Pleural effusion is not always visible as a meniscus in the costophrenic angle. A subpulmonic effusion may follow the contour of the diaphragm making it tricky to discern. In these cases, the only way to detect pleural effusion, is when you notice that there is an increased distance between the stomach bubble and the lung. The stomach is normally located directly under the diaphragm, so, on an erect PA radiograph, the stomach bubble should always appear in close proximity to the diaphragm and the lung. On the left images of a patient with signs of CHF. At first glance you might get the impression that there is a high position of the diaphragm. However when you notice the increased distance of the stomach air bubble to the lung base, you realize that there is a large amount of pleural fluid on both sides (arrow). #Clinical #Radiology #CXR #CHF #Pleural #Effusion #Subpulmonic #SubpulmonicEffusion #RadiologyAssistant
