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Opacified Hemithorax: Atelectasis Masses & Effusion Pneumonia

This document summarizes the radiographic findings and shifts seen with various conditions that can cause opacification of one hemithorax, including atelectasis, masses/effusions, and pneumonia. With atelectasis and large effusions/masses, there is shifting of the heart and trachea away from the side of opacification due to loss of lung volume or a large compressive fluid collection. With pneumonia, there is usually no shift of the heart or trachea from their normal positions since inflammatory exudate fills the air spaces without volume loss or compression. The document provides examples of chest x-rays demonstrating these findings and shifts.

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124 views13 pages

Opacified Hemithorax: Atelectasis Masses & Effusion Pneumonia

This document summarizes the radiographic findings and shifts seen with various conditions that can cause opacification of one hemithorax, including atelectasis, masses/effusions, and pneumonia. With atelectasis and large effusions/masses, there is shifting of the heart and trachea away from the side of opacification due to loss of lung volume or a large compressive fluid collection. With pneumonia, there is usually no shift of the heart or trachea from their normal positions since inflammatory exudate fills the air spaces without volume loss or compression. The document provides examples of chest x-rays demonstrating these findings and shifts.

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OPACIFIED

HEMITHORAX
Atelectasis
Masses & effusion
Pneumonia

Jovi Pardomuan Siagian


Department of Radiology
ATELECTASIS
Atelectasis, also
known as collapse, is
loss of lung volume
caused by inadequate
expansion of air
spaces.
Atelectasis of an entire
lung usually results
from a complete
obstruction of the right
or left main bronchus.
ATELECTASIS SHIFTING
Right-sided atelectasis Left-sided atelectasis
Heart
Moves leftward; right
Heart heart border overlaps the
Moves rightward; left spine
heart border may come to
lie near left side of spine
Trachea
Trachea
Shifts toward left
Shifts toward right
Hemidiaphragm
Hemidiaphragm
Left hemidiaphragm
Right hemidiaphragm
moves upward and may moves upward and may
disappear (silhouette sign) disappear (silhouette
sign)
Atelectasis
Child with
wheezing and
shortness of
breath

There is a shift of the


heart toward the left
such that the right
heart border no
longer projects to the
right of the spine
(black arrow). The
trachea (white
arrow) has moved
leftward from the
midline toward the
side of the
opacification.
MASSES & EFFUSION
Iffluid such as blood, exudate, or a
transudate fills the pleural space so as to
opacify almost the entire hemithorax, then
the fluid may act like a mass compressing
the underlying lung tissue.
When enough pleural fluid accumulates, the
large effusion pushes mobile structures away
and there is a shift of the heart and trachea
away from the side of opacification.
MASS SHIFTING
Right-sided mass/effusion Left-sided mass/effusion

Heart
Heart
Moves rightward; more of
Moves leftward; apex
heart protrudes to right
may lie near chest wall
of spine
Trachea
Trachea Shifts toward right
Shifts toward left
Left hemidiaphragm
Right hemidiaphragm Disappears (silhouette
Disappears (silhouette sign)
sign)
Large Pleural
Effusion

There is complete
opacification of the
right hemithorax. The
trachea is deviated to
the left (black
arrow), and the apex
of the heart is also
displaced to the left,
close to the lateral
chest wall (white
arrow).
PNEUMONIA
Inflammatory
exudate fills the air,
causing consolidation
and opacification.
There is neither a pull
toward the side of the
pneumonia by volume
loss nor a push away
from the side of the
pneumonia by a large
effusion.
PNEUMONIA SHIFTING
Right-sided pneumonia Left-sided pneumonia

Heart
Heart
There is usually no shift
There is usually no shift
of the heart from its
of the heart from its
normal position
normal position
Trachea
Trachea
Midline
Midline
Hemidiaphragm
Hemidiaphragm
Left hemidiaphragm may
Right hemidiaphragm
disappear (silhouette
may disappear
sign)
(silhouette sign)
Pneumonia
Left upper
lobe

There is near-
complete
opacification of the
left
hemithorax with no
shift of the heart and
little shift of the
trachea (white
arrows). There are
air bronchograms
suggested within the
upper area of
opacification (circle).
EXCERCISES
40-year-old man with fever and 62-year-old man with dyspnea,
dyspnea increased over the past several
months
31-year-old with acute shortness One year after pneumonectomy
of breath

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