The Apical Lordotic View (Chest Radiography)
1. Clinical Definition
The Apical Lordotic View is a specialized chest X-ray projection where the patient is positioned to lean backward, projecting the clavicles superiorly and away from the lung apices. This maneuver “unfolds” the apex of the lungs.
2. High-Yield Indications
- Apical Pathologies: The primary goal is to visualize the lung apices clearly without obscuration by the clavicles and first/second ribs.
- Tuberculosis (TB): Historically, the most common indication, as pulmonary TB classically affects the apical and posterior segments of the upper lobes.
- Pancoast Tumor (Superior Sulcus Tumor): Useful for early evaluation of tumors at the apex of the lung.
3. Key Radiological Findings
| Pathology | Radiographic Goal |
|---|---|
| Apical TB | To see cavitary lesions or infiltrates hidden behind the clavicle. |
| Apical Pleural Cap | Evaluation of thickening or masses in the superior sulcus. |
4. Exam Pearls
- Exam Classic: If a board question presents a patient with chronic cough, night sweats, or hemoptysis and mentions an apical lesion partially obscured by the clavicles on a standard PA view, the next best imaging step to clarify the apex is the Apical Lordotic view.
- Limitations: Like other special views, this has been largely replaced by CT of the chest, which provides superior detail of the apices without the need for complex patient positioning.
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