When patients arrive in the ICU, as soon as they are settled, an AP portable chest x-ray (CXR) is ordered. That x-ray will look different from one done in the radiology department, as the patient is likely semi-recumbent, may be in expiration and the projection is different than from an CXR taken from the back.

The lung has 5 lobes – three on the right and two on the left (the left lung is smaller to accommodate the heart). Each one of these lobes is connected to the trachea by one major airway, that may become plugged off, resulting in atelectasis or collapse of the lobe. As we often need to remove mucus plugs or other material causing these obstructions, it is imperative that you are able to identify the particular lobe that has collapsed. I sequentially go through each lobe of the lungs.

To identify a collapsed lung lobe I suggest that you follow the “Ds” listed in the image below.

In addition, radiologists often report lung units as being “consolidated.” This is a catch all phrase that identifies the presence of liquid or semisolid material in airspaces – infectious exudate, blood, mucus, water-fluid, gastric contents etc. You should be able, with you anatomical knowledge, to identify which lung lobe is affected, in particular if you are planning on performing a broncho-alveolar lavage. @ccmtutorials