I took chest X-ray two days after thoracentesis. I have attached for your reference. Chest X-ray shows possible air or fluid in the left pleura. Is there any visible damage to the left pleura? Is there any air or fluid there, and how much is the percentage of lung volume? If air or fluid is present, please mention the percentage.
I have reviewed the X-ray of chest PA (posteroanterior) and lateral views (attachment removed to protect the patient's identity). The following are the findings. First, there is a hydropneumothorax, which means fluid and air are present in the left pleural cavity. And the pneumothorax component is tracking laterally and reaching the left upper hemithorax. The fluid volume in the left pleural cavity might be approximately 350 to 450 ml, and the air over it might be once to one and half times or slightly more than the fluid volume. The total lung volume is 4 to 6 liters and is not a fixed volume. If we try to calculate by taking 5 liters as a mean volume, approximately 2.5 liters is the single lung volume. The importance of fluid in the left pleural cavity is approximately 14 to 20 percent of the left lung. The volume of air in the left pleural cavity can be from 16 to 25 percent of the left lung. The volumes are approximate and might differ by 10 percent on both sides. There is inflammation of the lung and pleural and fluid formation in the space. X-ray images do not show in detail, but there is a partial collapse of the left lung's lower lobe. Pleural effusion itself is an indirect sign of pleural inflammation. However, any visible structural damage to the pleura is not visualized in the X-ray image, but this needs detailed evaluation and follow-up.
I hope this helps.
Thanks for your reply.
Your information is beneficial. To confirm, is the air bubble in the area on the left side of the lung stretching from the top to somewhere below the middle while getting narrower at the bottom? Are the lung and air boundary a visible curved line on the frontal X-ray? I want to confirm this because I will be getting another X-ray examination very soon, and I need to estimate if the amount of air has grown since the last X-ray as I need to select the treatment among those offered.
You correctly identified the air bubble surrounding the left lung's inflated part and extending from the upper part to the lower part. The lung air boundary is indeed clearly visible as you have mentioned. I would like to add more points on what is visualized and the importance of viewing both frontal and lateral X-rays when interpreting any changes from the previous X-ray. It is not precisely tapering as we find in the frontal X-ray, and we need to imagine the structures in a three-dimensional view. The frontal X-ray gives us a two-dimensional picture. When we think about the three-dimensional perspective, there is air in the anterior-posterior plane that needs to be accounted for and is not visualized in the frontal X-ray but in the lateral X-ray. I would suggest you to please check the differences in X-ray findings in both frontal and lateral views for better understanding.
I hope this helps.
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