Grand Rounds - Opaque hemithorax.

Pulmonary Medicine Blog By Dr Deepu

Grand Rounds:

This patient an elderly lady presented to us with breathlessness and cough eith sputum with increased sputum in right lateral position. Spo2 was 89% 
Examination revealed trachea deviated to left. Apicak impulse felt in left axilla 5th Ics. Breath sounds diminished on left with added crepitations on left side.
This X ray was taken in emergency room.

 CT confirmed fibrosis of left lung.
Complete white out(opacification) of the hemithorax on CXR has a limited number of causes.
 The differential diagnosis can be zeroed on with one simple observation - the position of the trachea. 
Is it central, pulled or pushed from the side of opacification?
  • pulled trachea : pneumonectomy, total lung collapse, pulmonary fibrosis,pulmonary agenesis
  • central: consolidation, mesothelioma, collapse with effusion. Lung mass 
  • pushed: pleural effusion, diaphragmatic hernia.

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