Hemithorax white-out (differential)

Last revised by Ian Bickle on 30 Nov 2022

Complete white-out of a hemithorax on the chest x-ray has a limited number of causes. The differential diagnosis can be shortened further with one simple observation: the position of the trachea. Is it central, pulled or pushed from the side of opacification? Is there pulmonary volume loss or volume gain? Is there rib crowding? Is the heart pushed or pulled?

Trachea pulled toward the opacified side
Trachea remains central in position
Pushed away from the opacified side

See also

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Cases and figures

  • Case 1: collapse
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  • Case 2: pleural effusion
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  • Case 3: in an infant
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  • Case 4: Ewing sarcoma
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  •  Case 5: pneumonectomy
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  • Case 6: metastatic pleural effusion
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  • Case 7: pleural fibroma
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  • Case 8: hemothorax
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  • Case 9: pleural empyema
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  • Case 10: right main stem intubation
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  • Case 11: left hepatohydrothorax without ascites in a case of cirrhosis, portal hypertension and splenomegaly
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  • Case 13: airway foreign body in child
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  • Case 14: Hemithorax white-out (pneumonia)
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  • Case 15: Diaphragmatic hernia
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  • Case 16: Left lung aplasia
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  • Case 17: Agenesis of right lung
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  • Case 18: bilateral white out due to swine flu (H1N1 influenza)
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  • Case 19: malignant pleural effusion
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