Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate
Do not delay reperfusion, CT aortography or treatment of pulmonary oedema for a chest radiograph when the clinical diagnosis already demands urgent action.
Synopsis
Use the chest radiograph as a targeted assessment of cardiac size, pulmonary circulation, devices and alternative thoracic disease without over-reading a normal film.
Confirm patient, date, projection, rotation, inspiration and exposure before interpreting the heart or mediastinum.
Cardiothoracic ratio is meaningful on a well-inspired PA film; AP portable magnification can mimic cardiomegaly.
Upper-lobe venous diversion, interstitial markings, septal lines, perihilar air-space opacity and pleural effusions form a congestion spectrum.
Key red flags
Pulmonary oedema
Bilateral perihilar or diffuse air-space opacity, vascular indistinctness, septal lines and effusions support congestion; correlate with rapidity and volume status.
Investigation priorities
01
PA and lateral chest radiographsFirst step
Assess heart size, pulmonary vasculature, pleura and thoracic alternatives in a stable ambulant patient.
Management branches
Preferred routeSuspected heart failure
Dyspnoea, oedema or signs of congestion
Assess severity and treat hypoxaemia or pulmonary oedema immediately when present.
Obtain ECG, natriuretic peptide, renal function and chest radiograph as clinically appropriate.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.