91. Pleural effusion in supine position of CXR

ชาย 71 ปี เหนื่อยหอบ หายใจไม่อิ่ม 2 วัน O2 sat room air 62% CXR ดังนี้คิดถึงอะไร

ทำอัลตร้าซาวด์มี Pleural effusion both side

Moderate to large pleural effusions will found homogenous increase in density over the lower lung fields on a supine chest radiograph
About 200 ml of fluid is required to be visible on a PA view but just 50 ml will cause costo-phrenic blunting on a lateral view
Transudates usually occur bilaterally because of the systemic nature of the causative disorders
http://74.125.153.132/search?q=cache:ls5N0N6phqYJ:www.merck.com/media/mmpe/pdf/Table_060-3.pdf+pleural+effusion+bilateral+cause&cd=11&hl=th&ct=clnk&gl=th

The British Thoracic Society suggest that 'aspiration should not be performed for bilateral effusions in a clinical setting strongly suggestive of a pleural transudate, unless there are atypical features or they fail to respond to therapy'