Learning Radiology xray montage

(Hyper) Lucent Hemithorax



  • Pneumonectomy
    • Initially on the side of the resection; eventually fibrosis can lead to overexpansion of the opposite side

  • Pulmonary embolism
    • Usually large pulmonary emboli may lead to oligemia of the affected lung (Westermark sign)

  • Mucous plug
    • May result in air-trapping and overaeration

  • Pneumothorax

  • Radical Mastectomy
    • Removal of the breast and the underlying pectoralis major and minor muscles along with axillary lymph nodes; in a modified radical, the pectoralis is spared

  • Poland Syndrome
    • Congenital unilateral aplasia of the pectoralis muscle

  • Swyer-James Syndrome
    • Unilateral hyperlucent lung that usually develops during childhood as a sequela of post-infectious bronchiolitis obliterans

  • Pulmonary sling
    • Anomalous origin of the left pulmonary artery may obstruct the right main bronchus leading to air-trapping

  • Foreign-body aspiration (Obstructive Emphysema)
    • May result in over aeration of affected side due to air trapping

  • Bronchial atresia
    • Collateral drift leads to overexpansion

  • Congenital lobar emphysema
    • Usually in neonate and most often in left upper lobe

  • Technical issues
    • Patient is rotated
      • Side to which they are rotated my be more lucent
    • Lateral decentering of tube
      • Side toward which tube is centered is more lucent


Right Radical Mastectomy 

Right Radical Mastectomy. The right hemithorax is more lucent (darker) than the left because the patient had previously undergone a right radical mastectomy in which the breast and the pectoralis muscles were removed. Note the multiple metallic clips from the surgery.

Unilateral Hyperlucent Lung in Children. E Wasilewska, EY Lee and RL Eisenberg. AJR, May 2012, Volume 198, Number 5