What's the Diagnosis? By Dr. Lynn Manganiello

A 70 yo presents to your ED intubated by medics. The patient was reportedly having worsening respiratory distress, was trialed on CPAP but failed, ultimately requiring intubation prior to ED arrival. A stat portable CXR is done and shown below. What's the diagnosis?  (scroll down for answer)





Answer: Complete opacification of R hemithorax

  • Differential for complete "white out" of a hemithrorax is most commonly:
    • Pleural effusion (fluid, blood, empyema)
    • Atelectasis (from mucus plug, obstructive mass, mainstem intubation)
  • To differentiate- look at the mediastinum for the answer! (is the trachea central or deviated toward/away from the opacified side?)
    • Trachea deviates toward opacified side:
      • pneumonectomy
      • total lung collapse  (mainstem intubation)
      • pulmonary hypoplasia 
    • Trachea midline:
      • consolidation
      • pulmonary edema/ARDS
    • Trachea deviates away from opacified side: 
      • pleural effusion
      • large pulmonary mass
  • Can also use POCUS to to look for a large effusion if unclear/to confirm CXR !




Corne J, Carroll M, and Delany D. Chest X-ray Made Easy. 2nd ed., Churchill Livingstone, 2002