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.

CXR of pediatric subpulmonic pleural effusion
CXR AP (above) shows lateralization of the apex of the right hemidiaphragm and consolidation in the right lower lobe. Right lateral decubitus CXR (below) shows a large free flowing right pleural effusion.