Pleural effusion - supine

Case contributed by Alexandra Stanislavsky
Diagnosis certain


Shortness of breath

Patient Data

Age: 85 years
Gender: Male

Supine chest x-ray


Veiling of the right hemithorax.


Moderate free right pleural effusion and mild free left pleural effusion with relaxation atelectasis of both lower lobes.

Incidental pleural calcifications.

Case Discussion

This case demonstrates typical features of a white-out hemithorax due to a large pleural effusion in a supine patient.

Key features that lead to the diagnosis are:

  1. being aware that the patient is supine (note the label)
  2. mediastinal shift away from the white-out
  3. lung marking seen through the density indicate that it is adjacent to, rather than within the lung.

The smaller left sided effusion (as seen on CT) is barely appreciated on the x-ray, highlighting the limited sensitivity of radiographs for pleural fluid.  

Incidental finding of pleural plaques is seen on both x-ray and CT.

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