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

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