A normal chest x-ray | the basics

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Young man suffering from painful chest pain from a chronic disease.

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A normal chest x-ray | the basics

In this article we will describe what is a normal chest x-ray and how to interpret it.

This is a normal chest x-ray (CXR). It is a PA and lateral chest x-ray of a healthy woman. Note mild pectus excavatum on the lateral image (arrows).

Why is this a normal chest x-ray?

This is a normal chest x-ray because it has the following features:

Normal bones and soft tissues
Clear lung fields
Normal looking heart (CT ratio under 0.5)
No visible nodules, tumours, masses or foreign bodies
Clearly outlined chest cavity, with clear costodiaphragmatic angles
Normal vasculature.

Let’s go into some more detail.

Features of a normal chest x-ray

A normal chest x-ray typically displays the following features:

Bony Structures

Clavicles: Symmetrical and intact
Scapulae: Visible, with normal contours
Ribs: 10-12 pairs, with normal curvature and no fractures
Thoracic spine: Visible, with normal alignment and no fractures.

Soft Tissues

Lung parenchyma: Uniformly translucent, with no nodules or consolidations
Pleura: Not visible or minimally visible, indicating no pleural effusion
Mediastinum: Central, with normal width (less than 8 cm)
Heart: Normal size and shape, with a cardiothoracic ratio less than 50%
Diaphragm: Dome-shaped, with normal position and movement.

Pulmonary Vasculature

Pulmonary arteries: Visible, with normal calibre and no dilation
Pulmonary veins: Visible, with normal calibre and no dilation.

Other Features

Trachea: Central, with normal calibre and no deviation
Bronchi: Visible, with normal calibre and no dilation
Costophrenic angles: Sharp, indicating no pleural effusions.

Why are chest x-rays done?

A CXR is quick, cheap and non-invasive – and tells you alot about the heart (like an ECG) and lungs. This is why such an ‘old test’ is still so widely used.