Pleural effusion on point-of-care ultrasound

Case contributed by Zhan Lim

Presentation

Worsening breathlessness and abdominal discomfort 2 days post haemodialysis. Background history of end stage renal failure secondary to chronic glomerulonephritis, on haemodialysis via tunneled catheter.

Patient Data

Age: 40 years
Gender: Male

Large volume anechoic effusion visualized 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 edema. A right-sided central venous catheter is visualized with tip in adequate position.

Case Discussion

Point-of-care ultrasound (POCUS) is an excellent beside tool to provide good visualization 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, which revealed transudative pleural effusion. He was managed with isolated ultrafiltration (Iso-UF) and had his dry weight further reduced by the nephrology team. 

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