Imaging recommendation · Chest

Acute dyspnea / shortness of breath, adult — imaging triage

Q: What's the alternative imaging for acute dyspnea / shortness of breath, adult — imaging triage when pe suspected (wells / perc positive)?

CT — CTPA (see pe-suspected) (iv contrast).

Q: What's the alternative imaging for acute dyspnea / shortness of breath, adult — imaging triage when cardiogenic edema vs ards distinction?

XR — CXR + bedside echo (see pulmonary-edema, ards) (no contrast).

Q: What's the alternative imaging for acute dyspnea / shortness of breath, adult — imaging triage when pneumonia / consolidation suspected?

XR — CXR PA + lateral; CT chest if complications or non-resolving (see pneumonia) (no contrast).

Q: What's the alternative imaging for acute dyspnea / shortness of breath, adult — imaging triage when copd / asthma exacerbation?

XR — CXR to exclude pneumothorax / pneumonia (see copd-exacerbation, asthma-severe) (no contrast).

Q: What's the alternative imaging for acute dyspnea / shortness of breath, adult — imaging triage when chronic / progressive dyspnea — ild workup?

CT — HRCT chest (see ild-chronic) (no contrast).

Recommended: CXR (PA + lateral if upright, AP supine if not) is the preferred imaging study for acute dyspnea / shortness of breath, adult — imaging triage. CXR first — answers most calls (pulmonary edema, pneumonia, pneumothorax, pleural effusion).

Recommended study

CXR (PA + lateral if upright, AP supine if not)

XR No contrast Preferred Chest EmergencyAcute inpatient Reviewed 2026-05

CXR first — answers most calls (pulmonary edema, pneumonia, pneumothorax, pleural effusion). Add CTPA if PE is on the differential. Bedside lung US complements CXR — B-lines for cardiogenic edema, absent sliding for pneumothorax, consolidation for pneumonia. Echocardiography when structural cardiac cause is suspected.

If the default doesn't apply

PE suspected (Wells / PERC positive)

CT CTPA (see pe-suspected) IV contrast

Cardiogenic edema vs ARDS distinction

XR CXR + bedside echo (see pulmonary-edema, ards) No contrast

Pneumonia / consolidation suspected

XR CXR PA + lateral; CT chest if complications or non-resolving (see pneumonia) No contrast

COPD / asthma exacerbation

XR CXR to exclude pneumothorax / pneumonia (see copd-exacerbation, asthma-severe) No contrast

Chronic / progressive dyspnea — ILD workup

CT HRCT chest (see ild-chronic) No contrast

Watch-outs

Saddle PE on supine portable CXR

CXR is often unimpressive in massive PE — don't be reassured by a clean film with hypoxia and tachycardia.

Cardiogenic vs non-cardiogenic edema

Kerley B + cardiomegaly + central distribution → cardiogenic. Peripheral / bibasilar / no cardiomegaly → ARDS.

Pearls

Bedside lung US is faster than CXR for cardiogenic edema (diffuse bilateral B-lines).
BNP + CXR together outperform either alone in the dyspnea differential.
Severe dyspnea + clean CXR + hypoxia: get the CTPA.