Pleural X-Rays

PLEURAL EFFUSION

• Homogenous hyperlucency on the left chest• Curved upper border, concave medially and

upwards• Left costophrenic angle is obliterated• Cardiac shadow and trachea have shifted

slightly towards the right

• A small effusion BLUNTS the costophrenic angle• A larger effusion forms a MENISCUS laterally or

hides in a SUBPULMONIC location.

• Lateral film is more sensitive than the PA film for the detection of small effusions

• Pleural fluid is often seen tracking up the major fissure on the lateral view

Subpulmonic effusion

• Closely simulates an elevated diaphragm• Stomach bubble is separated from the lung

base by only the thin diaphragm• In subpulmonic fluid, gas bubble lies FARTHER

FROM the lung base (Stomach bubble sign)• Lateral decubitus X-Ray may be used to identify

- fluid will move to dependent part and a sharp edge appears between lung and fluid

Intrafissural effusion

• Also known as pseudotumour• The encapsulated effusion in minor fissure have

sharp margins in the PA & lateral views• In the major fissure margins are sharp in lateral

view (The beam must be parallel to the fissure to see it)

• Seen in CHF – disappears as the condition resolves (vanishing tumor)

PNEUMOTHORAX

• Increased translucency on the right side• Absence of bronchovascular markings• Sharp defined homogenous opacity is seen

lateral to the right cardiac border collapsed right lung

• Right dome of the diaphragm is slightly flattened

• Visceral pleura is seen as a thin white line b/w air in the lung and air in the pleural space

• In consolidated lung, pneumothorax appears as an edge adjacent to the air in the pleural space

• Erect film is more sensitive than the erect film

HYDROPNEUMOTHORAX

• Horizontal air-fluid level on left chest• Increased translucency above the horizontal line

(‘pneumo’ component)• Homogenous opacity below the horizontal line

(‘hydro’ component)• Homogenous opacity is uniform and medially

merged with the cardiac shadow• Trachea and cardiac shadow have shifted

towards the right

Extrapleural lesions

• Lesions that arise in structures within or bordering the extrapleural space (potential space that lies b/w the rib cage and the pleural space)

• Example – ribs, muscle connective tissue• Most common – rib fracture and rib

metastasis

• Lifts the adjacent parietal pleura and push it toward the lung

• The lesion appears convex with a sharp interface with the lung

• Forms a obtuse angle with the chest wall