X-ray
Frontal
Lateral
What is the main finding? Is this concerning?
Large left sided pleural effusion, without any fluid on the right. Yes, a unilateral pleural effusion is concerning, especially in a young patient without evidence of cardiac failure.
What are the main possibilities (very general terms)?
Malignant pleural effusion. Parapneumonic effusion (underlying pneumonia) or empyema. Haemothorax. Chylothorax.
What are some possibilities to explain these two findings (surgical clips and effusion)?
They could of course be unrelated, but in a young patient there is likely a link. Surgery in the supraclavicular region most likely represents a lymph node excisional biopsy (e.g. lymphoma, nodal metastasis, or TB suppurative node (although this patient has low demographic risk of TB)) or local surgery to skin (e.g. melanoma).
A large left sided pleural effusion is present with no fluid seen on the right. No evidence of cardiomegaly or pulmonary venous congestion. No evidence of trauma.
Multiple surgical clips are seen in the right supraclavicular fossa.