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.
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)
Identify: Costophrenic Sulcus
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Look for: Neurogenic tumour (e.g. neurofibroma, schwannoma) Multiple myeloma Pheochromocytoma Extramedullary hematopoiesis Neurenteric cyst, thoracic duct cyst Lateral meningocele Bochdalek hernia
