Pleural Effusion

If presenting with pleuritic chest pain, there’s unilateral loss of breath sounds at a base, with dullness to percussion all the way up to the fluid level.  Bilateral effusions can be tricky, because the findings are symmetrical — you just have to realize that breath sounds should be audible in the lower thorax.

A chest x-ray easily makes the diagnosis, as long as you order a lateral view as well as the PA.  A very small pleural effusion may require additional techniques, but wouldn’t cause pleuritic chest pain.

See posting Chest Pain – 2.