Chest X-ray Abnormalities
Tracheal displacement

Key points

  • Check for rotation
  • Check the trachea is central
  • If the trachea is displaced - try to determine if it has been pushed or pulled

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.

Tracheal displacement

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Tracheal displacement

  • No patient rotation - the spinous processes (red line) are central between the medial clavicles (blue lines)
  • Trachea (asterisk) 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

Tracheal displacement - seen on CT

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Tracheal displacement - seen on CT

  • Trachea (asterisk) shifted to the left of the midline (red line)
  • Soft tissue mass on right of the trachea (highlighted area)
  • The CT findings correlate well with the X-ray

Diagnosis

  • Mediastinal thyroid enlargement causing tracheal deviation