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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]
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.
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
A chest radiograph, chest X-ray ... To obtain this view, the patient stands facing a flat surface behind which is an x-ray detector. ... The right diaphragm is ...
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]
The cupola sign is seen on a supine chest or abdominal radiograph in the presence of pneumoperitoneum. It refers to dependent air that rises within the abdominal cavity of the supine patient to accumulate underneath the central tendon of the diaphragm in the midline. It is seen as lucency overlying the lower thoracic vertebral bodies.
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]
A) Normal chest radiograph; B) Q fever pneumonia affecting the right lower and middle lobes. Note the loss of the normal radiographic silhouette (contour) between the affected lung and its right heart border as well as between the affected lung and its right diaphragm border. This phenomenon is called the silhouette sign: Differential diagnosis