Post-traumatic subpulmonic effusion

Case contributed by Bálint Botz
Diagnosis certain

Presentation

Fall from height 10 days earlier, sustained multiple rib fractures on the left. Presented for trauma outpatient follow-up with mild dyspnea.

Patient Data

Age: 65
Gender: Male

The left lateral costophrenic recess is blunted, there is an apparent elevation of the left hemidiaphragm with increased distance from the gastric bubble, indicating a subpulmonic effusion. 

ultrasound

US quickly confirms the presence of a thin fluid in the pleural space on the left. 

The effusion shows a more typical layering on CT, with an accompanying subsegmental atelectasis due to compression. Adjacent to the fracture of the 7th rib of the rib there is a circumscribed, discrete, inhomogenous hyperdensity within the effusion, which could signal the injury of the intercostal artery (this was however unsupported by the lab parameters or the subsequent drainage), or can be caused by high density fibrinous material. 

Case Discussion

Subpulmonic effusions present no particular challenge in CT and US, but can be overlooked or misinterpreted more easily on erect CXR. 

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