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The diaphragm typically appears as two separate, curved outlines (hemidiaphragms) on a chest X-ray due to the heart and mediastinum obscuring its central portion. When air accumulates in the mediastinum or peritoneal cavity, it outlines the diaphragm, making its central portion visible and creating the appearance of a continuous line. [4]
Chest X-ray is known to be unreliable in diagnosing diaphragmatic rupture; [4] it has low sensitivity and specificity for the injury. [5] Often another injury such as pulmonary contusion masks the injury on the X-ray film. [6] Half the time, initial X-rays are normal; in most of those that are not, hemothorax or pneumothorax is present. [4]
In a posteroanterior (PA) view, the x-ray source is positioned so that the x-ray beam enters through the posterior (back) aspect of the chest and exits out of the anterior (front) aspect, where the beam is detected. To obtain this view, the patient stands facing a flat surface behind which is an x-ray detector.
The chest x-ray shows hyperinflation of the lungs including prominent pulmonary vascular markings, flattening of the diaphragm, and fluid in the horizontal fissure of the right lung. Signs and symptoms
Hoover's sign in pulmonology is one of two signs named for Charles Franklin Hoover. [1]It refers to inward movement of the lower rib cage during inspiration, [2] - instead of outward as is normal - implying a flat, but functioning, diaphragm, often associated with COPD. [3]
It's when the zone of apposition ( the portion of the diaphragm in contact with the parietal pleura during expiration in the base of the pleural cavity') is reduced by the flattening of the diaphragm during inspiration and the pressure in the last intercostal spaces changes from intra-abdominal to intra-thoracic pressure.
A chest X-ray is not useful to establish a diagnosis of COPD but it is of use in either excluding other conditions or including comorbidities such as pulmonary fibrosis and bronchiectasis. Characteristic signs of COPD on X-ray include hyperinflation (shown by a flattened diaphragm and an increased retrosternal air space) and lung hyperlucency. [5]
Pleural effusion, in which there is fluid abnormally present between the two pleurae of the lungs, is detected by an X-ray of the chest, showing fluid collecting in the angle between the ribs and diaphragm. [19] An X-ray may also be used to reveal a pneumoperitoneum, in which there is gas in the abdomen. An X-ray may also be used to check for ...