Start with an overview‚ do not forget the forest for the trees! What does the patient look like: male or female, fat or thin, young or old, straight up or bent over? Then, work from outside in: soft tissues, bones, pleura (not normally visible), lungs, mediastinal contour, heart size and configuration, great vessels, hila. Remember to check technical factors such as patient ID and side marker (right vs. left).
What are the major cardiovascular bumps‚ that form the silhouette of the mediastinum on the frontal chest x-ray working from top to bottom?
Ascending aorta (should not be prominent in patients under 50 years of age)
Right atrium Left side:
Aortic knob (should be thumb-sized in patients under 50)
Left pulmonary artery
Left atrial appendage (should be nearly concave)