Chest x-ray abnormalities
Tracheal displacement
Before deciding if the trachea is central it is important to establish that the patient is not rotated. (See the chest X-ray quality tutorial).
Trachea - Pushed or Pulled ?
If the trachea is genuinely displaced to one side, try to establish if it has been pushed or pulled by a disease process. Anything that increases pressure or volume in one hemithorax will push the trachea and mediastinum away from that side. Any disease which causes volume loss in one hemithorax will pull the trachea over towards that side.
Key points
- Check for rotation
- Check the trachea is central
- If the trachea is displaced - try to determine if it is pushed or pulled
Hover over image to show findings
Tracheal displacement
- No patient rotation - the spinous processes (red line) are central between the medial clavicles (blue lines)
- Trachea (*) shifted to the left of the midline
- Soft tissue mass mainly to the right of the trachea
Diagnosis
- Mediastinal thyroid enlargement
- The patient had a CT scan - see below
Click image to align with the top of the page
Hover over image to show findings
Tracheal displacement - seen on CT
- Trachea (*) shifted to the left of the midline (red line)
- Soft tissue mass (blue) to the right of the trachea
- The CT findings correlate well with the x-ray
Diagnosis
- Mediastinal thyroid enlargement