primary tuberculosis). Additional views Decubitus – taken while the patient is lying down, typically on their side. Useful for differentiating pleural effusions from consolidation (e.g. pneumonia) and loculated effusions from free fluid in the pleural space. In effusions, the fluid layers out (by comparison to an up-right view, when it often accumulates in the costophrenic angles). Lordotic view – used to visualize the apex of the lung, to pick up abnormalities such as a Pancoast tumor. Expiratory view – helpful for the diagnosis of pneumothorax. Oblique view – useful for the visualization of the ribs and sternum. Although it's necessary to do the appropriate adaptations to the x-ray dosage to be used. Landmarks In the average person, the diaphragm should be intersected by the 5th to 7th anterior ribs at the mid-clavicular line, and 9 to 10 posterior ribs should be viewable on a normal PA inspiratory film. An increase in the number of viewable ribs implies hyperinflation, as can occur, for example, with obstructive lung disease or foreign body aspiration. A decrease implies hypoventilation, as can occur with restrictive lung disease, pleural effusions or atelectasis. Underexpansion can also cause interstitial markings due to parenchymal crowding, which can mimic the appearance of interstitial lung disease. Enlargement of the right descending pulmonary artery can indirectly reflect changes of pulmonary hypertension, with a size greater than 16 mm abnormal in men and 15 mm in women. Appropriate penetration of the film can be assessed by faint visualization of the thoracic spines and lung markings behind the heart. The right diaphragm is usually higher than the left, with the liver being situated beneath it in the abdomen. The minor fissure can sometimes be seen on the right as a thin horizontal line at the level of the fifth or sixth rib. Splaying of the carina can also suggest a tumor or process in the middle mediastinum or enlargement of the left atrium, with a normal angle of approximately 60 degrees. The right paratracheal stripe is also important to assess, as it can reflect a process in the posterior mediastinum, in particular the spine or paraspinal soft tissues; normally it should measure 3 mm or less. The left paratracheal stripe is more variable and only seen in 25% of normal patients on posteroanterior views. Localization of lesions or inflammatory and infectious processes can be difficult to discern on chest radiograph, but can be inferenced