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Chest Imaging

E3230. The Lateral Chest Radiograph Simplified

Nemer O1,  Kallas J1,  Wang M1,  O'Neal D2,  Hall M.1 1. University of Rochester Strong Memorial Hospital, Rochester, NY; 2. Northeast Ohio Medical University, Rootstown, OH

Address correspondence to O. Nemer (Omar_nemer@urmc.rochester.edu)

Background Information: Despite advances in CT, the chest radiograph is still the most widely performed radiologic examination. The lateral chest radiograph (LCR) is an important, and often overlooked, adjunct to the frontal projection in localizing disease and evaluating areas not visualized on the frontal chest, such as the retrocardiac region. Interpretation of the LCR is often challenging due to superimposed structures from each hemithorax. Our goal is to review normal cardiothoracic anatomy commonly seen on the LCR with CT correlation and provide students and clinicians with an anatomy-based, systematic approach to LCR interpretation.

Educational Goals/Teaching Points: Our goal is for participants to understand the reasoning behind the appearance of each structure in the LCR, easily identify normal anatomy and its variants on the LCR, and provide a systematic, anatomy-based approach to LCR interpretation. The proper LCR technique will be discussed in detail with easily identifiable ways to determine the quality of a study. We will walk through the structures of the heart, lobes of the lungs, vascular structures, musculature, osseous, and gastrointestinal portions of the LCR with easily digestible diagrams and pictures and MDCT correlation. Areas where pathologies are often missed will be highlighted and participants will be trained to systematically check each of these areas thoroughly to reduce misses. Interactive questions throughout the presentation will help reinforce newly learned concepts and keep the reader engaged.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Our presentation will provide easy ways to recognize the cardiac structures, vasculature, mediastinum, pulmonary lobes, hila, diaphragm, and osseous structures. We will discuss the technique used for LCR and provide reasoning behind the appearances of each structure based on technique. We will go over systematic, anatomy-based approaches to reduce mistakes and misses with LCR.

Conclusion: The LCR is an extremely important yet often overlooked imaging procedure that can help in the assessment of localizing disease and evaluating areas not visualized on the frontal chest. Interpretation is complicated due to superimposed structures; however, an anatomic approach facilitates evaluation. We hope to make this often-challenging concept easy for radiologists to understand and interpret quickly on a daily basis.