Assessment of cardiomediastinal contours on chest x-ray (approach)

Last revised by Craig Hacking on 18 Feb 2024

Citation, DOI, disclosures and article data

Citation:

Manickam A, Hacking C, Knipe H, Assessment of cardiomediastinal contours on chest x-ray (approach). Reference article, Radiopaedia.org (Accessed on 18 Apr 2024) https://doi.org/10.53347/rID-62198

DOI:

https://doi.org/10.53347/rID-62198

Permalink:

https://radiopaedia.org/articles/62198

rID:

62198

Article created:

5 Aug 2018, Appukutty Manickam

Disclosures:

At the time the article was created Appukutty Manickam had no recorded disclosures.

View Appukutty Manickam's current disclosures

Last revised:

18 Feb 2024, Craig Hacking ◉ ◈

Disclosures:

At the time the article was last revised Craig Hacking had the following disclosures:

Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)

These were assessed during peer review and were determined to not be relevant to the changes that were made.

View Craig Hacking's current disclosures

Revisions:

5 times, by 3 contributors - see full revision history and disclosures

Systems:

Chest

Sections:

Approach

Tags:

cxr, chest radiograph

Described below is one approach to systematic assessment and associated pathology of the cardiomediastinal contours on chest x-ray.

Mediastinum

size: widened mediastinum can be seen in aortic dissection, traumatic aortic injury, vascular ectasia
abnormal contour, e.g. lymphadenopathy, anterior mediastinal mass
abnormal gas pattern, e.g. pneumomediastinum, hiatus hernia

Heart (cardiac silhouette)

assess position (frontal view): normally one-third right of midline and two-thirds left of midline
assess borders and both frontal and lateral for silhouette sign and abnormal appearance
pericardial fat pad (frontal view): normally in the cardiophrenic angle(s)
assess overall size
- normally the cardiothoracic ratio is <0.50 on a PA chest x-ray obtained in full inspiration
- can be enlarged, most commonly in cardiomegaly and pericardial effusion