Imaging Case of the Week 593 Answer

The chest x-ray shows left sided pleural based opacity protruding into the lung field with a reverse D appearance. This appearance of the chest x-ray should raise suspicion for an empyema.

A simple pleural effusion causes meniscus sign on the chest x-ray (concave upper border). Consider empyema if a reverse D opacity is seen on chest x-ray in a patient with sepsis.