Posteroanterior Chest X-ray Research Articles

Radiological diagnostics of pediatric lungs

Pediatric lung diseases are a common clinical problem. Besides the clinical examination and laboratory tests, imaging studies are the mainstay in the diagnostics of pediatric lung diseases. Thorough consideration of radiation protection based on optimized equipment also includes the protection of relatives and medical staff. The high impact of radiation protection in children necessitates a different choice of imaging modalities compared to adults. Ultrasound and magnetic resonance imaging (MRI) as adjunct or complementary imaging methods are of greater value than computed tomography (CT). The suspicion of pneumonia is the most common reason for chest imaging examinations in children. An anteroposterior or posteroanterior view chest X-ray is sufficient in most cases and sometimes in combination with ultrasound. The latter can also be used alone for follow-up examinations if the clinical presentation does not change. Additionally, ultrasound is applied to examine unclear structures seen on chest X-rays, such as the thymus or pulmonary sequestration in adjunct with color-coded duplex sonography. A chest X-ray is also the method of choice to examine the various forms of respiratory distress syndrome, such as wet lung disease or surfactant deficiency syndrome in newborns. Fluoroscopy is used in older children with suspected ingestion and/or aspiration of foreign bodies and CT is mostly used for staging and follow-up of thoracic and pulmonary structures in pediatric oncology. Recent technical advances, e.g. iterative reconstruction, have dramatically reduced the CT dosage. Apart from some indications (e.g. tumors and sequestration) MRI is rarely used in children; however, its potential for functional analyses (e.g. perfusion and ventilation) may increase the application in the near future.

English

Due to the universality and high percentage demand of chest X-rays and the importance of this examination in diagnostic radiology, there is a strong need for the assessment of its entrance surface air kerma. Entrance surface air kerma (ESAK) has been measured for a total of 60 patients undergoing posteroanterior chest x-ray from conventional diagnostic radiology in three diagnostic centers in Ogun State, Nigeria. ESAK was measured based on the x-ray equipment output obtained from a CONNY II dose rate meter. The entrance surface air kerma for the selected hospitals A, B and C are 0.20, 0.30 and 0.43 mGy, respectively with an average of 0.31 mGy. Variance analysis was performed to evaluate the significance of the difference between the entrance surface air kermas. The variation in entrance surface air kerma found among diagnostic centers in this survey showed that there is need to assess radiological techniques of x-ray examination and the personnel, among different diagnostic centers. In addition, when the ESAK average value is compared with other average values in some countries, it showed that the ESAK for Nigeria in chest PA examination is higher than other countries except Iran. This shows that optimal protection of patient against excessive radiation dose is possible by improving the influencing factors in diagnostic radiology examinations.   Key words: ESAK, posteroanterior, CONNY II, radiological techniques, optimal protection.

Phrenic Nerve Conduction Abnormalities Correlate with Diaphragmatic Descent in Chronic Obstructive Pulmonary Disease

Diaphragmatic weakness in chronic obstructive pulmonary disease (COPD) is ascribed to hyperinflation-induced diaphragm shortening as well as impairment in cellular and subcellular structures. Although phrenic neuropathy is known to cause diaphragmatic weakness, phrenic neuropathy is rarely considered in COPD. This work aimed at assessing phrenic nerve conduction in COPD and its relation to radiographic hyperinflation and pulmonary function. Patients and methods: Forty COPD patients were evaluated. Radiographic parameters of lung hyperinflation were measured on postero-anterior and lateral chest x-ray films. Flow volume loop parameters were obtained from all patients. Motor conduction study of the phrenic nerves was performed and potentials were recorded over the xiphoid process and the ipsilateral 7th intercostal space. Twenty-seven healthy subjects were enrolled as controls. Results: Parameters of phrenic nerve conduction differed significantly in patients compared to controls. Phrenic nerve abnormalities were detected in 17 patients (42.5%). Electrophysiological measures correlated with diaphragmatic angle of depression on lateral view films and with lung height on postero-anterior films. They did not correlate with the flow volume loop data or disease severity score. Conclusion: Phrenic nerve conduction abnormality is an appreciated finding in COPD. Nerve stretching associated with diaphragmatic descent can be a suggested mechanism for nerve lesion. The presence of phrenic neuropathy may be an additional contributing factor to diaphragmatic dysfunction in COPD patients.

Voice Assessment After Treatment of Subacute and Chronic Cough With Inhaled Steroids

Inhaled steroids are widely used for persistent cough treatment. Although the side effects of long-term inhaled steroids have been well described in the literature, their laryngeal side effects after short-term use have not yet been defined. The aim of this study was to evaluate the effect of 1 month application of inhaled steroid treatment on voice parameters in patients with subacute or chronic cough. Furthermore, the efficacy of inhaled steroids on cough was investigated, as well. This study included 46 patients (27 females and 19 males) with a persistent cough lasting at least 3 weeks and treated with inhaled steroids. All patients were examined by a pulmonologist and lung auscultation where a posteroanterior chest X-ray and spirometry were performed. The patients were also examined by an otolaryngologist. Anterior rhinoscopy, flexible fiberoptic nasopharyngoscopy, and laryngostroboscopy were performed. Also, the patients' acoustic voice analyses were performed and recorded using a multidimensional voice program. Cough symptom index (CSI) scores were used to evaluate the response to treatment. Patients with an underlying disease that was unresponsive to inhaled steroids were excluded from study. The 46 patients were administered inhaled budesonide 400 mcg twice a day, for 1 month, and their acoustic voice analyses were performed again at the end of the treatment. In addition, CSI scores were determined after stopping medication. When pretreatment and posttreatment acoustic voice analysis parameters (Fo, Jita, Jitt, Shim, APQ, vAm, and NHR) were compared, statistically significant differences were detected for vAm (P = 0.001) and F0 (P0.003). After treatment with inhaled steroids, the CSI score reduced from 3 to 1 (median), and the difference was statistically significant. Inhaled budesonide treatment in the proper dose seems to be an effective treatment for persistent cough, in the selected patient group. In addition, short-term budesonide application did not cause any negative effects on the voice parameters in these patients. These findings may be related to the steroid formulation used, the application method, and the duration of treatment. Further studies are needed on a larger group of patients with different formulations of inhaled steroids to clarify aforementioned issues.

Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD.

BackgroundThe diaphragm is the principal inspiratory muscle. The purpose of this study was to assess improvements in diaphragmatic movement before and after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD), using a fluoroscopy-guided chest X-ray.Patients and methodsAmong 117 patients with COPD receiving pulmonary rehabilitation who underwent the initial fluoroscopy-guided chest X-ray and pulmonary function test, 37 of those patients who underwent both initial and follow-up fluoroscopy and pulmonary function tests were enrolled in this study. After hospital education, participants received pulmonary rehabilitation through regular home-based training for at least 3 months by the same physiatrist. We assessed the changes in diaphragm area with fluoroscopy-guided posteroanterior chest X-rays between pre- and postpulmonary rehabilitation. To minimize radiation hazards for subjects, the exposure time for fluoroscopy to take chest X-rays was limited to less than 5 seconds.ResultsThere were significant improvements (2,022.8±1,548.3 mm2 to 3,010.7±1,495.6 mm2 and 2,382.4±1,475.9 mm2 to 3,315.9±1,883.5 mm2; right side P=0.001 and left side P=0.019, respectively) in diaphragmatic motion area during full inspiration and expiration in both lungs after pulmonary rehabilitation. Pulmonary function tests showed no statistically significant difference between pre- and postpulmonary rehabilitation.ConclusionThe study suggests that the strategy to assess diaphragm movement using fluoroscopy is a relatively effective tool for the evaluation of pulmonary rehabilitation in COPD patients in terms of cost and time savings compared with computed tomography or magnetic resonance imaging.

Correlation of VEGF genetic polymorphisms and lipid profile to aortic calcification

BackgroundAortic calcification is developed due to accumulation of a large amount of calcium in the aorta of the heart and it is the leading cause of aortic valve replacement and third leading cause of cardiovascular disease. The purpose of this study was to investigate the relation between aortic calcification and VEGF SNPs (−2578C>A, −1154G>A and +936C>T) and to evaluate the association of these SNPs with biochemical parameter in relation to aortic calcification. MethodsAortic calcification was diagnosed by examining the posteroanterior chest X-rays by a radiologist and graded into four groups. The real-time polymerase chain reaction with melting curve analysis in LightCycler was used to genotype the VEGF SNPs. ResultsAmong the VEGF SNPs, a significant genetic difference was found only between the aortic calcification and control group with VEGF SNP −2578C>A but haplotypes T–A–A of (+936/−1154/−2578) were significantly different in control and aortic calcification and could enhance the aortic calcification development. By regression analysis, it was found that age, hypertension, diabetes, dyslipidemia, and hyperhomocysteinemia were found significantly different with the different genotypes of VEGF SNPs which may induce aortic calcification development. ConclusionAge, hypertension, diabetes, dyslipidemia, and hyperhomocysteinemia were established as aggravating factors for the aortic calcification in association with different VEGF genotypes.

The role of thoracic computed tomography in penetrating cardiac injury

A 39-year-old male who was admitted to emergency department due to cutting and penetrating stab wounds had a 2.5 cm stab wound at the intersection of the left midclavicular line and sixth intercostal space. There was no significant finding on posteroanterior chest X-ray. Thoracic computed tomography which was performed to eliminate thoracic or mediastinal injuries revealed pleural effusion reaching 1 cm in thickness in the pericardial space and a retrosternal hematoma. The patient underwent median sternotomy urgently. After hematoma was removed in the pericardial space, a 1.5 cm laceration along the anterior surface of the left ventricle was seen. Bleeding was managed with finger inserted into the left ventricle. The injury site was repaired primarily with pledgeted 3/0 polypropylene and 2/0 polyethylene polyester sutures. The patient recovered without any complication. Thoracic computed tomography is an important diagnostic tool for cutting and penetrating stab wounds towards the heart.

Turban pin: an unusual cause of foreign body aspiration in young islamic adult.

Turban pin: an unusual cause of foreign body aspiration in young islamic adult.

Coronary computed tomography angiography with model-based iterative reconstruction using a radiation exposure similar to chest X-ray examination

AimsTo evaluate the feasibility and image quality of coronary computed tomography angiography (CCTA) acquisition with a submillisievert fraction of effective radiation dose using model-based iterative reconstruction (MBIR) for noise reduction.Methods and resultsIn 42 patients undergoing standard low-dose (100–120 kV; 450–700 mA) and additional ultra-low-dose CCTA (80–100 kV; 150–210 mA) reconstructed with MBIR, segmental image quality was graded on a four-point scale [(i): non-evaluative, (ii): good, (iii): adequate, and (iv): excellent]. Signal-to-noise ratio (SNR) was calculated dividing left main artery (LMA) and right coronary artery (RCA) attenuation by the aortic root noise. Over a wide range of body mass index (18–40 kg/m2), the estimated median radiation dose exposure was 1.19 mSv [interquartile range (IQR): 1.07–1.30 mSv] for standard and 0.21 mSv (IQR: 0.18–0.23 mSv) for ultra-low-dose CCTA (P < 0.001). The median image quality score per segment was 3.5 (IQR: 3.0–4.0) in standard CCTA vs. 3.5 (IQR: 2.5–4.0) in ultra-low dose with MBIR (P = 0.29). Diagnostic image quality (scores 2–4) was found in 98.7 vs. 97.8% coronary segments (P = 0.36). Introduction of MBIR for ultra-low-dose CCTA resulted in a significant increase in SNR (P < 0.001) for LMA (from 15 ± 5 to 29 ± 7) and RCA (from 14 ± 4 to 27 ± 6) despite 82% dose reduction.ConclusionCoronary computed tomography angiography acquisition with diagnostic image quality is feasible at an ultra-low radiation dose of 0.21 mSv, e.g. in the range reported for a postero-anterior and lateral chest X-ray.

Uzamış hava kaçağı ve inatçı plevral boşluk yönetiminde Heimlich valfinin etkinliği

Background: In this study, we evaluated the efficacy of the Heimlich valve used for prolonged air leaks and pleural space in patients undergoing surgery for any reason. Methods: Between August 2009 and March 2012, the Heimlich valve was applied to 26 patients with prolonged air leaks and persistent pleural space who were operated for any reason in our clinic. Patients were discharged after the evaluation of posteroanterior chest X-ray performed four hours after the intervention and scheduled for weekly visits with repeated posteroanterior chest X-ray. Tube thoracostomy was ended in patients in whom airfluid drainage was cut without residual pleural space or with an acceptable degree of aseptic pleural space. The intervention was regarded as successful, if the lungs were fully expanded or patients needed no additional intervention. Results: The Heimlich valves were inserted using the chest tubes 8-30 days after the operation and the patients were discharged. The mean removal time was 18 (range, 3 to 60) days. Complete expansion was observed in 19 patients (73%), while an acceptable degree of aseptic pleural space was found at the apex in five patients (19.2%) and in the laterobasal region in two patients (7.69%). The intervention failed in only one patient due to a large pleural space. The patient was reoperated and the space was obliterated with pectoral muscle flap. Conclusion: Persistent pleural space and prolonged air leaks are the most challenging problems for thoracic surgeons. The Heimlich valve is a safe and effective treatment modality in patients with such problems.

Calcification of the Aortic Arch Predicts Cardiovascular and All-Cause Mortality in Chronic Hemodialysis Patients

Background: Cardiovascular calcification represents a marker of cardiovascular risk in chronic dialysis patients. In the general population, aortic arch calcification (AAC) can predict cardiovascular mortality. We conducted a prospective study to investigate factors associated with AAC in hemodialysis patients and examined its prognostic value in long-term outcome. Methods: A total of 712 hemodialysis patients were enrolled. AAC was identified on postero-anterior chest X-ray films and classified as grade (Gr.) 0, 1, 2 or 3. Demographic data including age, gender, dialysis vintage, co-morbidity and biochemical data were reviewed and recorded. The patients were followed for 10 years. Results: AAC was present in 164 patients (23%) as Gr. 1, in 116 patients (16.3%) as Gr. 2 and in 126 patients (17.7%) as Gr. 3. An increase in the severity of calcification was associated with older patients who had lower albumin, higher calcium and glucose levels. During the follow-up period of 10 years, we found that the grade of AAC was directly related to cardiovascular mortality (Gr. 0: 5.3%; Gr. 1: 12.7%; Gr. 2: 18.9%, and Gr. 3: 24.4%; p < 0.05) and all-cause mortality (Gr. 0: 19.9%; Gr. 1: 31.1%; Gr. 2: 44.8%, and Gr. 3: 53.2%; p < 0.001). Multivariate Cox proportional hazards analysis revealed that high-grade calcification was associated with cardiovascular and all-cause mortality. Patients with AAC were associated with a worse outcome in survival analysis. The severity of AAC also influenced their survival. Conclusion: Calcification of the aortic arch detected in plain chest radiography was an important determinant of cardiovascular as well as all-cause mortality in chronic hemodialysis patients. The presence and severity of AAC predicted long-term survival.

Dose audit for patients undergoing two common radiography examinations with digital radiology systems.

We aimed to determine the radiation doses delivered to patients undergoing general examinations using computed or digital radiography systems in Turkey. Radiographs of 20 patients undergoing posteroanterior chest X-ray and of 20 patients undergoing anteroposterior kidney-ureter-bladder radiography were evaluated in five X-ray rooms at four local hospitals in the Ankara region. Currently, almost all radiology departments in Turkey have switched from conventional radiography systems to computed radiography or digital radiography systems. Patient dose was measured for both systems. The results were compared with published diagnostic reference levels (DRLs) from the European Union and International Atomic Energy Agency. The average entrance surface doses (ESDs) for chest examinations exceeded established international DRLs at two of the X-ray rooms in a hospital with computed radiography. All of the other ESD measurements were approximately equal to or below the DRLs for both examinations in all of the remaining hospitals. Improper adjustment of the exposure parameters, uncalibrated automatic exposure control systems, and failure of the technologists to choose exposure parameters properly were problems we noticed during the study. This study is an initial attempt at establishing local DRL values for digital radiography systems, and will provide a benchmark so that the authorities can establish reference dose levels for diagnostic radiology in Turkey.

Predicting risk of mortality in dialysis patients: a retrospective cohort study evaluating the prognostic value of a simple chest X-ray

BackgroundClinical outcomes of dialysis patients are variable, and improved knowledge of prognosis would inform decisions regarding patient management. We assessed the value of simple, chest X-ray derived measures of cardiac size (cardiothoracic ratio (CTR)) and vascular calcification (Aortic Arch Calcification (AAC)), in predicting death and improving multivariable prognostic models in a prevalent cohort of hemodialysis patients.MethodsEight hundred and twenty-four dialysis patients with one or more postero-anterior (PA) chest X-ray were included in the study. Using a validated calcification score, the AAC was graded from 0 to 3. Cox proportional hazards models were used to assess the association between AAC score, CTR, and mortality. AAC was treated as a categorical variable with 4 levels (0,1,2, or 3). Age, race, diabetes, and heart failure were adjusted for in the multivariable analysis. The criterion for statistical significance was p<0.05.ResultsThe median CTR of the sample was 0.53 [IQR=0.48,0.58] with calcification scores as follows: 0 (54%), 1 (24%), 2 (17%), and 3 (5%). Of 824 patients, 152 (18%) died during follow-up. Age, sex, race, duration of dialysis, diabetes, heart failure, ischemic heart disease and baseline serum creatinine and phosphate were included in a base Cox model. Both CTR (HR 1.78[1.40,2.27] per 0.1 unit change), area under the curve (AUC)=0.60[0.55,0.65], and AAC (AAC 3 vs 0 HR 4.35[2.38,7.66], AAC 2 vs 0 HR 2.22[1.41,3.49], AAC 1 vs 0 HR 2.43[1.64,3.61]), AUC=0.63[0.58,0.68]) were associated with death in univariate Cox analysis. CTR remained significant after adjustment for base model variables (adjusted HR 1.46[1.11,1.92]), but did not increase the AUC of the base model (0.71[0.66,0.76] vs. 0.71[0.66,0.76]) and did not improve net reclassification performance (NRI=0). AAC also remained significant on multivariable analysis, but did not improve net reclassification (NRI=0). All ranges were based on 95% confidence intervals.ConclusionsNeither CTR nor AAC assessed on chest x-ray improved prediction of mortality in this prevalent cohort of dialysis patients. Our data do not support the clinical utility of X-ray measures of cardiac size and vascular calcification for the purpose of mortality prediction in prevalent hemodialysis patients. More advanced imaging techniques may be needed to improve prognostication in this population.

Management of Pneumothorax in Emergency Medicine Departments: Multicenter Trial

Background:Pneumothorax is common and life-threatening clinical condition which may require emergency treatment in Emergency Medicine Departments.Objectives:We aimed to reveal the epidemiological analysis of the patients admitted to the Emergency Department with pneumothorax.Material and Methods:This case-control and multi-center study was conducted in the patients treated with the diagnosis of pneumothorax between 01.01.2010-31.12.2010. Patient data were collected from hospital automation system. According to the etiology of the pneumothorax, study groups were arranged like spontaneous pneumothorax and traumatic pneumothorax.Results:82.2% (n = 106) of patients were male and 17.8% (n = 23) of patients were female and mean age were 31.3 ± 20,2 (Minimum: 1, Maximum: 87). 68.2% (n = 88) of patients were spontaneous pneumothorax (61.36%, n=79 were primary spontaneous pneumothorax) and 31.8% (n = 41) of patients were traumatic pneumothorax (21.95% were iatrogenic pneumothorax). Main complaint is shortness of breath (52.3%, n=67) and 38% (n=49) of patients were smokers. Posteroanterior (PA) Chest X-Ray has been enough for 64.3% (n = 83) of the patients' diagnosis. Tube thoracostomy is applied to 84.5% (n = 109) of patients and surgery is applied to 9.3% (n = 12) of patients and 6.2% (n = 8) of patients were discharged with conservative treatment. Spontaneous pneumothorax showed statistically significant high recurrence compared with traumatic pneumothorax (P = 0.007). 4.65% of (n = 6) patients died. The average age of those who died (9.3 ± 19.9), statistically were significantly lower the mean age of living patients (32.4 ± 19.7) (t test, P = 0,006). 83.33% of the patients who died were neonatals and in the 0-1 years age group, and five of these patients were secondary spontaneous pneumothorax, and one of these patients were iatrogenic pneumothorax due to mechanical ventilation.Conclusions:Pneumothorax in adults can be treated by tube thoracostomy or surgically. Despite treatment, mortality of secondary and iatrogenic pneumothorax in newborns and 0-1 years age group is high.

Percutaneous nephrolithotomy: a cause of specific and iatrogenic thoracic complications

Background: This study aims to evaluate thoracic complications which are usually encountered in percutaneous nephrolithotomy. Methods: Between February 2005 and September 2012, 932 patients (586 males, 346 females; mean age 44.98±16.35 years; range 2 to 85 years) underwent percutaneous nephrolithotomy due to the nephrolithiasis. All patients were evaluated with preoperative posteroanterior chest X-ray while all patients who had supracostal access and who had suspected thoracic complications were evaluated with postoperative posteroanterior chest X-rays. Tube thoracostomy was performed in all patients with thoracic complications. Results: A subcostal access was performed in 849 patients (91%), whereas a supracostal access was performed in 83 patients (9%). Thoracic complications were developed in 18 patients (1.93%). Of them, 13 (1.39%) were in patients with supracostal and five (0.54%) were in patients with subcostal approach. Eleven supracostal accesses were performed above the 12th rib and two supracostal accesses were above the 11th rib. When all complications were evaluated, 12 hemothoraces, four pneumothoraces, and two urinothoraces were detected. Conclusion: Percutaneous nephrolithotomy is a cause of iatrogenic thoracic complications and supracostal approach has a more thoracic complication rate, compared to the subcostal approach. An early postoperative posteroanterior chest X-ray in sitting or standing position following supracostal access in particular is an essential diagnostic tool for early detection of thoracic complications. The tube thoracostomy is usually sufficient for the treatment of such complications.

An Unusual Foreign Body After Dental Filling

We report a case of a 71-year-old Caucasian woman who was referred to our emergency department for acute onset of dyspnoea and dry cough. She underwent dental filling for caries ~2h before. During the treatment, the distal part of the odontoiatric drill unintentionally fell off into the patient's oral cavity and was accidentally inhaled. Posteroanterior chest X-ray evidenced the foreign body localized in the right bronchial tree. A chest computed tomography scan showed the drill (with the tip pointed upward) wedged at the beginning of the right basal pyramid. A subsequent fiberoptic bronchoscopy confirmed the tip of the drill in the right lower bronchus, and the foreign body was easily removed due to the favorable position of the tip. The patient was discharged in first postoperative day without consequences.

An Unexpected Appearance in Thoracic Computed Tomography

A 77-year-old woman presented at our emergency department with a meat particle stuck in her throat. She was conscious, fully cooperative, and had normal vital signs and physical examination. As no foreign material was observed in the postero-anterior chest X-Ray, a thoracic computed tomography (CT) with intravenous (IV) contrast was obtained and given below. What is your diagnosis? Quiz Test THE JOURNAL OF ACADEMIC EMERGENCY MEDICINE 112

Prediction of right ventricular dysfunction from radiographic estimates of right descending pulmonary artery in hemodynamically stable pulmonary embolism patients

The evaluation of right ventricular (RV) dysfunction by echocardiography is one of the most important established determinants of the prognosis of acute pulmonary embolism. The aim of the study was to investigate possible association between diameter of right descending pulmonary artery on chest X-rays and RV dysfunction by echocardiography in hemodynamically stable pulmonary embolism patients. Eighty-nine patients with the diagnosis of hemodynamically stable pulmonary embolism were included. The frequency of RV dysfunction was significantly higher in patients with an enlarged right descending pulmonary artery on chest X-rays (p = 0.001). There was a significant positive correlation between the diameter of the right descending pulmonary artery on postero-anterior chest X-rays and the diameter of the RV (r = 0.469; p = 0.002). Diameter of right descending pulmonary artery on chest X-rays was also found as a significant predictor of RV dysfunction besides the troponin-T levels and systolic pulmonary arterial pressure (p < 0.05). Diameter of right descending pulmonary artery on chest X-rays may provide information about the risk for pulmonary embolism patients and may be used as a prognostic radiological parameter for the appropriate management of acute pulmonary embolism.

Mediastinal Mass and Air Bubble in Two Elderly Patients

Diaphragmatic hernia is a defect of the diaphragm that causes migration of abdominal contents to the chest cavity. Because a diaphragmatic hernia can mimic a mediastinal mass, a chest X-ray showing an intrathoracic air bubble is an important diagnostic indicator of this disease. In the two elderly patients with diaphragmatic hernia reported here, however, initial posteroanterior chest X-rays did not show this typical finding. Diaphragmatic hernia was not suspected until follow-up, when a further posteroanterior chest X-ray showed an intrathoracic air bubble. The diagnosis of diaphragmatic hernia was further confirmed by the chest computed tomography scan. However, surgical repair was refused in both cases, and medical treatment was limited to relief of symptoms.

Eventration of Diaphragm or Pseudo Pleural Effusion

Background : Physicians frequently encounter chest-x ray reports of pleural effusion in patients. Thoracocentesis is the second step to diagnosis, but if there isn’t any effusion actually, thoracocentesis may lead to complication. Case Report: A 47-year-old man with a history of dyspnea and dry cough and posteroanterior (PA) chest x-ray (and right lateral decubitus) report of pleural effusion referred for thoracocentesis, but vesicular sounds at over the lungs were normal. Spiral lung CT scan revealed localized eventration of diaphragm. Conclusion: Localized eventration of right diaphragm may cause the appearance of pleural effusion in PA and also right lateral decubitus chest x-ray.