Detection of pneumothorax and pleural effusion with horizontal beam radiography

Forty-seven patients with a known history of thoracic trauma or clinical suspicion of pneumothorax were selected for thoracic imaging. The patient population was composed of 42 dogs and five cats. Standard vertical beam (VB) left and right lateral and ventrodorsal/dorsoventral (VD/DV) projections were obtained for each patient, and at least one horizontal beam (HB) projection (VD projection made in lateral recumbency). A total of 240 images were reviewed. Subjective assessment for the presence and degree of pneumothorax and pleural effusion was made more confidently with HB projections. Pneumothorax was identified in at least one projection in 26 patients (26 dogs) and pleural effusion in 21 patients (19 dogs and two cats). Pneumothorax and pleural effusion were present concurrently in 17 dogs. Pneumothorax and pleural effusion were graded for each image as absent, mild, moderate, or severe. Right (P < 0.001) and left (P < 0.05) lateral HB VD projections and the standard VB left lateral projection (P < 0.05) were significantly more likely to detect and grade pneumothorax severely than the VB VD/DV views. The right lateral HB projection had the highest rate of detection and gradation of severity for pneumothorax compared with other views. VD/DV projections had the lowest sensitivity for detection of the pneumothorax and gradation of severity for pneumothorax and pleural effusion. No significant difference in diagnosis (P = 0.9149) and grade (P = 0.7757) of pleural effusion were seen between views, although the left lateral HB had both the highest rate of detection and grade of severity.