Subpulmonic pleural effusion

Case contributed by Dr Nafisa Shakir Batta

Presentation

A patient of carcinoma of the ovary undergoing chemotherapy.

Patient Data

Age: 49 yrs
Gender: Female
Modality: X-ray

The left dome of diaphragm is higher than right with increased distance of diaphramatic outline to the fundal air bubble of stomach, suggestive of a subpulmonic pleural effusion.

Modality: CT
CT confirms the effusion which layers posteriorly in the supine position.

Case Discussion

Subpulmonic effusions are also called infrapulmonary effusions. Minimal to moderate subpulmonic effusions can be missed unless carefully kept in mind.

Many signs have been described in literature to diagnose this condition on a plain frontal chest skiagram obtained in the upright position.

  • Raised dome of diaphragm, easier to diagnose when seen on left side, but a difference of two intercostal spaces higher on right side also raises the suspicion of subpulmonic fluid.
  • Increased distance between left diaphramatic outline and the fundal gas bubble in the stomach.
  • Abrupt termination of lung markings at the diaphragmatic interface attributable to fluid being denser to the  normal translucency of lung base.
  • The pseudodiaphragm (visceral pleural interface) appears flattened specially at medial margins, with blunting of the cardiophrenic angle.
  • The pseudodiaphragm shows a more lateral peak - 'lateralisation of diaphragmatic apex'
  • Crowding of lung markings at lower zones in cases of moderate to large subpulmonic effusions.
  • In some cases parietal  pleural calcifications may help to delineate and diagnose the effusion.
  • Lateral chest radiograph may show blunting of the posterior costophrenic recess.

In larger subpulmonic effusions, there may be blunting of the lateral costophrenic angle on frontal skiagram of chest.

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Case Information

rID: 24982
Case created: 25th Sep 2013
Last edited: 4th Oct 2015
System: Chest
Inclusion in quiz mode: Included

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