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Opaque hemithorax: Clinical, histological and radiological assessment of 30 cases at a tertiary care hospital- a preliminary study

Background: Whitening out of half of the lung field on a chest X-ray is known as opacification of a hemithorax, and its presence usually indicates a significant disease in a patient. This study was done with an aim of finding different etiologies as the cause of complete opacification of a hemithorax on chest radiograph. Materials and Methods: An observational cross-sectional study of patients whose chest radiograph had opaque hemithorax was included and after clinical laboratory and advanced radiological - ultrasonography (USG) and computed tomography investigation of these patients the diagnosis responsible for the complete opacification of half the lung field in chest X-ray was recorded. Results: A total of 30 patients (23 males and 7 females) were enrolled for the study. Out of the 30 patients, 17 involved the left while 13 involved the right hemithorax. Fifteen patients had clear pleural effusion, 13 patients had mass with pleural effusion and 2 patients were postpneumonectomy cases. Mediastinal shift to contralateral side was seen in 18 out of 30 patients having opaque hemithorax. Eleven patients have biochemical features of tuberculosis. All 13 patients with mass and effusion were confirmed to have malignancy on histology. USG could detect malignancy in only ten cases. Chest pain was most frequent symptom and smoking or tobacco habit was associated with 14 cases. Conclusion: Plain pleural effusion was the most common etiology of opaque hemithorax in our study followed by mass with effusion. Among other rarer causes, only pneumonectomy was seen. For other rare causes that may present as opaque hemithorax larger study may be done.