48 year old Nurse, with long history of rheumatoid arthritis presents with cough and shortness of breath for the past two months. She is on 15 mgm of Prednisone daily.

 

Findings:

  • Density
  • In dependent portion
    • Costophrenic angle in PA view
    • Anterior and posterior portions of gutter in lateral view
    • Along sides in lateral decubitus position
    • Along posteriorly in supine position, giving diffuse haziness on the side of effusion
  • Silhouette of upper limit of density
    • Upper margin high in axilla in PA view
    • Upper margin high interiorly and posteriorly in lateral view
  • Blunting of costophrenic angle 
  • Lack of identifiable diaphragm  (silhouette sign principle

Diagnosis

Rheumatoid Pleural Effusion

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