Blurred diaphragmatic margin on chest x-ray

The article is professionally consulted by Master, Resident Doctor, Specialist I Trinh Le Hong Minh - Department of Diagnostic Imaging - Vinmec Central Park International General Hospital

The diaphragmatic margin opacity signifies a small triangular abnormality that detracts from the normal shape of the diaphragm. This is the image secondary to the lesion causing atelectasis in the superior lagoon. This image is produced by traction of the pleura or the great interlobar fissure and the subpleural ligament.

What is the diaphragm? The diaphragm is a flat, wide, dome-shaped muscle that forms a tendon-muscle wall between the rib cage and the abdomen. The diaphragm plays an important role in respiratory physiology. When the diaphragm contracts, the diaphragm is lowered, the ribcage expands, the pressure in the chest decreases, and air is inhaled.
Sometimes pain or discomfort can be felt in the diaphragm , although in some cases the pain may come from a nearby body part.

The diaphragmatic margin opacity signifies a small triangular abnormality that detracts from the normal shape of the diaphragm. This image is secondary to the lesion causing atelectasis in the upper lung. This image is produced by traction of the pleura or the great interlobar fissure and the subpleural ligament.

Blurred diaphragmatic margin on chest x-ray images is common in a number of diseases such as:
Localized pleural effusion: Fluid may be localized in the diaphragm, chest wall, mediastinum, or groove interlobar, little or no movement when changing patient position. The shading of localized fluid usually has a sharply rounded base, a fuzzy upper margin, and a greater height than width. Free pleural effusion: On straight film, standing position, the fluid at the bottom of the lung gives a dark, uniform opacity; not clearly see the diaphragm, the heart border; whose upper limit is an indistinct fuzzy curve, concave up and inward, that is the radiographic Damoiseau curve; The translation changes position according to the patient's position. Effusion - pneumothorax: On the upright chest X-ray, the patient stands with a horizontal level of fluid. The lung parenchyma collapses around the hilum, protruding from the fluid surface like a rock. If the effusion-pneumothorax is localized, multiple levels of fixed fluid may be seen. On computed tomography scan, the lung was found floating on the surface of the fluid. Computed tomography is useful in differentiating focal pneumothorax from multiple peripheral lung abscesses.

Primary pleural tumor: Peripheral opacity with irregular margins; less or more pleural effusion. No calcification, no cavernous ulceration. There may be faint nodules in the lung parenchyma, chest wall bone lesions. Secondary pleural tumor: Metastatic pleural opacities are the most common pleural malignancies, often originating from tumors of the lung, breast, gastrointestinal tract, and kidney. Manifestations are opacities, sometimes bilateral, adjacent to the peripheral pleura or mediastinal pleura, diaphragm, interlobar fissure. Pneumothorax: The image is too bright in the apex and axillary region, no blood vessels can be seen, the visceral pleura can be seen as a very thin blurred line separating the pneumothorax and the lung parenchyma that is passively pushed and collapsed. Abnormal opacity in the mediastinum : Abnormal opacity in the mediastinum is characterized by uniform shading; external limit is clear and continuous, convex to the lung, the angle of contact with the mediastinum is an obtuse angle; The inner limit is not seen because the shadow is mixed with the shadow of the mediastinum.

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