Effusion – Blunted Angles and Thickening
2. Evaluate for Effusion – Blunted Angles/Thickening
Blunting of the costophrenic angles (see normal sharp angles) generally indicates a pleural effusion. Blunting can also indicate thickening of the pleura.
Diaphragm – Free Air
4. Evaluate for Diaphragm – Free Air
Free air under the diaphragm suggests pneumonperitoneum (i.e. bowel perforation). Right image indicates where free air is located.
Diaphragm – Elevation
2. Evaluate for Diaphragm – Elevation
An elevated hemidiaphragm can be caused by a diaphragm paralysis, lung resection/pneumectomy, atelectasis and pregnancy. A pleural effusion may also result in an apparent elevation.
No image available
Diaphragm – Depression
3. Evaluate for Diaphragm – Depression
A depressed hemidiaphragm can be the result of asthma, COPD, a tumour or a large pleural effusion. The image below depicts flattened diaphragms as a result of bullous emphysema.
Diaphragm
1. Evaluate for Diaphragm
On the lateral film the costophrenic (CP) angle of each hemidiaphragm (HD) should be sharp.
Right Image: Close up of CP angle of each HD. (RD = right HD and LD = left HD)
Costophrenic Sulcus
Identify: Costophrenic Sulcus
Mediastinal Mass – Superior
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Mediastinal Mass – Posterior
Look for:
- Neurogenic tumour (e.g. neurofibroma, schwannoma)
- Multiple myeloma
- Pheochromocytoma
- Extramedullary hematopoiesis
- Neurenteric cyst, thoracic duct cyst
- Lateral meningocele
- Bochdalek hernia
Mediastinal Mass – Middle
Everything from the heart and great vessels to a line 1 cm posterior to the anterior border of the thoracic vertebral bodies.
Look for:
- Esophageal carcinoma, esophageal duplication cyst
- Metastatic disease
- Lymphadenopathy (all causes)
- Hiatus hernia
- Bronchogenic cyst
Mediastinal Mass – Anterior
Anterior to heart and great vessels.
Look for:
- Teratoma, thyroid, parathyroid or thymic neoplasm
- Thymic or pericardial cyst, epicardial fat pad
- Foramen of Morgagni hernia
