1
2
Right pleural effusion blunting the right costophrenic angle
extending posteriorly with some fluid tracking into the major
fissure seen on the lateral exam.
Upright
3
The difference in an effusion on an
upright film and on a supine film
with the typical veil type density
layering on the supine film and the
upright film showing findings more
suspicious for an elevated
hemidiaphragm due to
subpulmonic collection of fluid.
Supine
4
5
Small amount of fluid tracking laterally in the right
hemithorax.
6
Larger effusion with some fluid tracking into the minor fissure.
7
Fluid tracking into the major fissure on the left
8
Large pleural effusion collecting laterally along the right lateral chest wall
with extension into the minor fissure.
9
10
Films show large pleural effusion and
its change with decubitus position
with the fluid layering dependently –
note the beads in the left marker
change position to indicate the
position of the patient.
Decubitus
11
Decubitus
12
13
13
Large subpulmonic effusion colleting under the inferior aspect
of the left lower lobe – notice the apparent distance between
the gastric bubble and the lung; this is the subpulmonic fluid.
14
Notice how large the
effusion is with the
decubitus position.
Decubitus
14
Normal right costophrenic
angle.
15
Supine
Upright
16
Subpulmonic effusion
collecting on the right.
Note change in the effusion
with supine positioning.
17
Lateral
18
Opacified hemithorax with mediastinal shift. Notice only one
hemidiaphragm is visualized on lateral.
19
20
Patient with a pneumonectomy; notice the opacified chest with shift of the
mediastinum towards the side of increased density. This is the distinguishing feature
of the shift of the mediastinum towards or away from the opacifying thorax.
Pneumothorax and pleural fluid (hydropneumothorax) note
the straight air fluid level inferiorly in the right costophrenic
angle and the elongated air fluid level on the lateral view.
23
Films show an empyema in the left
costophrenic angle – notice the convex
margin with the air fluid level. Compare
that with the hydropneumothorax with a
small amount of air in the pleural space
collecting superiorly.
24
26
26
Films shows a pleural pseudo tumor due to loculated fluid tracking in
the major fissure on the PA and lateral.
27
The CT Scan shows the loculated fluid simulating a mass.
28
Films show rounded density
representing a rounded atelectasis in
the right base with some pleural fluid
as well. The effusion allows for
atelectasis of the lung due to some
compression of the effusion.
29
30
On the CT scan this can be seen as atelectatic lung. This is
another pseudotumor where the rounded density simulates a
mass.
Soft tissue window
31
32
Bone window
33
Films shows density laterally in
the left hemi thorax on PA
view representing loculated
pleural fluid collecting along
the left lateral chest wall seen
on soft tissue and lung
windows.
LT.
LT.
34
Films show loculated effusion
collecting on the PA and lateral
with vague hazy density over the
right hilar region and pleural
fluid laterally.
35
34
The loculated fluid seen
on the previous film is
best demonstrated on
this CT scan.
35