16. Do you agree so far?
Two very similar projections.
Bild 16
- What are they? What is the difference? How can it be explained?
(Click here for the answer) Pleural effusion: left = prone, right = standing up.
We may also demonstrate those effects also by means of sonography.
Bild 17
- Pleural process? How are the two pictures achieved?
(Click here for the answer) Difference in diaphragm position proves it is expiration (left) and inspiration (right). Partly encapsulated effusion considerably deforms with breathing.
Bild 18
- Same case. What technique is applied here?
(Click here for the answer) Subtraction of in- and expiration. It demonstrates diaphragmal mobility and form instability of the mass lesion. This mobility is a good argument for "encapsulated effusion".
Bild 19
- One form of pleural effusion often overlooked: the "subpulmonal” effusion, which (as an exception) we see here very clearly. Why?
(Click here for the answer) There is free air in the abdomen caused by gastric perforation. This thin layer of air causes a (caudal) silhouette of the diaphragm. Thus the thick layer between diaphragm and lung will be a subpulmonal effusion.
Bild 20
- Diagnosis? What do the black points show?
(Click here for the answer) A dark line, difficult to pick out, corresponds to paradiaphragmal fat. This gives us an idea of the diaphragm position and of the effusion on top of it:
basal = subpulmonal effusion.