Pediatric Subpulmonic Pleural Effusion

  • Etiology:
    — Non-infected fluid in pleural space
    — Common cause is infection – Streptococcus pneumonia, Staphylococcus aureus, Group A Streptococcus, Mycoplasma, Tuberculosis
    — Less common causes are cardiac failure, rheumatologic
  • Imaging CXR:
    — Elevation of the hemidiaphragm with lateralization of the apex of the hemidiaphragm on the AP view
    — Decubitus view will show free flowing pleural effusion
  • Imaging US: Clear pleural fluid between the inferior border of the lung and the diaphragm
  • DDX: Diaphragm eventration, diaphragm paralysis
  • Complications: May evolve into infected pleural empyema
  • Treatment: If large may require a chest tube
  • Clinical:

Radiology Cases of Subpulmonic Pleural Effusion

CXR and CT of subpulmonic pleural effusion and empyema
CXR AP (above) shows a right lower lobe infiltrate and elevation of the right hemidiaphragm and lateralization of its apex. Coronal 2D reconstruction from CT with contrast of the chest (below) shows a loculated fluid collection between the inferior border of the right lung and the right hemidiaphragm.