Search

Introduction The federal False Claims Act (FCA) was first enacted during the Civil War to combat defense contractor fraud. The statute lay largely dormant until legislative amendments in 1986 authorized [...]

Physiotherapy can aid the removal of secretions following a whole lung collapse, presenting as an opaque hemithorax or “whiteout” on chest radiograph (CXR). Identifying the cause of an opaque hemithorax can prove difficult due to low sensitivity of chest radiography (CXR). Thoracic ultrasound (TUS) is a diagnostic technique able to differentiate between pathologies. The aim of this report is to highlight the impact of TUS on physiotherapy practice. A 63-year-old patient underwent elective cardiac surgery. Post-operatively he sustained a cerebral artery infarct with a dense hemiplegia and an ineffective cough. He required nasal pharyngeal suction and use of a cough-assist machine. Increased oxygen requirements prompted a CXR showing an opaque hemithorax. Physiotherapy was requested to aid sputum removal and lung recruitment. Prior to initiating physiotherapy treatment TUS showed a large pleural effusion. Despite this new information a bronchoscopy elicited no significant sputum plug. A second TUS scan showed no change in the effusion. A chest drain was inserted which elicited 3500 mls within an hour. A third TUS showed an absence of any pleural effusion. Following physiotherapy treatment a final TUS scan showed normal aeration. An opaque hemithorax can be caused by a significant pleural effusion even when sputum retention is suspected. When patients are referred to physiotherapy TUS can highlight pathologies not amenable to physiotherapy treatment. It seems reasonable to address the pleural effusion first and then implement physiotherapy treatment. TUS will also allow rapid repeated imaging to assess whether treatments have been successful immediately after being administered.

Complete whitening of one half of the thorax on a chest radiograph (CXR) is termed an opaque hemithorax. It often indicates the presence of significant pathology resulting in respiratory compromise. There are numerous causes of an opaque hemithorax, but these are not immediately apparent on CXR. Thoracic ultrasound (TUS) has a higher accuracy to differentiate between opacities on CXR and may help to correctly identify underlying pathologies. The purpose of this literature review is to report the causes of an opaque hemithorax, identify how TUS can assist diagnosis and explore the role physiotherapy has opaque hemithorax management. A systematic search was conducted (PubMed, Medline, Embase, CINAHL, AMED and BNI) up until March 2018. Inclusion: Adults. Primary research reporting a complete opaque hemithorax on CXR. 1117 papers were identified in search. Following inclusion and exclusion criteria: 58 papers were selected. 54 papers were case reports and four were observational studies. The causes of the opaque hemithorax were collated and divided into 16 categories. Eight studies included the use of TUS to differentiate the cause of the opaque hemithorax. Two studies reported the involvement of physiotherapy in opaque hemithorax. Numerous pathologies can cause an opaque hemithorax on CXR making differential diagnosis difficult. Even when mediastinal shift is present it does not appear to be a reliable way to identify the underlying cause. Thoracic ultrasound has the potential to much more accurately differentiate between pathologies. This would assist physiotherapists to identify patients amenable to physiotherapy treatment techniques.