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According to the history, physical examination, and radiological investigations, the possible diagnosis is right-sided hemothorax, lung contusion, elevated right hemidiaphragm due to subpulmonic effusion, diaphragmatic eventration, phrenic nerve injury, or even diaphragmatic rupture.
Chest X-ray revealed a small right lower lobe infiltrate with subpulmonic effusion. Echocardiography revealed mild concentric left ventricular hypertrophy, impaired LV relaxation with abnormal (paradoxical) septal motion consistent with LBBB, noncompaction of ventricular apex, mild aortic regurgitation, and mitral regurgitation.
A chest x-ray on discharge showed minimal right subpulmonic effusion. As an outpatient, the patient was maintained on prednisone 60 mg daily and hydroxychloroquine 200 mg twice a day.
2), features suggestive of a subpulmonic effusion (lateral peaking of an apparently raised hemidiaphragm) (Fig.