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The Three Radiographic Zones of Simple Pleural Effusions

Medical Service of Sea View Hospital, Staten Island, New York

This excerpt was created in the absence of an abstract.

The upper border of simple pleural effusions has been described by many prominent clinicians during the past century, particularly Wintrich, Skoda and Niemeyer. Of all descriptions, the one familiar to most is the curved line of flatness of Damoiseau¹ and the line of Ellis², an excellent account of which can be found in Garland's monograph.³

Since the advent of radiography we have added to our knowledge of physical signs the curved radiographic shadow which, together with the line of Ellis, has come to be regarded as the upper border of simple pleural effusions.

In some experiments⁴ conducted in the study of liquid surfaces of pleural effusions, I was able to show that in simple effusions the upper zone of liquid is too thin to cast a radiographic shadow, and that the upper border of the effusion is considerably higher than that indicated by either the curved radiographic shadow or the line of Ellis.

For the sake of accuracy, it should be stated that by a simple pleural effusion is meant here an effusion uncomplicated by pneumothorax, pulmonary consolidation or pleural adhesion to a degree sufficient to disturb the natural physical conditions. Fig. 1A is an example of such an effusion. It shall be described in conjunction with Figs. 1B and 2 to illustrate the three zones.

Looking at the pectorogram (Fig. 1A), we note, from below upward, first the characteristic dense shadow, the upper border of which curves concavely upward from the hilum at the eleventh rib to the seventh rib in the axillary line.

Received for publication June 6, 1936.

This article has been cited by other articles:

				J. KAUNITZ LANDMARKS IN SIMPLE PLEURAL EFFUSIONS JAMA, September 30, 1939; 113(14): 1312 - 1314. [Abstract] [PDF]