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• W1780230528 abstract "The typical roentgenogram in cases of pleural effusion is quite familiar. Briefly, the effusion in the absence of pneumothorax first produces a uniformly dense opacity obliterating the costophrenic angle. The medial border is crescentic and extends downward and inward toward the diaphragm. As the effusion increases, it extends medially over the diaphragm and upward along the lateral aspect of the chest. The free margin is concave and the density is higher in the lateral or costal portion of the thorax than in the medial. In the absence of a fixed mediastinum, large pleural effusions cause displacement of the mediastinal contents to the opposite side. The upper concave margin seen in the roentgenogram does not, however, represent the actual height of the fluid. Kaunitz (1, 5) has demonstrated that simple pleural effusions may be divided into three regions. The lowest and most radiopaque zone is made up almost entirely of fluid, the middle or translucent area is due to a moderate amount of fluid, slightly compressing the lung, and the uppermost area is transparent but represents a film of fluid that is too thin to be seen in the x-ray film. Small collections of fluid may not be seen in the conventional upright posteroanterior roentgenogram, the effusion being hidden in the posterior and anterior costophrenic sulci by the liver and the diaphragm. Thus Kaunitz (1) injected 300 c.c. of normal saline into the pleural cavity of an adult and was unable to obtain a shadow in the lateral costophrenic angle. Ganter (2) has shown that less than 400 c.c. of pleural fluid cannot be demonstrated by physical examination or the ordinary chest film. This fact serves to emphasize the necessity for altering the usual methods of roentgen diagnosis to detect small pleural effusions. This has been ably done by Rigler (3, 4), who showed that all pleural transudates and most pleural exudates, especially those of recent origin and non-purulent character, shift markedly as the position of the patient is changed. By placing the patient in a variety of positions for roentgenographic study, one can take advantage of this fact to detect small pleural effusions and differentiate thickened pleura from fluid. Thus, when a small pleural effusion is suspected because of clouding of the costophrenic sinus, a postero-anterior roentgenogram with the patient in the lateral decubitus position will often disclose a dense or hazy shadow occupying the inferior costal gutter, which in this position is the most dependent portion. This position, therefore, will often reveal the presence of fluid that is concealed by the liver and diaphragm when the patient is erect. When the patient is supine, the characteristic appearance of fluid is no longer present but the involved hemithorax becomes cloudy instead." @default.
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• W1780230528 date "1945-08-01" @default.
• W1780230528 modified "2023-10-01" @default.
• W1780230528 title "Unusual Pleural Effusions" @default.
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• W1780230528 doi "https://doi.org/10.1148/45.2.147" @default.
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