Chest X-ray Anatomy
Trachea and major bronchi

Key points

  • The large airways contain air and are therefore less dense (blacker) than surrounding tissue
  • The trachea should be central

The large airways are visible on most good quality chest X-rays. They contain air and so are of lower density (blacker) than the surrounding soft tissues. The trachea branches at the carina into the left and right main bronchi, which can be followed as they branch beyond the hila into the lungs.

Normal chest X-ray

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Normal chest X-ray

  • The trachea and bronchi are visible - branching at the carina
  • The trachea passes to the right of the aorta and so may be slightly off mid-line to the right
  • Highlight these structures by hovering the mouse over the image (mobile devices - tap on/off image)

Assessing the airways

Start your assessment of every chest X-ray by looking at the airways. The trachea should be central or slightly to the right at the level of the aortic knuckle.

If the trachea is deviated, it is important to establish if this is because of patient rotation or if it is due to pathology. If the trachea is genuinely deviated you should then try to decide if it has been pushed or pulled by a disease process.

Page author: Salisbury NHS Foundation Trust UK (Read bio)

Last reviewed: February 2020