Chest x rays made easy
In the second of a five part series, Elizabeth Dick begins to look at chest abnormalities, starting with the mediastinum and heart
The trachea can be pulled or pushed, almost always by one of three processes (two that push, one that pulls). A right sided pleural effusion will push the trachea and mediastinum to the left (fig 2). Similarly, a left sided tension pneumothorax will push the mediastinum to the right, as air builds up in the left pleural space and cannot be released (fig 3).
On the other hand, if there is collapse on the left this will pull the trachea and mediastinum to the left side (fig 4). Most other processes (consolidation, nontension pneumothorax, etc) have little effect on the mediastinum. If you see the mediastinum is shifted then you need to think of these three things and look for them (see future article).