DIAGNOSTIC IMAGING OF

SMALL AMOUNTS OF PLEURAL

FLUID : PLEURAL EFFUSION VS
PHYSIOLOGIC PLEURAL FLUID
Mayshia Prazitya Shakti
1410029050
Pembimbing :
Dr. Freddy Yoedyanto, Sp. Rad

INTRODUCTION

Pleural space is only potential space between the parietal and visceral pleura and it is
covered by a thin fluid layer.

The data on the smallest amount of pleural fluid detectable by imaging methods vary
considerably >> lateral decubitus and usg

There is no clear consensus definition of small pleural effusion on chest radiography and
on sonography

There are no fixed boundaries between the amount of pleural fluid detected by imaging
methods in physiologic and pathologic conditions

CHEST RADIOGRAPHY
The amount
Upright
position
of 175
to
PF500
accumulate
mL couldinbeinfrapulmonary
hidden in pleural
space
space
on
forming
erect the
PA views
infra or
radiographs
sub
pulmonary
>>
Small PEeffusion
= meniscus sign

Lateral erect + injected saline 25 mL to PF could be detected as a subpulmonic

LESS RELIABLE
>> HIGH RISK
accumulation (1)
Hard to erect
Lateral
interpret
Junction
the sign without
of the major
previous
fissure
lateral
withchest
the diaphragm
x-rays and
in straight
the cases
triangular
of
shadow
at anterior diaphragmatic
superimposing
fat in anterior
contour
mediastinum (2)
Facilitates
distinction
between
small
and
artefacts
(skin folds,
sheets andair-fluid
subcutaneous
New
criteria
: fluid density
form
3 mm PE
to 15
mm
in thickness,
with horizontal
level at
Lateral
Decubitus
+ expiration
fat) and
the amount
of PF
lateral
dependent
chest
walldetectable with this technique was as little as 5 mL

(1) Collins et al (2) Hessen et al; Peterson et al

CHEST ULTRASONOGRAPHY (US)

US ofofpleural
USG
pleuralspaces
spacesfrom
frombehind,
behind,with
withthethepatient
patientsitting
sittingposition
position + elbow position

Patient placed in lateral decubitus position for 5 minutes first, then US examination while
he/she leaning on the elbow

IMAGING PHYSIOLOGIC PLEURAL FLUID

In 1951 reported that four percents of physiologic pleural fluid was detected by lateral
decubitus chest radiography in 300 healthy persons and in 22% of healthy women after
childbirth (3)

In this study (using the same techniques in more than 100 health individual >> didnt find

Four recent studies showed that physiologic pleural fluid is easy to detect by chest
sonography in about to 25 to 30 oercent of healthy individual using elbow position. In
healthy pregnant woman the percentage is raised up to 60%

(3) Hessen et al

CONCLUSION

There is a dry Pleural Space and Wet Pleural Space in healthy individual

The term PE >> pleural illness

In spite of all those investigations clear border between physiologic PF and PE remains
stil indeterminate.

Lateral Decubitus + expiration and US with elbow Position

THANK YOU!!