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

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