Right hemithorax white-out: pleural effusion

Case contributed by Dr Roberto Schubert

Presentation

Dyspnoea.

Patient Data

Age: 65
Gender: Female
X-ray

Chest x-ray

Frontal and lateral radiographs of the chest demonstrate complete white out of the right hemithorax. There is evidence of positive mass effect upon the mediastinum which is shifted towards the left (including the trachea), with leftward bowing of the azygo-oesophageal recess. The right ribs are also splayed. 

On lateral projection only one pleural cavity is visible (the left one). 

Annotated image

Annotated images

Signs of positive mass effect on the right include: 

  1. shift of the mediastinum and trachea (blue) to the left
  2. leftward bowing of the azygo-oesophageal recess (yellow)
  3. splaying of the ribs on the right (red)

On the lateral film one knows that the affected side is the right because: 

  1. the aortic arch is visible (orange)
  2. the visible hemidiaphragm and pleural surface (green) abuts the posterior border of the heart (IVC)
  3. grastic air bubble (purple) abuts the visible hemidiaphragm

Note that the film has been obtained with the right side against the film (opposite to normal) and thus it is the left hemidiaphragm which is magnified. 

Case Discussion

This case illustrates the typical appearance of a very large pleural effusion (in this case form a pulmonary malignancy) and demonstrates the signs which enable it to be confidently distinguished from collapse or consolidation of the right lung. 

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Case information

rID: 16075
Case created: 15th Dec 2011
Last edited: 3rd May 2017
System: Chest
Inclusion in quiz mode: Included

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