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Howdy #Medtwitter / @MedTweetorials! I wanted to throw together a little #tweetorial on this little bugger which is the most impressive loculated pleural #effusion I've ever seen! Check it out!
Howdy #Medtwitter / @MedTweetorials! I wanted to throw together a little #tweetorial on this little bugger which is the most impressive loculated pleural #effusion I've ever seen! Check it out!
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As @DRsonosRD, ( #POCUS guru, #Kashlak POCUS Chief) and many others would say, this is a loculated pleural effusion!
The little thin-walled pockets are loculations (aka divisions) made up of fibrous tissue.
As @DRsonosRD, ( #POCUS guru, #Kashlak POCUS Chief) and many others would say, this is a loculated pleural effusion!
The little thin-walled pockets are loculations (aka divisions) made up of fibrous tissue.
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These can be seen in several conditions. They are usually the result of significant pleural inflammation, seen in empyema, hemothorax, TB and malignancy - to name a few cases
These can be seen in several conditions. They are usually the result of significant pleural inflammation, seen in empyema, hemothorax, TB and malignancy - to name a few cases
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You can see on the #ultrasound the diaphragm overlying the liver, and adjacent to that are the loculations with fibrinous "tendrils" and some evidence of flowing fluid, perhaps with a few air bubbles...
You can see on the #ultrasound the diaphragm overlying the liver, and adjacent to that are the loculations with fibrinous "tendrils" and some evidence of flowing fluid, perhaps with a few air bubbles...
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... the air can be seen in cases where the pleural fluid
pus or is otherwise loaded with gas producing organisms (think anaerobes) which often cause empyemas to form (frank pus, low pH, low glucose, high LDH)
... the air can be seen in cases where the pleural fluid
pus or is otherwise loaded with gas producing organisms (think anaerobes) which often cause empyemas to form (frank pus, low pH, low glucose, high LDH)
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When you see this, you should NOT expect a simple thoracentesis to solve the problem. Plan for a thoracostomy tube. To that effect, several studies such as this one, suggest a small-bore tube may be just fine! https://erj.ersjournals.com/content/52/suppl_62/PA888
When you see this, you should NOT expect a simple thoracentesis to solve the problem. Plan for a thoracostomy tube. To that effect, several studies such as this one, suggest a small-bore tube may be just fine! https://erj.ersjournals.com/content/52/suppl_62/PA888
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The goal is to drain the *likely* infected space, obtain labs (pH, glucose, LDH, Cx, ?adenosine deaminase if worried about TB, ?TG if worried about #chylothorax and cyto to eval for malignancy. Then you can hook your newly placed tube to a collection chamber
The goal is to drain the *likely* infected space, obtain labs (pH, glucose, LDH, Cx, ?adenosine deaminase if worried about TB, ?TG if worried about #chylothorax and cyto to eval for malignancy. Then you can hook your newly placed tube to a collection chamber
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Then... You kinda watch and wait. Oftentimes we end up using TPA & Pulmozyme in these cases ( #MIST2) - more can be seen here!
https://www.wikijournalclub.org/wiki/MIST2
If that's a no go, it's good to have a relationship with your friendly CT surgeons to consider decortication.
Then... You kinda watch and wait. Oftentimes we end up using TPA & Pulmozyme in these cases ( #MIST2) - more can be seen here!
https://www.wikijournalclub.org/wiki/MIST2
If that's a no go, it's good to have a relationship with your friendly CT surgeons to consider decortication.
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So, that's a quick and dirty on loculated effusions! Hope you enjoyed the image. I'll also share this awesome chest tube teaching graphic from @nickmmark on http://www.onepagericu.com - this might help you out some day!
So, that's a quick and dirty on loculated effusions! Hope you enjoyed the image. I'll also share this awesome chest tube teaching graphic from @nickmmark on http://www.onepagericu.com - this might help you out some day!
