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Chest x-ray is the first test done to confirm an excess of pleural fluid. The lateral upright chest x-ray should be examined when a pleural effusion is suspected. In an upright x-ray, 75 mL of fluid blunts the posterior costophrenic angle. Blunting of the lateral costophrenic angle usually requires about 175 mL but may take as much as 500 mL.
Blunting of costophrenic angle (in adults)—Loss of sharpness of one or both costophrenic angles. Blunting can be related to a small amount of fluid in the pleural space or to pleural thickening and, by itself, is a non-specific finding (except in children, when even minor blunting may suggest active TB).
In radiology, the deep sulcus sign on a supine chest radiograph is an indirect indicator of a pneumothorax. [1] [2] In a supine film, it appears as a deep, lucent, ipsilateral costophrenic angle [3] within the nondependent portions of the pleural space as opposed to the apex (of the lung) when the patient is upright.
Between 250 and 600mL of fluid must be present before upright chest X-rays can detect a pleural effusion (e.g., blunted costophrenic angles). [16] Chest computed tomography is more accurate for diagnosis and may be obtained to better characterize the presence, size, and characteristics of a pleural effusion.
They may be seen in any zone but are most frequently observed at the lung bases at the costophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs. [3] Causes of Kerley B lines include pulmonary edema, lymphangitis carcinomatosa and malignant lymphoma, viral and mycoplasmal pneumonia, interstitial pulmonary ...
There needs to be at least 75 mL of pleural fluid in order to blunt the costophrenic angle on the lateral chest radiograph and 200 mL of pleural fluid in order to blunt the costophrenic angle on the posteroanterior chest radiograph. On a lateral decubitus, amounts as small as 50ml of fluid are possible.
Costovertebral angle (CVA) tenderness is pain that results from touching the region inside of the costovertebral angle. [1] The CVA is formed by the 12th rib and the spine. [ 1 ] Assessing for CVA tenderness is part of the abdominal exam , and CVA tenderness often indicates kidney pathology .
The cardiophrenic angle is the angle between the heart and the diaphragm, as seen on imaging (most commonly X-ray). There are two cardiophrenic angles, however the one on the right is obscured by the cardiohepatic angle (the angle between the heart and liver ).