Discussion of infrapulmonary pleural effusion can be found in radiological literature and literature on the chest but has been completely omitted in general medical publications. Consequently, this peculiar type of pleural fluid collection frequently exists unrecognized or misdiagnosed, for it produces the illusion of an elevated diaphragm. It is, of course, necessary to distinguish pleural effusion from diaphragmatic elevation, because the underlying causes of the two abnormalities, which may be entirely different, must be determined before proper therapeutic measures can be undertaken. The differentiation may not be made by diagnostic thoracentesis, for liquid in the infrapulmonary space may not be accessible to the aspirating needle by the ordinary tapping procedure. The diagnosis can be established specifically by simple roentgenographic methods, but these procedures are not performed routinely; before appropriate roentgen examinations are recommended, infrapulmonary effusion must be suspected. It is necessary therefore that all doctors who have the opportunity to
Wilson JW. DIAGNOSIS OF INFRAPULMONARY PLEURAL EFFUSION. JAMA. 1955;158(16):1423–1427. doi:10.1001/jama.1955.02960160017006
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