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Old 08-05-2016
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Default Atelectasis and pleural effusion on CXR

Can anyone tell me how to DDx the two conditions on a chest x-ray?
They are both unilateral opacifications.
Do I look for mediastinal shift, fluid lines or history (e.g. ventilation for atelectasis)?

Thanks!
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Old 08-05-2016
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hi ... for me i see pleural effusion in the lower lungs always ,, ( pay attention to the lateral angle of the lung , it wont be clearly obvious because its filled with fluid.. plus it appears bright white,,,

for atelectasis , ive seen an xray once,, showing upper lobe atelectasis ,, it appeared like linear opacification ,, like the whole upper lobe is shut down ,,,

dont depend on the trachea deviation ,, cause sometime pleural effusion wont be large enough to cause shifting ,, although it can help..like shifting to the other side in effusion , and shifting to the same side in atelectasis ,,,
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Old 08-05-2016
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Quote:
Originally Posted by dr.hiba View Post
hi ... for me i see pleural effusion in the lower lungs always ,, ( pay attention to the lateral angle of the lung , it wont be clearly obvious because its filled with fluid.. plus it appears bright white,,,

for atelectasis , ive seen an xray once,, showing upper lobe atelectasis ,, it appeared like linear opacification ,, like the whole upper lobe is shut down ,,,

dont depend on the trachea deviation ,, cause sometime pleural effusion wont be large enough to cause shifting ,, although it can help..like shifting to the other side in effusion , and shifting to the same side in atelectasis ,,,
Thanks for the reply, what about in the case of a massive pleural effusion or lower/mid lobe atelectasis? I am assuming deviation/shifting will be more prominent here.
Also are you saying that pleural effusion is "solid" white on x-ray where atelectasis is more translucent where ribs can be counted?
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Old 08-06-2016
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Quote:
Originally Posted by Step-One View Post
Can anyone tell me how to DDx the two conditions on a chest x-ray?
They are both unilateral opacifications.
Do I look for mediastinal shift, fluid lines or history (e.g. ventilation for atelectasis)?

Thanks!
Pleural effusion
- Massive: trachea deviates away from the pathological site
- Meniscus sign
- Costophrenic angle (blunting)

Atelectasis
- Trachea & mediastinum: Deviate towards the site of pathology
- Collapse usu involves lobe/lobes
- So, "radio-opaque" would be seen for example at the upper lobe with loss of volume of hemithorax / volume loss for the pathological site involved.

Both conditions can also co-exist:
(i) Sign on X-ray chest - depends on which is more predominating
(ii) Look for clue if any - cut-off of bronchus
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Old 08-06-2016
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i understand.. if u notice this pic

https://www.google.com/imgres?imgurl...act=mrc&uact=8

u will find that atelectasis in lower lobes always has linear ( kind of oblique presentation )


but in pleural effusion its always appears ALMOST horizental and the costophrenic angle DISSAPEARED

https://www.google.com/imgres?imgurl...act=mrc&uact=8

if u notice,, the effusion appears whiter ,, bright whiter ,, like when u see more n more X rays ,, u will sense the defferenece in whitness ( thats my way of recognizin it ) ,,,,
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Old 08-07-2016
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Thanks to both of you, much clearer!
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dr.hiba (08-07-2016)



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