Radiology – Chest X ray Pleural Effusion Part 4 -Dr. Sheetu Singh

1
Radiology Chest X ray

• PA view - the lateral costophrenic angle is
  obliterated. Minimum fluid required in pleural
  cavity 175-500 ml
• Shift of trachea/mediastinum to opposite side
• Effusion with no tracheal/mediastinal shift?
• Meniscus sign / Ellis S shape curve The
  density of the fluid is high laterally and curves
  gently downward and medially with a smooth,
  meniscus-shaped upper border to terminate at the
  mediastinum.

2
Chest X ray PA view
3
Radiology Chest X ray

• Lateral view - the upper surface of the fluid
  density is semicircular, high anteriorly and
  posteriorly, and curving smoothly downward to its
  lowest point approximately midway between the
  sternum and the posterior chest wall.
• Minimum amount of pleural fluid to be visualized
  on lateral x ray 75 ml

4
Chest X ray Lateral view
5
Radiology Chest X ray

• Signs on Supine film
• Blunting of the costophrenic angle
• Increased homogenous density superimposed over
  the lung
• Loss of the hemidiaphragm silhouette
• Apical capping
• Elevation of the hemidiaphragm
• Decreased visibility of lower lobe vasculature
• Accentuation of the minor fissure

6
Chest X ray supine film