CTICasesLeft Subpulmonic Pleural Effusion — Stomach-to-Diaphragm Distance Sign
Imaging findings
Sequential frontal chest radiographs post-CABG demonstrate basal left opacity with loss of the normal lateral costophrenic margin and increased distance between the stomach gas bubble and the apparent left hemidiaphragm, indicating subpulmonic fluid lifting the lung away from the diaphragm. CT confirms substantial layering left pleural effusion occupying the subpulmonic space.
Key takeaways
A subpulmonic pleural effusion can be suspected on the frontal radiograph when the apparent left hemidiaphragm is laterally displaced with loss of the normal sharp costophrenic angle, combined with an abnormally increased distance between the stomach gas bubble and the apparent diaphragm. This stomach-diaphragm distance sign, when increased to more than 2 cm, suggests subpulmonic fluid interposition between the lung base and the diaphragm.
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