Which chest X-ray finding is typical of a pleural effusion?

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Fluid in the pleural space settles at the lung bases and changes the contour seen on chest X-ray. The hallmark sign of a pleural effusion is blunting of the costophrenic angle on an upright film, where the sharp angle between the diaphragm and rib cage becomes rounded as fluid accumulates. If the effusion is small, you might notice a subtle meniscus or minimal basilar atelectasis; a lateral view or lateral decubitus film can help by showing the fluid layering. Hyperlucent lungs point to increased air content, such as in hyperinflation or pneumothorax, not fluid; cardiomegaly without effusion doesn’t indicate an effusion; a normal lung field shows no effusion. So the blunting of the costophrenic angle is the typical finding for a pleural effusion.