Paediatric- Pleural effusionCreated OnMay 6, 2020Last Updated OnOctober 26, 2020byadmin You are here: Main Radiology Paediatric- Pleural effusion < All Topics Table of Contents Chest X-Ray Chest X-Ray is the most commonly used examination to assess for the presence of a pleural effusion. Lateral Decubitus film most sensitive, able to identify small amount of fluid. Obtained with the patient lying on their side, effusion side down, with a cross table shoot through technique) can visualize small amounts of fluid layering against the dependent parietal pleura. Both PA and AP erect films are insensitive to small amounts of fluid (required 250-600 ml of fluid before it becomes evident). Features include: Blunting of the costophrenic angle Blunting of the cardiophrenic angle Fluid within the horizontal or oblique fissures Meniscus sign with large volume effusions, mediastinal shift occurs away from the effusion On the other side, supine films can mask large quantities of fluid. Image shows left lower lobe consolidation, representing pneumonia. Also note the meniscus in the left costophrenic angle indicating parapneumonic left pleural effusion. Massive right pleural effusion results in mediastinal shift to the left. Ultrasound Allows detection of small amounts (3-5mls) of pleural locular fluid Useful in differentiating loculated pleural fluid and thickened pleura Effective in guiding thoracentesis. Characterised by an hypoechoic space between visceral & parietal pleura. Septations seen in pleural fluid may indicate underlying infection. A) Small pleural effusion (right chest) B) Large pleural effusion (left chest) causing compressive atelectasis of adjacent lung, giving the lung a tissue-like echogenicity. C) Loculated pleural effusion. A complex pleural effusion with loculations between the lung, diaphragm, and a diaphragmatic metastasis. *Some of the image photo is taken from web, we do not own this, it’s for knowledge sharing purpose.
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