Chest Radiography (CXR)

A CXR is the most commonly performed radiological examination in the ED. After taking a history and performing a clinical examination, CXR is essential for most causes of dyspnoea both in terms of making a diagnosis and influencing treatment with 63.5% of physicians reporting treatment decisions based on CXR results [5]. The prevalence of positive CXR findings in patients presenting with dyspnoea was found to be 56% for patients over the age of 40 years [6]; the authors of this study concluded that any patient over the age of 40 who has symptoms or signs of thoracic disease should have a CXR.

Specific radiological findings associated with specific pathological causes of dyspnoea are presented in the table below.

Table 6: Radiographic findings in conditions presenting with breathlessness

Condition Radiographic finding Comment
Pneumothorax Absence of pulmonary vascular markings Diagnostic
Tension pneumothorax Absence of pulmonary vascular markings
Mediastinal displacement
Pneumonia Localised/diffuse pulmonary infiltrationSegmental pulmonary atelectasis/consolidation Diagnostic in contextDiagnostic in context
Pulmonary oedema Cardiomegaly
Interstitial oedema
Kerley B lines
Pleural effusion
Taken together, these findings
are diagnostic
Pulmonary embolism No diagnostic featuresNormal chest x-rayLocalised pulmonary atelectasisSmall pleural effusion

Wedge shaped infarct

Suggestive in context

Rare finding

Rare finding

Rare finding

Asthma No diagnostic featuresHyperinflation Useful to exclude complicating pneumothoraxSuggestive in context
COPD No diagnostic featuresHyperinflation Useful to exclude complicating pneumothorax or pneumoniaSuggestive in context
Pleural effusion Unilateral / bilateral dense opacification Diagnostic in context
Anaphylaxis No diagnostic features
Cardiac tamponade No diagnostic features
Suggestive in context