X-ray of a surgically removed lung

Why is this hemithorax opaque?

• a. There is a large left pleural effusion


• b. There is a large right pneumothorax


• c. Atelectasis of the left lung because of a mucus plug


• d. Pneumonia in the left lung


• e. The left lung has been surgically removed

Correct Answer: e.The left lung has been surgically removed

Explanation
There is opacification of the left hemithorax. There is a shift of the heart and mediastinal structures (i.e. the trachea) toward the side of opacification. This eliminates pleural effusion, pneumonia and pulmonary edema as possibilities. A tension pneumothorax will displace the heart and mediastinal structures away from the side of the pneumothorax but it will not cause complete opacification of the opposite lung. In addition, there should be no lung markings visible in the hemithorax which contains the pneumothorax. If you look carefully, there is a missing rib on the left side. That indicates a thoracotomy has been performed, at which time the left lung was removed (pneumonectomy) for cancer treatment.