Tag Archives: Pleural Effusion

Great example of a pleural effusion

June 10, 2013

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This patient came in dyspenic, has a history of metastatic lung cancer:

Pleural effusion

This is a good example of a pleural effusion.  The upright chest xray shows a fluid level on the right representing a large right pleural effusion.  The patient had a therapeutic thoracentesis and felt much better.

Author:  Russell Jones, MD

Image Contributor:  Carieann Drenten, MD

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SVC Syndrome

January 11, 2013

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I received an interesting CT Chest from one of our EM residents in a patient with SVC (Superior Vena Cava) syndrome.  The patient had a PORT in place with clot around the PORT occluding the SVC.  This is an interesting case with a couple common and a couple rare findings:

SVC 1SVC 2SVC 3SVC 4

This is a complicated CT showing multiple findings:

A:  Good example of a right pleural effusion, large, seen on CT.  The patient also has a left sided effusion.

B:  Cross-section of the SVC showing the PORT cath and clot occluding the vessel

C:  Longitudal view of the SVC, again with PORT and clot

D:  The patient had the contrast injected from a right arm peripheral IV.  There are extensive collaterals in the arm and right chest with blood flow returning through these collaterals rather than traditional axillary vein to SVC.

E:  This view shows one of the collaterals actually connecting to the pulmonary vein.

Author:  Russell Jones, MD

Image Contributor:  Julie Phan, MD

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Dyspnea

November 1, 2012

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A 62-year-old male presented with dyspnea and a portable upright chest X-ray looked like this:

The radiograph shows a complete opacification of the right hemithorax with tracheal deviation in that direction.  The differential diagnosis for this radiograph includes:

1.  Large pleural effusion

2.  Hemothorax (especially in trauma and known malignancy)

3.  Pneumonia involving all right lobes

4.  Empyema

5.  Obstructing mainstem bronchus (mass or foreign body)

6.  Massive aspiration

If this patient is in extremis bedside ultrasound would be very beneficial to see if this is a drainable effusion.  It turns out this patient was not in severe respiratory distress, bedside ultrasound was not consistent with pleural effusion, and the patient went to CT scan.  Chest CT showed a completely obstructed mainstem bronchus and fluid-filled lung parenchyma with associated atelectasis.  There was no pleural effusion.

One of the interesting points of the radiograph is the tracheal deviation.  This usually indicates a volume loss on the side of the deviation or a volume gain on the opposite side.  Since there is no identifiable volume gain (pneumothorax) on the left side this indicates a volume loss in the form of atelectasis on the right side.  This is a good example of why one should be wary of immediately performing therapeutic thoracentesis with this X-ray.  Use your bedside ultrasound if you have it!

Author:  Russell Jones, MD

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