT, name the pattern: usual interstitial pneumonia shows basal, subpleural honeycombing with traction bronchiectasis; NSIP shows ground-glass with reticulation and subpleural sparing; organising pneumonia shows peripheral patchy consolidation.
Vascular and cardiac
On CTPA a filling defect confirms clot; a right ventricular to left ventricular ratio above 1.0 suggests right heart strain. Dissection is Stanford A when the ascending aorta is involved (surgical emergency) and B when only the descending aorta is affected; intramural haematoma and penetrating atherosclerotic ulcer are variants. Late gadolinium enhancement separates ischaemic (subendocardial, following a coronary territory) from non-ischaemic (mid-wall, epicardial) disease.
Traps
Questions exploit the silhouette sign, mix DeBakey with Stanford, and offer ground glass where consolidation is correct. Tension pneumothorax is a clinical diagnosis, not a radiological one.
Rule of thumb
A pneumothorax measuring 2 cm or more at the hilum on a radiograph generally warrants drainage; smaller collections are managed on symptoms.