The Role of Relative Determination of the Right Lung Volume by the Diaphragmatic Index in the Diagnosis of Pulmonary Atelectasis

Dorot. Medical Center for Rehabilitation and Geriatrics, Netanya, Israel

*Corresponding Author: Michael D Levin, MD, Ph.D, Dorot. Medical Center for Rehabilitation and Geriatrics, Department of Pediatric Radiology of the 1-st State Hospital, Minsk, Belarus, Dorot. Medical Center for Rehabilitation and Geriatrics, Amnon veTamar, Netanya, Israel, Tel: 972-538281393, Email: [email protected]

Received Date: February 10, 2026

Published Date: February 27, 2026

Citation: Levin MD. (2026). The Role of Relative Determination of the Right Lung Volume by the Diaphragmatic Index in the Diagnosis of Pulmonary Atelectasis. Mathews J Case Rep. 11(1):217.

Copyrights: Levin MD. © (2026).

ABSTRACT 

Introduction: Radiographic signs of pulmonary atelectasis have been described in the literature and include elevation of the diaphragm on the side of atelectasis, compensatory overinflation of the contralateral lung, mediastinal shift, cardiac rotation, and changes in pulmonary vessels and ribs. These signs are largely descriptive and lack clear quantitative standards. Although CT and MRI provide higher diagnostic accuracy, plain chest radiography remains more accessible and cost-effective. Seventy-five patients with pulmonary atelectasis detected by us on chest radiographs were admitted to a rehabilitation and geriatric medical center from other hospitals; however, only two of them had a prior diagnosis confirmed by CT, while the remaining cases were diagnosed as recurrent pneumonia. Methods: To diagnose atelectasis, we applied a method for determining the relative volume of the right lung using the diaphragmatic index (DI). A horizontal baseline was drawn on the chest of radiograph along the lower edge of the tenth thoracic vertebra. A vertical line was drawn from the highest point of the right diaphragmatic dome to the baseline, and its length was recorded in centimeters with a positive or negative sign depending on its position relative to the baseline. A second vertical line was drawn from the intersection of the baseline with the right chest wall to the costophrenic sinus and measured similarly. The diaphragmatic index was calculated as the sum of these two values. In healthy individuals with normal breathing, the DI ranges from 0 to +5. Results: Diagnostic accuracy of conventional radiographic assessment was compared with evaluation incorporating the DI. In the entire cohort, the use of DI increased diagnostic accuracy by 39%. The increase was 27% for right-sided atelectasis, 31% for left-sided atelectasis, and 68% for bilateral atelectasis. The analysis demonstrated that hyperinflation of the lung contralateral to atelectasis represents not merely an indirect radiographic sign but a physiological phenomenon, the absence of which indicates additional pathology. Conclusion: Treatment strategies aimed at preventing recurrent pneumonia and facilitating patient rehabilitation depend on timely diagnosis of atelectasis. The use of the proposed quantitative method for evaluating chest radiographs increases the diagnostic accuracy of atelectasis by 39% compared with standard descriptive assessment.

Keywords: Chest X-Ray, Atelectasis, Bronchiectasis, Pneumonia, Diaphragmatic Index, Diagnosis.