How to Interpret a Chest X-Ray (Lesson 5 - Cardiac Silhouette and Mediastinum)

A review of cardiomegaly, left atrial and right ventricular enlargement, mediastinal masses, and hilar enlargement.

Video includes the following images (among others):

[StrongMed]

There have been 3 questions/comments that have come up multiple times in the 9 years since this was posted:

1. Yes, there is an error @8:27. The pericardial and epicardial layers are switched. (Pericardial far is the anterior "cookie layer", while epicardial far is the posterior one.) Sorry, I wish there was a way to fix this without editing out that section altogether.

2. @1:45, the left and right lung are labeled and oriented that way (i.e. right lung on the left, and left lung on the right) because this is the universal convention for cross-sectional imaging in radiology: it's the view you would see if you were at a supine patient's feet and looking up towards their head. I know it feels unnatural for many people learning radiology - it felt unnatural to me too - but becoming familiar with that orientation will make CT scans that much easier later on.

3. Regarding the use of "dextrocardia" @10:26, in the US it is most common to use the term to only refer to the orientation/sidedness of the heart without directly imply anything about the intraabdominal organs. So while this particular person's gastric air bubble and relative hemi-diaphragmatic heights imply they likely have situs inversus (i.e. all internal organs are the mirror image of "normal"), the term dextrocardia still applies. This usage might not be the same in all countries and contexts.

[osatal]

I love how he just roasted Oreo cookies ..."supposedly chocolate flavored discs" lool savage

[raymondokeefe]

Hi Eric, You're a talented teacher and I thank you for the time and effort you have put into these outstanding videos. As a practicing nurse anesthetist, 17 years post graduation, the opportunity to review clinically significant anatomy and physiology has been a great joy, renewing my passion for the science behind what I do. Keep doing the good work for all of us out here in the trenches with you. Best.

[StrongMed]

Errata: @8:27, pericardial and epicardial layers are switched. (Pericardial fat is the anterior "cookie layer", while epicardial fat is the posterior one)

[queziasink]

Thank you so much! No professor can be so clear like you ! ⚘❣

[StrongMed]

+MoSh (YouTube is not letting me directly reply to your comment...) I'm sorry but the CXR videos were created directly in Adobe Premiere, and it's cumbersome to export them into a non-video format.

[manufonseca]

Internal med resident here, just wow! Cant believe i just found this videos. God bless you!

[chrow]

I believe your Dextrocardia film is full Situs Inversus. Gastric bubble and liver are swapped as well.

[amykowald]

Your video demonstrations are so helpful. Thank you for them. Also, I love the way you say "What is that?" in reference to the mitral valve replacement.

[davidpowell]

At 2:35 the difference in the apparent size of the heart on the two films of the same heart is amazing.

[janinebuck]

NP needing to review for a job possibility. Have not had CXR reading for some time. Excellent, thanks so much for posting for us.

[StrongMed]

@ambioct Yes, you are correct.  Unless there are clues on the PA film, discerning RV enlargement from an anterior mediastinal mass on the lateral view can probably not be done reliably.

[luckypenny]

Excellent video!!! Please do more like this for pulmonary and the new LungRADS guidelines

[doctorasifali]

Excellent effort with matching presentation...

[anapaulacintra]

Hi Eric, You´re an amazing teacher, thank you for sharing this precioues material with us.

[albertpirehzad]

Thank you for all helpful lectures and GOD BLESS.

[ruwanwickramaratna]

Thank you for taking the time to make these videos.

[kamalpreethara]

Very useful videos. helped me a lot in my medicine rounds. thank you

[argonmed]

Excellent Study Aids
Thank you Eric
Continue Your good work

[sylvandude]

in looking at the diagram I believe the lungs are labeled backwards??? when you demonstrate the size of the heart in ap and pa, aren't the lungs labeled wrong? I am kind of confused?