![]() A, accessory lobe Cd, caudal lobe CdCr, caudal part of left cranial lobe Cr, right cranial lobe CrCr, cranial part of left cranial lobe Cs, costophrenic sulcus F, interlobar fissure F’, mediastinal reflection between the left caudal lobe and the accessory lobe (pleural fluid may accumulate adjacent to this reflection) L, left M, mediastinal reflection Md, right middle lobe R, right. These fissures are more likely to be seen when the patient is in ventral recumbency. D, Fissures on the ventral aspect of the lungs. The costophrenic sulcus may become rounded when patients with pleural fluid are in dorsal recumbency. These fissures are more likely to be seen when the patient is in dorsal recumbency. C, Fissures on the dorsal aspect of the lungs. These fissures are more likely to be seen when the patient is in right recumbency. B, Fissures of the lateral aspect of the right lung (looking medial to lateral). These fissures are more likely to be seen when the patient is in left recumbency. A, Fissures of the lateral aspect of the left lung (looking medial to lateral). Only fluid-filled fissures that are struck tangentially are seen. The exact fissures visible when pleural fluid is present depends on the position of the patient, the volume of fluid, and whether the x-ray beam strikes the fissure tangentially, or head-on. 31-5 The location of interlobar fissures in the thorax. Radiographic signs of free pleural fluid are listed in Box 31-1.įig. These effects of VD versus DV recumbency on the radiographic appearance of pleural fluid can be seen in Figure 31-6. Thus, overall thoracic radiopacity is greater in ventral recumbency in patients with pleural effusion. The absolute depth of the fluid is greater when the patient is in ventral recumbency (A) because the ventral part of the thoracic cavity is narrower, and the fluid rises to a higher level. When the patient is in dorsal recumbency for the VD radiograph (B), the fluid gravitates dorsally and is not in contact with the heart thus the cardiac silhouette is visible because it is surrounded by air-filled lung that provides contrast. The fluid is in contact with the heart, thus obscuring the heart because of border effacement. A, The patient is in ventral recumbency for a DV radiograph, and fluid gravitates ventrally. 31-4 Diagram of the effect of dorsal versus ventral recumbency on the radiographic appearance of pleural fluid. Also, the overall opacity of the thorax will be greater in DV radiographs in patients with pleural fluid because the fluid depth is greater (see Fig. ![]() In VD radiographs, pleural fluid usually does not obscure the heart because the fluid is in the dorsal aspect of the thorax, where it does not make contact with the heart and cause border effacement ( Fig. In DV radiographs, fluid gravitates ventrally and causes border effacement of the heart. 1 It is important to realize that the radiographic appearance of pleural fluid in ventrodorsal (VD) versus dorsoventral (DV) radiographs can be quite different. Pleural fluid distributes itself according to gravity and the ability of the lung to expand-that is, lung compliance. E, Exudate M, modified transudate T, transudate.
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