2.9 Hemithorax Opacification Flashcards
List the main differential diagnoses for hemithorax opacification.
Compare and contrast findings in the CXR of the opacified hemithorax that may help you to form a differential.
What’s this?
What can cause this?
This is a massive pleural effusion.
As the pleural effusion does not fill the entire lung, a meniscus is seen.
Can be caused by: malignancy, TB, trauma (haemothorax), liver disease. CHF can also cause this but it is usually bilateral.
What’s this?
What can cause this?
This is complete atelectasis.
It results from complete obstruction of a main bronchus leading to no air entering that lung.
Visceral and parietal pleura remain attached.
Shift of mediastinal structures towards collapsed lung.
Ddx: Neoplasm, mucous plugs, such as in asthma and cystic fibrosis.
What’s this?
What’s this?
The space fills with fibrotic fluid and tissue and the ‘opacification’ occurs over 5-6 weeks after the pneumonectomy.
Mediastinal structures also shift to the side of the pneumonectomy, similar to the complete atelectasis.
Would you expect a mediastinal shift in all cases of atelectasis?
No, if there is a mixed picture, e.g. atelectasis + fluid, that could stop structures in mediastinum shifting.
In most mixed cases, the mediastinal shift is not necessarily predictable.
You have an opacified hemithorax on CXR and from the images are unsure of the exact differential.
What should you do next?
CT chest.
