The Reverse Lordotic View
1. Clinical Definition
The Reverse Lordotic View (also known as the prone lordotic view or caudocranial projection) is a specialized chest X-ray view where the patient is positioned to lean forward with the X-ray beam angled cranially. This projects the clavicles inferiorly, away from the lung apices.
2. High-Yield Indications
- Obscured Apices: Used when a standard apical lordotic view is contraindicated, painful, or technically difficult for the patient.
- Clarification of Apical Lesions: Intended to clear the clavicles and first ribs from the lung apices to identify occult lesions, cavitary disease (e.g., TB), or apical scarring.
3. Key Differences
| Feature | Lordotic (Standard) | Reverse Lordotic |
|---|---|---|
| Patient Position | Leaning backward (supine). | Leaning forward (prone). |
| Primary Goal | Clear clavicles from apices. | Clear clavicles from apices. |
4. Exam Pearls
- Clinical Context: Like the classic lordotic view, this is primarily an historical/board-specific technique. It is physically demanding for patients and provides significantly less diagnostic information than a Chest CT.
- Board Strategy: If a question asks for a way to clear the clavicles from the lung apices and gives options, both lordotic and reverse lordotic views are functional equivalents for that specific diagnostic goal.
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