Pericardial versus pleural effusion on PLAX view

We may find both pericardial and pleural effusions in the parasternal long axis (PLAX) view and mistaking one for the other can lead to inappropriate management. The descending thoracic aorta is the anatomical landmark to differentiate between these two effusions. Fluid anterior to the descending aorta (toward the top of the screen) is pericardial effusion and the fluid at or posterior is likely pleural effusion. Here is a cross section of thorax demonstrating the relationship of the descending aorta to the left lung and pleura.

Here are two sonographic images illustrating this concept.

Below is an example of left pleural effusion in a patient with malignancy that can be easily confused with pericardial effusion on quick beside exams. Pay attention to the location of descending aorta. Scanning in different views helps further. Also note fibrin stranding in the mid-axillary view suggestive of exudative pleural effusion.

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