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What position is required for decubitus imaging of a left-sided pneumothorax?

  1. An upright inspiration, expiration PA chest

  2. Left lateral decubitus

  3. Right lateral decubitus

  4. Dorsal decubitus

The correct answer is: Right lateral decubitus

For the purpose of imaging a left-sided pneumothorax, utilizing the right lateral decubitus position is essential. This positioning allows the air that has collected in the pleural space on the left side to rise to the top of the thoracic cavity, providing a clear indication of the pneumothorax on the radiograph. By positioning the patient on their right side, gravity will assist in pushing any free air in the left hemithorax to the superior aspect, which enhances visibility during imaging. In contrast with upright imaging options, the right lateral decubitus position specifically capitalizes on the orientation of the pneumothorax, making it easier to identify compared to other methods where the air may not delineate as clearly. By ensuring that the patient's left side is elevated, the air can be more easily discerned from the surrounding lung tissue. This technique is critical in accurately diagnosing and evaluating the severity of the pneumothorax, as it directly affects how the air is visualized on the chest radiograph.