Presentation
Increased work of breathing and decreased air entry at right lung base.
Patient Data
Elevation of the right lung base with apparent lateralization of the diaphragmatic apex.
Increased cardio-thoracic ratio.
C-shaped mitral annular calcification.
There is moderate right basal pleural effusion, depth up to 65 mm. There is moderate atelectasis within the right lower lobe about the effusion.
Dilated left and right atria and right ventricle. Coarse mitral annular calcification.
Calcification of the left anterior descending and circumflex coronary arteries.
Small amount of perihepatic fluid.
Case Discussion
This case demonstrates the x-ray appearance of a right-sided subpulmonic pleural effusion. There is an apparent elevation of the right hemidiaphragm. The apex of this pseudohemidiaphragm is displaced laterally, and this suggests a subpulmonic effusion as the diagnosis rather than a true raised hemidiaphragm1. Subsequent CT demonstrates a pleural effusion which is posteriorly located with the patient supine.
*Thanks to Dr Brad Davis for his input on this case.
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