CTICasesBilateral Pleural Effusions Masked on Digital Radiography
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Imaging findings
A portable chest radiograph of an ICU patient with diffuse pulmonary edema appears to show no significant pleural effusions. However, a chest CT performed just 20 minutes earlier clearly demonstrates large, bilateral, symmetric, layering pleural effusions.
Key takeaways
Large, symmetric, bilateral pleural effusions can be almost completely masked on supine or semi-upright digital radiographs. Because the effusions layer posteriorly and are of equal size, the automatic exposure control and image reconstruction algorithms of modern digital radiography systems adjust the overall image contrast to optimize the lung parenchyma, inadvertently hiding the diffuse, symmetric fluid attenuation.
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