UMEM Educational Pearls

Title: What's the diagnosis?

Posted: 8/10/2013 by Haney Mallemat, MD (Emailed: 8/12/2013) (Updated: 8/12/2013)
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Question

Patient with liver disease presents with dyspnea, fever, and the following ultrasound? What's the diagnosis? (Hint: there are two)?

Answer

Answer: Complex pleural effusion and ascites

The take away point from this case is to always place the diaphragm in the center of the screen in order to distinguish peritoneal from thoracic fluid. Fluid in both compartments will sometimes be present (as in this case).

Complex pleural effusions

Ultrasound can help differentiate simple versus complex effusions
Simple effusions tend to be consistent with:
- Acute volume overload from resuscitation
- Heart failure
- Conditions with low oncotic pressure (e.g., nephrotic syndrome)
- Hepatic hydrothorax
Complex effusions tend to be consistent with:
- Hemothorax
- Empyema
- Malignancy

References

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