Despite the ever-increasing number of new diagnostic imaging techniques available to today's clinician, the chest x-ray remains a simple, easy, inexpensive, and most informative examination. In some areas it has been replaced by more sensitive techniques; for example, sonography in the evaluation of pericardial effusions. Still, the chest roentgenogram provides invaluable information as part of the crucial first step in differential diagnosis and in following progression of disease. An appreciation of normal, abnormal, and normal variants in cardiovascular anatomy is essential. A systematic approach is presented that sequentially examines (1) heart size and shape, (2) pulmonary vasculature (lung fields and hilum), (3) aorta, and (4) thoracic cage. Figure 34.1 shows a normal posteroanterior (PA) view of the chest.
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