Presentation
Worsening breathlessness and abdominal discomfort 2 days post haemodialysis via tunnelled catheter. End stage renal failure secondary to chronic glomerulonephritis.
Patient Data
Large volume anechoic effusion visualised superior to diaphragm and spleen on bedside ultrasound. There is evidence of increased renal echogenicity in the left kidney consistent with chronic kidney disease.
Moderate volume unilateral pleural effusion seen at left base with accompanying features of interstitial oedema. A right-sided central venous catheter is visualised with tip in adequate position.
Case Discussion
Point-of-care ultrasound (POCUS) is an excellent beside tool to provide good visualisation of pleural effusion 1,2. It can also detect certain sonographic features which may suggest exudative pleural effusion including septations, increased echogenicity or pleural thickening 2. Anechoic effusion, shown in the above case, can be either transudate or exudate in nature.
A follow-up bedside thoracentesis was performed for the patient under ultrasound guidance and analysis revealed a transudative pleural effusion. He was managed with isolated ultrafiltration (Iso-UF) and his dry weight was further reduced by appropriate treatment.
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