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.