Lateral Decubitus Views Research Articles

M-Mode Ultrasonic Localization of Pleural Effusion

Fifty patients had nondiagnostic physical and roentgenographic examinations and were believed at high risk for exploratory thoracentesis. Negative echograms for pleural fluid were recorded for 13 patients. For 34 patients, the characteristic M-mode display of a central echo-free space, indicative of pleural fluid, was recorded. Aspiration yielded fluid that was localized by echography in 30 (88%). Of the 30 patients, 13 (43%) had normal lateral decubitus views, and 10 (33%) had experienced unsuccessful aspiration before ultrasound localized the fluid loculation. The remaining seven patients, including three receiving mechanical ventilation who were believed to have increased risk for thoracentesis had successful initial tap based on echographic localization of fluid. Ultrasound allows detection and localization of pleural fluid when roentgenographic and physical diagnostic means are not helpful.

The double contrast barium enema: Improvements to lateral decubitus views including the use of a wedge filter

The prognostic importance of early detection of colonic carcinoma is emphasised and the contribution of an accurate barium enema technique is stressed. Horizontal beam lateral decubitus films are routine in double contrast barium enemas, and it is still common practice in many departments to support the cassette for these views either in the bucky tray or with sandbags. The lateral decubitus views of 100 patients using these methods of cassette support were reviewed. A large number of the films (67%) were technically so unsatisfactory due to unilateral under- or over-penetration that they did not provide acceptable visualisation of the colon. The cause of these technical faults, and the methods by which they may be overcome, are described. In addition, a wedge filter was designed to reduce the absorption by dependent soft tissues in obese patients.

The lateral decubitus view: an aid in evaluating poorly defined pulmonary densities in children

The upper lung on a lateral decubitus chest radiograph is uniformly better expanded than on a frontal upright chest radiograph. The lateral decubitus view is useful in distinguishing pulmonary vascular structures mimicking pneumonia from actual pulmonary infiltrates in infants and young children in whom deep inspiratory chest films are difficult to obtain. This study included 20 children whose initial radiographs could not be obtained in deep inspiration and demonstrated equivocal areas of pulmonary infiltrate. Clinical follow-up was possible in 16 of the 20 patients. We reviewed the routine chest radiographs and lateral decubitus views independently and retrospectively. The decubitus films showed more appropriate correlation with the subsequent clinical course and consistently allowed more confident interpretation of the radiographs.

The use of prone films for suspected bowel obstruction in infants and children

Prone frontal and cross-table lateral views of the abdomen are recommended as most helpful in radiographic evaluation of infants and children suspected of having obstructive of nonobstructive ileus. A series of films in multiple projections is recommended to evaluate the gas in the large bowel, particularly the rectum. When studies must be limited, prone and left lateral decubitus views are recommended. In obstructive ileus, the collapsed rectum contains little or no air. Utilization of the prone view will often obviate the use of fluoroscopic contrast studies. The level of obstruction, as well as the cause, can often be determined by this plain film approach. Six cases are presented to illustrate these points.

The prone chest film.

Frontal chest radiographs in the prone position enhanced visualization of the posterior lung base in the presence of pleural effusions. Though the lateral decubitus view often displaced fluid adequately, in several cases only the prone film revealed basilar lung pathology; this was due to gravitational shift of the fluid away from this region as well as improved aeration of the lower lobe in the prone position, as shown by horizontal-beam lateral views. The prone chest film is recommended for evaluation of the lung base when obscured by fluid.

Roentgenographic Recognition of Pleural Effusion

THE presence of pleural effusion often suggests a diagnosis, indicates the need for further study, or, through thoracentesis, provides material for direct diagnostic studies. This article will review the many roentgenographic manifestations of pleural effusion. The Table gives a morphological classification of these effusions. <h3>Upright Roentgenogram</h3> On the upright chest roentgenogram, pleural effusion is usually seen as a density on the diaphragm, with a concave meniscus along the chest wall. Approximately 250 ml of fluid must be present to obliterate the costophrenic sinus. Unless other roentgenograms show a recent change, a costophrenic sinus obliterated by pleural thickening may be indistinguishable from one obliterated by fluid. Roentgenograms taken in the supine or decubitus positions will allow differentiation: fluid will gravitate to the dependent part of the pleural space. <h3>Lateral Decubitus View</h3> This accumulation of fluid in the dependent areas of the chest is the basis for the use of the lateral

Frequency of pleural effusions in mycoplasma and viral pneumonias.

Abstract A prospective study was undertaken to investigate the often-denied frequency of pleural effusions in mycoplasma and viral pneumonias. Fifty-nine patients with nonbacterial pneumonias satisfied serologic criteria for association with either a mycoplasma, viral, or cold-agglutinin-positive pneumonia. Twelve of these patients had roentgenographic evidence of pleural effusions. Four patients had no evidence of fluid on routine posteroanterior and lateral views, but pleural fluid was demonstrated on the lateral decubitus views. The possibility of a mycoplasma pneumonitis should not be dismissed merely because of the presence of a pleural effusion.

Acute emphysematous cholecystitis: Report of a case

A discussion of the main clinical and radiological features of acute emphysematous cholecystitis is presented, and a further case of this rare condition has been described. Straight radiographs of the abdomen, including erect or lateral decubitus views, in cases of acute cholecystitis showing toxicity disproportionate to other clinical findings will enable the condition to be diagnosed early, and prompt surgery performed. A discussion of the main clinical and radiological features of acute emphysematous cholecystitis is presented, and a further case of this rare condition has been described. Straight radiographs of the abdomen, including erect or lateral decubitus views, in cases of acute cholecystitis showing toxicity disproportionate to other clinical findings will enable the condition to be diagnosed early, and prompt surgery performed.

Double contrast study of colon: routine lateral recumbent view.

The difficulties and pitfalls involved in identifying small polypoid lesions of the colon by means of double-contrast enema are well recognized. The medical literature contains a considerable number of articles concerning various technics of preparation, examination, and positioning, including such innovations as dilute barium (1) and high-voltage radiography (2). It is the purpose of this article to re-emphasize the diagnostic usefulness of routine left and right lateral decubitus views as part of the survey procedure. The use of the horizontal beam is as old as air-contrast study itself. Fischer (3), in 1925, was the first to describe a satisfactory method, and as part of that initial technic he examined his patients in the upright and lateral decubitus positions, preferring to use a horizontal beam. Weber (4) and Gershon-Cohen (5), the early exponents of the double-contrast study in this country, used primarily the vertical beam for their survey films, with certain other modifications of Fischer's method. The need for multiple views was recognized early because of poor visualization due to overlapping coils of bowel, and the desirability of reproducing questionable changes in more than one projection. The commonly described views include anteroposterior and postero-anterior, which are often taken stereoscopically, the obliques, and Trendelenburg. For all these projections a vertical beam is used. It is our belief that not enough emphasis has been placed on use of the horizontal beam. Polgar (6), one of the more recent advocates of the horizontal beam, recommends performance of both the, regular barium enema and air study in the recumbent position. He describes the convenience of this method in terms of ease of technical procedure and the use of local air filling in segmental evaluation, but he does not sufficiently stress the diagnostic superiority of total colon survey films in this position over those obtained with the more commonly employed vertical beam. Our procedure of double-contrast examination is as follows: The patient is scheduled at least two days in advance, so that he may be placed on a low-residue diet for forty-eight hours prior to study. He is given a mimeographed diet sheet and instructions and is advised of the importance of carefully following them. Institution of the low-residue diet has resulted in noticeable improvement in the degree of cleanliness of the bowel, and has proved particularly useful in evaluation of the right colon. One ounce of castor oil is taken at four o'clock the afternoon prior to examination; 2 ounces are given if the patient is in the habit of taking laxatives. Use of the low-residue diet allows the patient to continue his meals, there being no elimination of either the evening meal or breakfast prior to examination. In the mid-morning, tap-water enemas are taken until the return is clear. The enema tip is lubricated with soap rather than vaseline.

Scout Film of the Abdomen

A “Scout film” of the abdomen is one obtained without the use of a contrast medium or any preparation on the part of the patient. Such an examination is usually an emergency procedure and is often done at the bedside. That it has not received the recognition it deserves is the fault of the roentgenologist, who has not brought its value as a diagnostic aid in acute abdominal conditions to the attention of the surgeon. Upon the former it makes special demands. Used to regular hours and “Sundays off,” he is too often not available for an emergency x-ray examination. These acute cases, however, do not choose their time of entry; they are as likely to come in after hours or on a week-end as at a more convenient time. Unless the roentgenologist is prepared for emergency calls, he will not cultivate “x-ray mindedness” on the part of the surgeon. On the other hand, if he is prepared for such inconveniences as are entailed, he will be well rewarded by the satisfaction of a diagnosis well made and the knowledge that a life-saving procedure was due in great part to his co-operation. Most acute conditions of the abdomen have a well established history, with well known physical findings. It is not with such cases that this paper is concerned, though they may require an x-ray examination to substantiate the diagnosis. It will deal, rather, with the obscure case, in which the history is unsatisfactory, or physical findings are inadequate, and further aid in diagnosis is required. We have found a “scout film” of the abdomen of significant aid in substantiating or establishing a diagnosis in the conditions discussed below. Perforated Ulcer: The diagnostic value of the demonstration of free air in the abdomen, between the liver and diaphragm, in the upright film as an indication of a perforated ulcer is well known (Fig. 1). An additional anteroposterior view in the lateral decubitus position, with the left side down, is desirable and as a sole view is to be preferred. This view can easily be made at the bedside and, in one instance, has shown the air where the upright view failed (Fig. 2). While the condition of the patient may be such that an upright film is difficult to obtain, it is easy for him to roll on his left side for a lateral decubitus view. Another advantage of the lateral decubitus position is the avoidance of a possible error which once occurred, when a diagnosis of a perforated viscus was made on a right-sided stomach. The normal gasbubble was mistaken for free air in a patient with acute abdominal pain. A lateral decubitus film would have prevented that error. Non-Opaque Ureteral Stone: Although strictly speaking the diagnosis of a nonopaque ureteral stone is not made without further x-ray examination, the condition may be included here. The abdominal findings are important in a negative sense, in that no abnormal bowel dilatation may be present.