Assessment of cardiomediastinal contours on chest x-ray (approach)
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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
injuriesinjury, 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
-<li>size: widened mediastinum can be seen in aortic dissection, traumatic aortic injuries</li>-<li>abnormal contour, e.g. lymphadenopathy, anterior mediastinal mass</li>-<li>abnormal gas pattern, e.g. pneumomediastinum, hiatus hernia</li>- +<li>size: widened mediastinum can be seen in <a title="Aortic dissection" href="/articles/aortic-dissection">aortic dissection</a>, <a title="Traumatic aortic injury" href="/articles/traumatic-aortic-injury">traumatic aortic injury</a>, vascular ectasia</li>
- +<li>abnormal contour, e.g. <a title="Lymphadenopathy" href="/articles/lymph-node-enlargement">lymphadenopathy</a>, <a title="Anterior mediastinal mass" href="/articles/differential-for-an-anterosuperior-mediastinal-mass">anterior mediastinal mass</a>
- +</li>
- +<li>abnormal gas pattern, e.g. <a title="Pneumomediastinum" href="/articles/pneumomediastinum">pneumomediastinum</a>, <a title="Hiatus hernia" href="/articles/hiatus-hernia">hiatus hernia</a>
- +</li>
-<a href="/articles/epicardial-fat-pads">pericardial fat pad</a> (frontal view): normally in the cardiophrenic angle(s)</li>- +<a href="/articles/pericardial-fat-pads-2">pericardial fat pad</a> (frontal view): normally in the cardiophrenic angle(s)</li>
-<li>normally the <a href="/articles/cardiothoracic-ratio">cardiothoracic ratio</a> <0.50 on a PA chest x-ray obtained in full inspiration</li>-<li>can be enlarged most commonly in <a href="/articles/cardiomegaly">cardiomegaly</a> and <a href="/articles/pericardial-effusion">pericardial effusion</a>- +<li>normally the <a href="/articles/cardiothoracic-ratio">cardiothoracic ratio</a> is <0.50 on a PA chest x-ray obtained in full inspiration</li>
- +<li>can be enlarged, most commonly in <a href="/articles/cardiomegaly">cardiomegaly</a> and <a href="/articles/pericardial-effusion">pericardial effusion</a>
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