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Chapter 31: Critical Care Ultrasound
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A 23-year-old woman presents with worsening of right-sided pleuritic chest pain, intermittent episodes of nighttime chills, and a cough productive of yellow sputum. She received a 5-day oral course of azithromycin without relief. Her initial vital signs are temperature of 97.8°F, heart rate of 141 beats/min, respiratory rate of 34 breaths/min, and oxygen saturation of 86% on room air. A chest radiograph is performed and is pictured in Figure 31-10.
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Figure 31-10. Portable chest radiograph.
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A medical intensive care unit (ICU) consultation is called for evaluation of multilobar and impending respiratory failure. A lung ultrasound of the right lung base is performed and is pictured in Figure 31-11.
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Figure 31-11. Thoracic ultrasound obtained in the midaxillary scan line.
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This image is highly suggestive of what process?
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B. Complex pleural effusion
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B. Complex pleural effusion
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The image shown was acquired on the lateral thorax in the midaxillary line using a low-frequency convex probe with the indicator pointed cephalad. The key anatomic boundaries for defining a pleural effusion are shown: the chest wall (anterior), diaphragm (caudad), liver (caudad) pleural surface, and lung (cephalad). Identification of the diaphragm is imperative to avoid an intra-abdominal tap. Choice A is incorrect because there is no fluid seen below the diaphragm in this image. Choice C is incorrect because there is no pleural mass noted. Choice D is incorrect because atelectasis would appear simple without septations or loculations often with a small tail at the lung edge, known as the plankton sign. The prevalence of pleural effusions in IUCs can range as high as 60% to 90%. Pleural ultrasound can detect as little as 3 to 5 mL of fluid and has been shown to have a higher sensitivity for detecting and characterizing pleural effusions than chest radiographs. Compared with chest computed tomography, pleural ultrasound had a sensitivity and specificity of 93%. The presence of septations seen in part B on pleural ultrasound is highly suggestive of empyema (Fig. 31-22).
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Figure 31-22. Complex pleural effusion with appropriate landmarks. Septations of a complex pleural effusion.
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A 23-year-old woman presents with worsening of right-sided pleuritic chest pain, intermittent episodes of nighttime chills, and a cough productive of yellow sputum. She received a 5-day oral course of azithromycin without relief. Her initial vital signs are temperature of 97.8°F, heart rate of 141 beats/min, respiratory rate of 34 breaths/min, and oxygen ...