probe prevents probe…

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….

  1. Turner JP, Dankoff J. Thoracic ultrasoundEmerg Med Clin North Am. 2012 May;30(2):451-73.
  2. Ultrasound Podcast Episode 31 (Pneumothorax & Pleural Effusion) & Episode 32 (Pneumonia & ARDS)
  3. Sonocloud

5 thoughts on “probe prevents probe…

  1. 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.

    • 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.

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