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IVC and the right pleural effusion

In a twitter poll asking what the arrow was pointing to in this image, only ~54% answered correctly.

The correct answer is right pleural effusion. Below illustration explains why the pleural fluid appears to be ‘beneath’ the IVC in the angle we are scanning.

Another example:

Pleural effusion (particularly the right) is often visualized from the subxiphoid window as we discussed multiple times before. Here is a nice image obtained from the same patient that shows right pleural effusion, ascites as well as mild pericardial effusion from this window.

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