UMEM Educational Pearls

Title: What is the diagnosis ? (Case by Hussain Alhashem)

Keywords: Pleural effusion; POCUS (PubMed Search)

Posted: 4/17/2017 by Tu Carol Nguyen, DO
Click here to contact Tu Carol Nguyen, DO

Question

A 50 years old male with a history of CHF, presenting to the ED with progressively worsening shortness of breath. POCUS was performed. The picture shows the left lower part of the chest. What is the diagnosis?

Answer

Answer: Pleural effusion

POCUS is faster than X-rays and better at quantifying the amount of fluid in a pleural effusion.
It is also useful in guiding thoracentesis.
The diagnosis of pleural effusion by ultrasound is made by visualizing fluid above the diaphragm.
One sign that can help with detecting fluid is the presence of V lines (not shown in this image). V lines are the spine shadows visualized through a pleural effusion. The presence of V lines strongly supports the presence of fluid in the pleural space.

References

Eibenberger, K. L., Dock, W. I., Ammann, M. E., Dorffner, R., Hörmann, M. F., & Grabenwöger, F. (1994). Quantification of pleural effusions: sonography versus radiography. Radiology, 191(3), 681-684.

Atkinson, P., Milne, J., Loubani, O., & Verheul, G. (2012). The V-line: a sonographic aid for the confirmation of pleural fluid. Critical ultrasound journal, 4(1), 19.