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How to Diagnose Pleural Effusion on X-Ray Clinical Clues: Patients commonly present with chronic cough 🗣️, difficulty in breathing 😮💨, and chest heaviness ⚖️. Always correlate symptoms with imaging findings. Blunting of the Costophrenic Angle: Normally, the costophrenic angle appears sharp 📐 on a chest X-ray. In pleural effusion, this angle becomes obscured and rounded 🔵 due to fluid accumulation in the pleural space. Meniscus Sign: The pleural fluid forms a characteristic concave upward (meniscus-like) opacity 🌊 at the lung base, differentiating it from other causes of lung opacities. Possible Mediastinal Shift: In cases of massive pleural effusion, the trachea and mediastinal structures may shift to the opposite side 🔄 due to increased intrathoracic pressure. Importance of Clinical Correlation: Always assess symptoms and consider additional imaging like ultrasound 🏥 or CT scan 🖥️ for confirmation, especially in borderline cases. Key Takeaway: If a patient presents with cough + breathlessness and the X-ray shows costophrenic angle blunting and a meniscus sign 📸, pleural effusion should be suspected! 🚨