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 |
Diagnostic |
| 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 Cardiomegaly |
Suggestive in context |