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September 8, 1975

Masquerade With Mediastinal Pleural Fluid

Author Affiliations

From the Department of Radiology, San Bernardino County General Hospital (Dr. Roghair), San Bernardino, Calif. Mr. Donnelly is a medical student. Dr. Roghair is now at Riverside (Calif) General Hospital.

JAMA. 1975;233(10):1086-1088. doi:10.1001/jama.1975.03260100056021

A TRIANGULAR density in the right paraspinal area has been considered as evidence of right lower lobe atelectasis.1-3 Fluid density merging with the right margin of the heart may be interpreted as an enlarging heart.4 Finally, with known disease of the right lower lobe, a subsequent increase in density off the right margin of the heart may suggest development of right middle lobe disease as well. We propose that fluid accumulation in the mediastinal pleural space should be considered in lieu of any of these three possibilities.

Report of a Case  A 36-year-old man was admitted unconscious in October 1971 following an automobile accident.Physical examination disclosed a normal chest and a rigid abdomen with absent bowel sounds. A supine chest roentgenogram was normal. An abdominal roentgenographic series and an intravenous pyelogram suggested retroperitoneal trauma and possible liver laceration, with loss of liver margin and displacement of the