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RADIOLOGY OF CHEST

PLEURAL EFFUSION

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PLEURAL EFFUSION

This is the presence of fluid in pleural

cavity.

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TYPES OF PLEURAL FLUID:

Transudate.

Exudate.

Sanguinous. (Blood) Empyema.

Chylous.

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CAUSES OF PLEURAL

EFFUSION:

TRANSUDATE:

Heart failure

Renal failure

Hepatic failure

Hypoproteinemia

Meigs syndrome

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CAUSES OF PLEURAL

EFFUSION:

EXUDATE:

Inflammatory

Bacterial pneumonia

Viral

Tuberculosis

Pancreatitis

Neoplastic Pulmonary infraction

Subpherenic / liver abscess

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CAUSES OF PLEURAL

EFFUSION:

SANGUINOUS (Haemothorax)

Traumatic

Infection

Neoplastic

Bleeding disorders

Infarction

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CAUSES OF PLEURAL

EFFUSION:

EMPYEMA (Pyothorax).

Pneumonia

Liver/subpherenic/lung abscess

Tuberculosis

CHYLOUS (Chylothorax)Traumatic rupture/Obstruction of

thoracic duct

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RADIOLOGIC SIGNS OF

PLEURAL EFFUSION

FREE FLUID

Homogenous basal opacity in erect film

starting in costopherenic angle with miniscus,

curved upper margin extending along lateralchest wall, may extend into a fissure.

Change in appearance as posture changes

Transudate, exudate, Haemorrhagic or chylouseffusion requires aspiration for distinction.

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RADIOLOGIC SIGNS OF

PLEURAL EFFUSION

Exudates, haemorrhagic effusion or empyema can

lead to pleural thickening, altering diaphragmatic

contour. Can later calcify esp. in tuberculosis

Lateral decubitus view is needed for distinction

between small effusion and pleural thickening. But

ultrasound is more sensitive.

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RADIOLOGIC SIGNS OF

PLEURAL EFFUSION

More than 200 cc of fluid is needed to obscurelateral costophernic angle.

Massive effusion cause homogeneously opaquehemithorax with shifting of mediastinum towardsopposite side. Diaphragm can be depressed oreven inverted.

HYDROPNEUMOTHORAX provides air fluid

level.

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LOCAULATED PLEURAL

EFFUSION

IN-FISSURES: - In oblique or horizontal fissure

Ovoid in shape

Usually in heart failure Disappears as fluid state is corrected

(vanishing tumour).

SUBPULMONARY. LOCULATED EFFUSION ALONG

CHEST WALL.

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UprightMeniscus

SupineUnilateralincreased density

DecubitusEffusion

layered on downside

Pleural Effusion

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Pleural Effusion

Supine patient

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Pleural Effusion

Semiupright..Lung base opacityfades superiorly

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Pleural Effusion

63-year-old man recovering from

congestive heart failureEffusion

loculated in fissure

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Massive Pleural Effusion

or

Total Lung Atelectasis

Massive pleural effusion

Heart and

mediastinum

shifted away fromwhited out hemithorax

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Massive Pleural Effusion

or

Total

Lung Atelectasis

Total Atelectasis

Heart and mediastinum

shifted towardwhited out hemithorax

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PNEUMOTHORAX

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PNEUMOTHORAX

It is the air in the pleural space with

relaxation of lung tissue.

RADIOLOGICALLY

There is white line of lung margin and no

pulmonary marking beyond.

More obvious on expiratory film esp. whenit is small.

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TYPES OF PNEUMOTHORAX

Simple/Spontaneous pneumothorax.

Open pneumothorax. Tension pneumothorax.

Bronchopleural fistula.

Hydropneumothorax.

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CAUSES OF PNEUMOTHORAX

IDIOPATHIC

Most common type, usually in tall thin males

Rupture of small bleb/bulla

TRAUMATIC Rib fracture esp 1st or 2nd --- associated with haemothorax, surgical emphysema.

Surgical --- CVP line complication.

Accidental --- stab

Ventilator pressure

Pleural aspiration

Perforated oesophagus

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CAUSES OF PNEUMOTHORAX

MEDIASTINAL/SUBCUTANEUS EMPHYSEMA

Status-asthmaticus

Oesophageal tear.

RUPTURED BULLAE

In COPD

CONNECTIVE TISSUE DISORDER

Rheumatoid arthritis

NECROTIC TUMOUR

Ca. Bronchus

Metastasis esp. Osteosarcoma

HYALINE MEMBRANE DISEASE

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Trace the lung vascular

markings out to the border of

the rib cage. When the lung

markings stop short of the rib

cage and there is increased

radiolucency in the pleuralspace, the patient has a

pneumothorax.

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Tension Pneumothorax

PNEUMOTHORAX

**

Examine patient

* Look for deviated heart and

mediastinum, depressed

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Supine Patient

Medial

Pneumothorax

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Is there a pneumothorax or isnt there?

Order a Lateral Decubitus chest radiograph

With the side of the chest in question as the upside

Possible left pneumothorax get right lateral

decubitus chest

Look for displaced visceral pleura along upside

lateral chest wall

Order Upright Expiratory chest radiograph

Look for pneumothorax at lung apex

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Pneumopericardium

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