A 68 year old male with a history of DM, HTN, and breast cancer presents to the ED with progressively worsening dyspnea over the past three to four days. On exam she is tachycardic to 120, appears tachypneic with accessory muscle usage and pulse ox is 88% on room air. You perform a lung ultrasound which reveals the following:
What is the diagnosis?
Pleural Effusion.
Ultrasonographic findings of pleural effusion:
- Fluid appears dark (anechoic) cephalad to the diaphragm and may be homogeneous or heterogeneous depending on the etiology of the fluid.
- Lung may be seen as a triangle-like structure floating in the pleural fluid
- Thoracic spine sign: the spine is able to be visualized due to loss of mirror artifact as a hyperechoic area posterior to the fluid as the fluid acts a medium through which the ultrasound waves can be transmitted
Case continued:
A pigtail was placed to remove the fluid with the patient experiencing improvement in respiratory status status post drainage of approximately 800mL of fluid.
Resources:
Deschamps, Jade, and Vi Dinh. “Lung Ultrasound Made Easy: Step-By-Step Guide.” Pocus 101, 2023, www.pocus101.com/lung-ultrasound-made-easy-step-by-step-guide/. Accessed 6 Nov. 2024. Co-authors: Jessica Ahn, Satchel Genobaga, Annalise Lang, Victor Lee, Reed Krause, Devin Tooma, and Seth White. Oversight, review, and final edits by Vi Dinh.
Huang, Calvin, Andrew S. Liteplo, and Vicki E. Noble. “Lung and Thorax.” Practical Guide to Emergency Ultrasound, edited by Vicki E. Noble and Bret P. Nelson, 2nd ed., Cambridge University Press, 2011, pp. [specific page numbers if available].
