Chest pain x ray

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Chest pain Microchapters


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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]


An x-ray may be helpful in the diagnosis of common causes of chest pain.

X Ray

Class I
"1 In patients presented with acute chest pain, chest radiograph is useful for evaluation of other potential causes of symptom including cardiac, pulmonary, thoracic origin . (Level of Evidence C)"
The above table adopted from 2021 AHA/ACC/ASE Guideline[1]

An x-ray may be helpful in the diagnosis of common causes of chest pain. Findings on an x-ray include:

Aortic dissection[2][3][4]

Aortic dissection with marked widening of the mediastinum[5]
Aortic dissection with marked pleural effusion (blue arrow), left upper mediastinal mass (yellow arrow), and tracheal deviation (orange arrow)[6]

Pulmonary embolism[7][8][9][10]

    • Hampton hump: peripheral wedge-shaped density above the diaphragm
    • Westermark sign: vasoconstriction distal to the pulmonary embolus
    • Elevated hemidiaphragm
    • Pleural effusion
    • Palla's sign: enlarged right descending pulmonary artery


Pneumothorax Source:Case courtesy of A.Prof Frank Gaillard,, rID: 8250

Gastroesophageal reflux disease

Source: Case courtesy of Dr Hani Salam, From the case "">rID: 9585<


  1. Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ (November 2021). "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 144 (22): e368–e454. doi:10.1161/CIR.0000000000001029. PMID 34709879 Check |pmid= value (help).
  2. de Lacey G, Morley S et-al. The Chest X-Ray: A Survival Guide. Saunders Ltd. ISBN:0702030465.
  3. Lai V, Tsang WK, Chan WC, Yeung TW (August 2012). "Diagnostic accuracy of mediastinal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dissection". Emerg Radiol. 19 (4): 309–15. doi:10.1007/s10140-012-1034-3. PMC 3396328. PMID 22415593.
  4. Gleeson CE, Spedding RL, Harding LA, et al The mediastinum—Is it wide? Emergency Medicine Journal 2001;18:183-185.
  5. Case courtesy of Dr Wayland Wang,, rID: 50763
  6. Case courtesy of Dr Devanshi Pathania,, rID: 68763
  7. Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE (October 1993). "Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study". Radiology. 189 (1): 133–6. doi:10.1148/radiology.189.1.8372182. PMID 8372182.
  8. Rossi SE, Goodman PC, Franquet T (June 2000). "Nonthrombotic pulmonary emboli". AJR Am J Roentgenol. 174 (6): 1499–508. doi:10.2214/ajr.174.6.1741499. PMID 10845470.
  9. CHANG CH, DAVIS WC (April 1965). "A ROENTGEN SIGN OF PULMONARY INFARCTION". Clin Radiol. 16: 141–7. doi:10.1016/s0009-9260(65)80007-1. PMID 14272525.
  10. Palla A, Donnamaria V, Petruzzelli S, Rossi G, Riccetti G, Giuntini C (September 1983). "Enlargement of the right descending pulmonary artery in pulmonary embolism". AJR Am J Roentgenol. 141 (3): 513–7. doi:10.2214/ajr.141.3.513. PMID 6603760.
  11. Sharma, Anita; Jindal, Parul (2008). "Principles of diagnosis and management of traumatic pneumothorax". Journal of Emergencies, Trauma and Shock. 1 (1): 34. doi:10.4103/0974-2700.41789. ISSN 0974-2700.

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