Chest - PA ErectChest - Left Lateral (Erect)Chest - AP SupineChest - ApicalChest - LordoticChest - Lordotic (Right Middle Lobe)Chest - Lateral DecubitusChest - Dorsal DecubitusChest - Ventral Decubitus Chest - Oblique Ribs - PA (Anterior Ribs)Ribs - AP (Posterior Upper Ribs 1-8)Ribs - AP (Posterior Lower Ribs 9-12)Ribs - Oblique (Axillary Ribs)

Sternum - RAOSternum - Lateral (Left or Right)

Sternoclavicular - PASternoclavicular - ObliqueSternoclavicular - Axiolateral (Kurzbauer)

Radiation fibrosis The trachea is deviated to the left. It is possible to say this with confidence because the patient is not rotated - the spinous processes lie midway between the medial ends of the clavicles. Any deviation of the trachea from the midline is therefore genuine. Whenever you see deviation of the trachea, ask yourself if it has been PUSHED or PULLED. Here the trachea has been PULLED to the left by the volume loss in the left upper lobe caused by localised lung fibrosis. In this case this was due to previous radiation treatment.

PneumonectomyThe trachea, hila and mediastinum are deviated to the left. Are they PUSHED or PULLED?This patient has had a pneumonectomy (removal of the left lung) to treat a lung cancer. Note the left main bronchus is abruptly cut off (arrowhead). The left hemithorax is filled by the heart and great vessels which have moved to the fill the space vacated by the removed lung. The right lung has expanded to fill the space vacated by the heart.

The left hemithorax is black due to air in the pleural cavity. Signs of tension The left lung is completely compressed (arrowheads). The trachea is pushed to the right (arrow) The heart is shifted to the contralateral side - note right heart border is pushed to the right (red line)The left hemidiaphragm is depressed (orange line) RememberIf you diagnose a tension pneumothorax clinically - do not request an X-ray - TREAT THE PATIENT!