The causes of an

opacified
hemithorax
KEVIN SURJADI, MD
RADIOLOGY DEPARTMENT
MAYAPADA HOSPITAL JAKARTA SELATAN
Case

 Mr. Smith, 31 y.o., comes into

emergency department acutely
short of breath.

 Would you recommend:

1. Bronchoscopy for atelectasis?
2. Emergent thoracentesis for a
large pleural effusion?
3. A course of antibiotics for his
large pneumonia?
Causes of an opacified hemithorax

1. Atelectasis of the entire lung

2. Massive pleural effusion
3. Pneumonia of the entire lung
4. Pneumonectomy (removal of an entire lung)
1. Atelectasis of the entire lung

 Complete obstruction of the right or left main

bronchus  no air can enter the lung.
 The remaining air in the lung is absorbed into the
bloodstream through the pulmonary capillary
system  loss of volume
 Cause: obstructing neoplasm, asthma, foreign body
2. Massive pleural effusion

 The large effusion “pushes” mobile structures away

and there is a shift of the heart and trachea away
from the side of opacification.
 Commonly as the result of malignancy:
bronchogenic carcinoma or secondary to
metastases to the pleura
 At times, there may be a perfect balance between
the push of a malignant effusion and the pull of
underlying obstructive atelectasis from the
malignant itself.
3. Pneumonia of the entire lung

 Inflammatory exudate fills the air spaces with pneumonia

causing consolidation and opacification of the lung.
 No longer contains air
 No shift of the heart or trachea.
4. Postpneumonectomy

 Pneumonectomy = removal of an entire lung.

 For about 24 hours following the surgery, only air
occupies the hemithorax from which the lung has
been removed
 By 4 months after surgery, the pneumonectomized
hemithorax should be completely opaque.
Case

 Mr. Smith, 31 y.o., comes into

emergency department acutely
short of breath.

 Would you recommend:

1. Bronchoscopy for atelectasis?
2. Emergent thoracentesis for a
large pleural effusion?
3. A course of antibiotics for his
large pneumonia?
Case

 Black arrow  shift of the trachea

toward the left
 White arrow  the heart is displaced
toward the left
 Both of these mobile structures have
moved toward the side of
opacification  atelectasis of the
entire left lung.
 Mr. Smith, 31 y.o., and has a history of
asthma, a mucus plug is the most likely
cause. The plug was removed
bronchoscopically.