Chest X-ray Level 2 Tutorial: Congestive Heart Failure
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Tutorial: Congestive Heart Failure
Learn an approach to CHF findings on chest x-ray
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Tutorial: Congestive Heart Failure Fluid in fissures
Times Practiced
Cases Completed
1h 24m
Total Time spent
1m 24s
Average Time
Fluid in fissures
Along the continuum of pathophysiology in congestive heart failure, the increased fluid pressure and volume will start in the LA then go into the pulmonary vessels, pulmonary interstitial spaces, the alveolar spaces, and then the fluid will actually exit the lung and enter the pleural space.

When this happens, a pleural effusion is produced. Pleural effusions can be seen on chest x-ray.

When fluid exists between the lobes of the lung, the oblique fissures (seen on lateral chest x-ray) and horizontal fissure (see on frontal chest x-ray) become thicker and more white and are easier to see.

Here are some examples of "fluid in the fissure":

The x-ray above shows a very thick horizontal fissure. Often, the fissure is bright white but no so thick. In fact, in this chest x-ray, you can see evidence of the fluid between the lung and the ribs as well: