Chapter 11 Intensive Care Unit

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SECTION 1 • Techniques and Methods in Critical Care

Bilateral Pleural Effusion

Pleural Effusion (decubitus)

FIGURE 11-6. Left: Bilateral pleural effusions with characteristic crescentic blunting on the upright PA film. Right: Mobile effusion in left lateral decubitus orientation. Arrows demarcate the fluid separating left lung from ribs.

Pneumothorax Pneumothorax is often difficult to detect on porta- ble CXRs. Relatively few ICU patients exhibit the typical patterns seen on upright CXRs performed in noncritically ill patients. Proper positioning assumes great importance in detection. On supine films or

noted, the clinician should reduce airway pressures to the extent possible and maintain a high level of vigilance and be prepared to emergently insert chest tubes. Fortunately, such catastrophic developments have become much less likely in the present era of lung-protective ventilation.

A B FIGURE 11-7. A: Radiographic signs of a subpulmonic effusion ( 1 ) hemidiaphragm elevation with separation of lung from gastric bubble, ( 2 ) lateralization of the diaphragmatic dome, and ( 3 ) abrupt transition from lucency to soft tissue density. B: Left subpulmonic effusion in upright position. Note abrupt transition of density at the lung base and lateral displacement of what appears to be the hemi- diaphragmatic dome.