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The inexperienced scanner may identify the recess as the diaphragm and the liver as an echodense pleural effusion with inadvertent subdiaphragmatic device insertion. It is required to positively identify the kidney, the liver (or spleen), and the diaphragm when accessing a pleural effusion. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 9th intercostal space in the right mid-axillary line.