Year : 2013  |  Volume : 16  |  Issue : 4  |  Page : 301-

Interesting facts about chest radiograph

Narendra Bodhey 
 Department of Radiodiagnosis, All India Institute of Medical Sciences Raipur, Raipur, Chhattisgarh, India

Correspondence Address:
Narendra Bodhey
Additional Professor and Head, Department of Radiodiagnosis, All India Institute of Medical Sciences Raipur, Raipur, Chhattisgarh

How to cite this article:
Bodhey N. Interesting facts about chest radiograph.Ann Card Anaesth 2013;16:301-301

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Bodhey N. Interesting facts about chest radiograph. Ann Card Anaesth [serial online] 2013 [cited 2021 Dec 1 ];16:301-301
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The Editor,

The article "necklace shadow in the neck after surgery" by authors Rawat et al., is really interesting. [1]

Reading a chest radiograph has not been an easy task to any radiologist as well. A chest radiograph could very well be considered a graveyard for any radiologist undergoing an assessment in any stage of his career. There should be a step by step approach to read a chest skiagram, which is available to the readers elsewhere. However, the few key points that need to be looked into are thus - look at the position of the trachea whether it is central or not and the distance of the medial end of the clavicles from the center, which also is an indicator of positional accuracy.

Following this, the extreme difference between the appearance of the two lungs which is not explained by the clinical findings, the sternal sutures falling away from the shadows of the vertebrae, the cardia occupying more of the left hemithoracic space suggests that the radiograph is not true frontal, but more in rotated position. The radiograph in the published report has the medial end of the right clavicle overlapping on the vertebral shadows, cardia going to the left, the right lung appearing more translucent than the left (left lung is not as pathological as it might appear to be); these findings suggesting that patient position is in such a rotation that the right hemithorax is nearer the tube. [1]

The finding in discussion in this particular report is of calcification of the cartilages. This is a normal variant as described in the report as observed by their radiologist before re-exploration. The calcification of the tracheal cartilage and the anterior ends of the lower ribs is seen in the present radiograph as well. The rib cartilage calcification is generally central and called as "male type (penile)" in females and marginal "female type (vaginal / cupshape)" in the males. [2],[3],[4] The central shape of the calcification is evident only on the left side owing to again the rotation where the anterior ends of the right sided ribs tend to overlap on the vertebral column and also more pierced by the X-rays. Had the necklace been a foreign body around the neck, the line would have gone across more laterally while coursing up rather than continuing in the same more or less, the central location.

The learning points are thus look for the position of the patient, look for the available markers within or on the patient's body seen in the radiograph, never fail to compare all the imaging carried out before and to discuss with other colleagues before attempting any other procedure like laryngoscopy, changing the depth of the lines and re-exposing the patient or finally before re-exploring.


1Rawat RS, Mehta Y, Trehan N. Necklace shadow in the neck after surgery. Ann Card Anaesth 2013;16:223.
2Felson B. The thoracic wall. Felson's Principles of Chest Roentgenology, Ch. 13. Philadelphia, USA: WB Saunders; 1998. p. 450-63.
3Navani S, Shah JR, Levy PS. Determination of sex by costal cartilage calcification. Am J Roentgenol Radium Ther Nucl Med 1970;108:771-4.
4Teale C, Romaniuk C, Mulley G. Calcification on chest radiographs: The association with age. Age Ageing 1989;18: 333-6.