Opaque Hemithorax: Causes, Symptoms and Treatment Options

Opaque hemithorax (OH) is a chest X-ray finding where half of the lung appears white, indicating a potential serious underlying health condition.

Causes:

1. Pleural effusion (PE): A large amount of fluid in the pleural cavity (space between the parietal pleura and visceral pleura). Common causes include tuberculosis, malignancy, and empyema.

2. Lung Collapse: Due to obstruction in the trachea or bronchi, which could be caused by a long-standing foreign body, tumor, or enlarged lymph node.

3. Surgery: History of pneumonectomy (surgical removal of a lung).

4. Congenital Anomalies:

   • Pulmonary agenesis: A rare and often fatal defect where one or both lungs fail to develop during embryonic life.

   • Pulmonary aplasia: A rare congenital anomaly where one lung is severely underdeveloped.

5. Malignancies: A large mass in one side of the thorax.

Diagnostic Workup:

• Chest Radiograph: Initial imaging to identify OH.

• Ultrasonography: Useful in detecting pleural effusion.

• Computed Tomography (CT) Scan: Provides detailed information about effusion, thoracic mass, trachea, and bronchi.

Case Presentation: A 52-year-old male, chronic alcoholic (half a bottle per day), and smoker (10-12 bidis per day), presented with pleuritic chest pain on the left side of the chest for the past 4-5 days, associated with dyspnea on exertion (DOE). There was no history of fever, cough, weight loss, or night sweats.

On examination, the patient was conscious, alert, and afebrile. Chest auscultation revealed absent breath sounds on the left side, along with decreased vocal fremitus. The left side of the chest was dull on percussion. Heart sounds were normal, and no murmur was audible. The abdomen was soft and non-tender, with no hepatosplenomegaly. Bowel sounds were normal, and there was no clubbing, cyanosis, edema, or jaundice.

An X-ray was taken based on the auscultation findings, revealing an opaque left hemithorax. USG chest confirmed pleural effusion.

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   Chest X Ray PA view showing opaque left hemithorax in the patient caused by pleural effusion underlying pathology is empyema.

   Management: The patient was managed at a tertiary care center in the Chest and TB Department. A USG-guided chest tube was placed, and fluid was sent for cytology, which reported normal findings. The final diagnosis was empyema. The patient was advised to have the chest tube dressing changed every alternate day and to take the antibiotic Clindamycin. The chest tube was removed after one and a half months. A repeated USG of the chest revealed 50-60 ml of pleural fluid, which was not significant, and the patient was finally cured.