Chiropractors should look for an asymmetry of the hemi diaphragm, or a blunting of the costophrenic angle
on every film where the diaphragm can be visualised.
Chest radiograph [Figure 1]a revealed a homogeneous mass lesion in the left lower lung field with obliteration of the costophrenic angle
. Computed tomography scans of the chest [Figure 1]b and [Figure 1]c disclosed a huge mass over the left lower thorax and upper abdomen with compression of the heart and shift of the esophagus and descending aorta to midline and diffuse emphysematous change in the rest of the lungs.
I later learned that he clipped my costophrenic angle
and pleaded with the radiologist, "Please don't make me do it again; the patient is Dan Hobbs." Later, I laughed as that story was told to me.
The simplest method for estimation of pleural effusion is classifying it as minimal, if the hypoechoic space is seen only at the costophrenic angle
; small if it covers the costophrenic angle
but limited within the image formed by the transducer; moderate if the space is larger than the image but limited within two images; and large or massive if it is larger than two images formed by the transducer.11 But being a qualitative classification, this does not give the amount of effusion in each category.
Chest radiograph showed bilateral nonhomogenous opacity predominantly in mid and lower zones that were clearly depicted as reticular and nodular shadows with some cystic shadows in upper zones in the scanogram and homogeneous opacification of the right costophrenic angle
suggestive of pleural effusion [Figure 1].
A PA chest radiograph demonstrated loss of definition of the left costophrenic angle
and diaphragm, with mediasfinal air and cervical subcutaneous air.
Chest radiograph showed tip of nasogastric catheter upturned and lying in the thoracic stomach, mediastinal shift to the right, obliteration of the left costophrenic angle
, elevation of left hemidiaphragm, and multiple contusions in the left lung mid-zone area.
Caption: Figure 2: CXR (AP) shows a prominent thymus, normal cardiothoracic ratio, sharp costophrenic angles
without cardiomegaly, consolidation, or increased perivascular markings.
On chest X-ray, the costophrenic angles
were closed and an appearance of hydrothorax was observed (Figure 1(c)).
Chest X-ray showed blunting of both costophrenic angles
with no other pulmonary features suggestive of inflammation or pneumonia.