Pleural Disease

In addition to the features of an uncomplicated pneumothorax, note the marked mediastinal shift to the left in this young patient with a right tension pneumothorax.

The patient’s left pneumothorax is more difficulty to diagnose on this supine film. This study demonstrates the “deep sulcus” sign, with the left costophrenic sulcus descending below the edge of the film. Other clues include a hyperlucent left hemithorax and slight sharpening of the left mediastinal border. This patient also has a tracheostomy, evidence of a prior sternotomy (not the multiple circular sternal wires), and a central venous catheter with its tip in the right ventricular outflow tract. The circular structures projecting over the chest, some with wires extending from them are ECG leads.

This patient has a moderate-sized right pleural effusion. The lateral decubitus film places the effusion in the dependent position and will show layering unless the effusion is loculated. This is noted in the same patient’s left lateral decubitus film.

Normal PA film of a male. Note the right and left clavicles (cl), posterior (p1-4) and anterior (a1-2) ribs, right and left costophrenic angles(cpa), right cardiophrenic angles (cdpa), right and left hemidiaphragms (hd), gastric air bubble (gab), trachea (tr), right and left mainstem bronchi (br), mediastinal shadow (med), carina (ca), and right and left hila (hi). The normal position of the minor fissure (mi) is also indicated.