Ebook Chest X-ray in clinical practice: Part 2
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Ebook Chest X-ray in clinical practice: Part 2
Chapter 5The PleuraPleural AbnormalitiesPleural abnormalities are a common finding on chest X-ray, the significance of which varies from trivial to ma Ebook Chest X-ray in clinical practice: Part 2arked. In order to ensure that such abnormalities are not missed, it is important that all check areas are examined on each chest X-ray. Some abnormalities of the pleura can be subtle and may be missed. Typical areas to identify pleural abnormalities are at the costophrenic and cardiophrenic angles, Ebook Chest X-ray in clinical practice: Part 2 the apices, and the peripheral outline of both lungs.Three main categories of pleural abnormalities are seen: effusions, pleural thickening or calcifEbook Chest X-ray in clinical practice: Part 2
ication, and pneumothoraces. These arc dealt with separately in the following sections. and in the first section we will consider pleural effusions.R.Chapter 5The PleuraPleural AbnormalitiesPleural abnormalities are a common finding on chest X-ray, the significance of which varies from trivial to ma Ebook Chest X-ray in clinical practice: Part 2s are a common finding. Further investigation of a pleural effusion, in addition to a detailed history and examination. may include a pleural lap. This establishes whether the effusion is a result of an exudate or a transudate. This knowledge further helps elucidate the cause of the effusion Table 5 Ebook Chest X-ray in clinical practice: Part 2.1.We will be limiting our discussion to the chest X-ray findings. although clearly interpretation needs to be made within the clinical context of theEbook Chest X-ray in clinical practice: Part 2
patient.The typical findings of an effusion are opacity al the lung base with a meniscal appearance laterally at the costophrenic angle. If the effusChapter 5The PleuraPleural AbnormalitiesPleural abnormalities are a common finding on chest X-ray, the significance of which varies from trivial to ma Ebook Chest X-ray in clinical practice: Part 2 films can be very useful. If the abnormality is longstanding and unchanged, thickening is more likely. If doubt persists, examination with ultrasound is a very sensitive method of demonstrating fluid.A moderate effusion is usually easier to identify as a fluid level, with again a laterally placed m Ebook Chest X-ray in clinical practice: Part 2eniscus (Fig. 5.1). Il is also usually accompanied by significant signs and symptoms.A very large effusion may cause complete opacification of the affEbook Chest X-ray in clinical practice: Part 2
ected hemi-thorax. Illis can be differentiated from complete collapse of the lung (see Fig. 4.13) as the mediastinum will not move toward the affectedChapter 5The PleuraPleural AbnormalitiesPleural abnormalities are a common finding on chest X-ray, the significance of which varies from trivial to ma Ebook Chest X-ray in clinical practice: Part 2 and we have grouped them broadly into benign and malignant.Chapter 5. The Pleura 115Table 5.1. Common causes of pleural effusions.Transudate (often bilateral, pleura normal)Exudate (often unilateral, pleura abnormal)LVF Fluid overload I lypoalbumincmia. c.g.. cirrhosis, nephrotic syndromeInfection Ebook Chest X-ray in clinical practice: Part 2Infarction Malignancy Inflammation, e.g.. Rheumatoid arthritis, systemic lupus erythematosus Ascites, e.g.. cirrhosis, Meigs syndrome Traumatic, c.g..Ebook Chest X-ray in clinical practice: Part 2
chest trauma, oesophageal rupture Rare causes, c.g.. yellow nail syndromeFigure 5.1. Moderate right pleural effusion. Note the blunting of the costopChapter 5The PleuraPleural AbnormalitiesPleural abnormalities are a common finding on chest X-ray, the significance of which varies from trivial to ma Ebook Chest X-ray in clinical practice: Part 2e right pleural effusion. Note the mediastinal shift away from the effusion.5.1Benign Pleural EffusionIllis is usually classified into a unilateral or bilateral effusion.5.1.1UnilateralA unilateral pleural effusion is generally more significant than bilateral and will require further investigation t Ebook Chest X-ray in clinical practice: Part 2o exclude a malignant cause.Common benign causes include infection and infarction. It may be impossible to elucidate a cause from the chest X-ray5.1 BEbook Chest X-ray in clinical practice: Part 2
enign Pleural Effusion 117RIGHT 2Ekìuri: 5.3. Right pleural effusion with mid zone consolidation.alone and clinical history and examination play theirChapter 5The PleuraPleural AbnormalitiesPleural abnormalities are a common finding on chest X-ray, the significance of which varies from trivial to ma Ebook Chest X-ray in clinical practice: Part 2y (Fig. 5.3). Infarction may also be associated with consolidation, classically wedge shaped. This is. however, rarely present and often the chest X-ray is normal in a case of pulmonary embolism. Infarction typically gives a blood-stained tap.Traumatic effusions are also likely to contain blood and Ebook Chest X-ray in clinical practice: Part 2there is usually an appropriate clinical context. There may be adjacent rib fractures or hydro-pneumothorax. Empyemas may resemble simple pleural effuEbook Chest X-ray in clinical practice: Part 2
sions, but are often loculated and tethered (Fig. 5.4). Occasionally these extend upward toward the apex, without occupying the whole pleural space anChapter 5The PleuraPleural AbnormalitiesPleural abnormalities are a common finding on chest X-ray, the significance of which varies from trivial to ma Ebook Chest X-ray in clinical practice: Part 2ema. There is dense pleural opacification. This continues up the lateral henii-lhorax (as it is loculated) without “’lining up" the left henii-lhorax.Chapter 5The PleuraPleural AbnormalitiesPleural abnormalities are a common finding on chest X-ray, the significance of which varies from trivial to maGọi ngay
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