🩻 A-B-C-D-E CXR Reading Principle

🅰️ A = Airway (airway)

What to see:

Trachea (Great Trachea): Should be midline

Carina: Right-left bronchial junction, clearly visible.

See if trachea deflects.

👉 Deflect into lesions → atelectasis, fibrosis

👉 Deflect from lesions → tension pneumothorax, pleural effusion, mass

See if the ET tube / tracheostomy tube / NG tube exists and is in the right place.

🧠 Remembered:

"A = Airway is in the middle and the pipe is right."

🅱️ B = Breathing (lung)

What to see:

Compare right-left lung fields with the same transparency?

Lung markings (pulmonary veins):

If missing → pneumothorax

If tight solid → consolidation, edema

Infiltrate / Consolidation: White solid in some segments → pneumonia

Pleural space:

Pleural effusion: solid white below, with meniscus sign

Pneumothorax: No lung marking, apparent lung margin

Lung volume: small shrink (atelectasis) or overextended (hyperinflation, such as COPD)

🧠 Remembered:

"B = Both lungs need to breathe equally."

C = Circulation (Cardiovascular)

What to see:

Heart size:

Use Cardiothoracic ratio (CTR) =

(Heart width × chest width)

Normally in PA film is 40%

Heart border: Is the left-right heart border clear?

If dim → lingular / RML consolidation

Aorta: See aortic knob and mediastinum.

If mediastinum width > 8 cm → suspected aortic dissection or mass

Pulmonary vessels:

Increase (prominent) → pulmonary congestion

Cephalization (upper veins more prominent than lower) → pulmonary venous hypertension

"Bat-wing pattern" → pulmonary edema

🧠 Remembered:

"C = Cardiac & Circulation - Look at the heart not growing, the blood vessels not swelling."

D = Diaphragm (midriff)

What to see:

The midrib. The right is 1-2 ribs taller than the left (because there is a liver).

Costophrenic angles (side angles) and cardiophrenic angles (heart angles) should be pointed clear.

If blurry → pleural effusion

Free air under diaphragm → pneumoperitoneum (penetrating intestine)

Look at the midriff shape.

BAN → COPD

High → atelectasis, paralysis

🧠 Remembered:

"D = Diaphragm must be symmetrical, sharp-angle, no air under it."

E = Everything else (other things)

What to see:

Bone: Rib, clavicle, vertebra → fracture, lytic lesion

Soft tissue: Is there a subcutaneous emphysema, swelling or air leak?

Devices / Lines: ET tube, NG tube, central line, pacemaker → Right position?

Upper abdomen: Is there wind in the stomach?

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