Recently, a colleague of mine was wanting to perform a diagnostic tap on a patient with cough, fever and a CXR suggesting a left sided pleural effusion….
I was asked to perform a bedside USS to mark out the safest place to perform the pleural aspirate.
I percussed the chest to the dullest point and then slapped the ultrasound on (left posterior chest wall, longitudinal plane, just below tip of scapula).
This is what I saw…
Needless to say the needle was re-sheathed and the procedure aborted. I am convinced that if we were going by x-ray and clinical examination alone we would have created more problems for this guy.
What made a difference….
- Turner JP, Dankoff J. Thoracic ultrasound. Emerg Med Clin North Am. 2012 May;30(2):451-73.
- Ultrasound Podcast Episode 31 (Pneumothorax & Pleural Effusion) & Episode 32 (Pneumonia & ARDS)
- Sonocloud
Hey Chris.
So did he go straight for a decort based on your scan?
Hey mate,
Nope off to the ward for IVABx.
As far as I’m aware, no surgical consult or drainage during admission.
Did you think that this had a few suspicious features for empyema? Just on the loop you provide there appear to be septations and adhesions from the lung base and pericardium to the pleura.
I guess that it wasn’t if he just got better!!
Nice work on the website, looking really good.
Thanks Alex !
I agree, re: adhesions etc
I’ve got the fellas MRN & I’ll check on his final outcome tomorrow…..
Alex;
A progress note on our patient.
- CT demonstrated loculated (complicated) pleural effusion.
- Two attempts of pleural drainage (1x blind on the ward…. ehhh, the 2nd under USS guidance in radiology). Neither attempts successful.
- Clinically improved over 7 days, on IV ABx, so discharged home.