Pleural Effusion – ChestDB.com

Case 51

ICU/Surgery, Lines/Tubes/Devices / Age 31-60, Chest Tube, Emphysema, Lung Volume Reduction Surgery, LVR, Pleural Effusion, Pleural Tent, Staple Line, Surgical Lung Volume Reduction

This radiograph demonstrates the expected postoperative appearance of a pleural tent following lung volume reduction surgery in the right upper lobe (note the visible staple line), though this can be done after upper lobectomies for any cause. The anatomy of upper lobectomies in particular is unfavorable for post-operative pleura-pleura apposition, increasing the risk for air leaks from the staple line. In this procedure, the visceral pleura is peeled from the chest wall and draped over the staple line. This promotes apposition and decreases the chance of an air leak. A chest tube is placed under the tent intraoperatively, as seen here, and will eventually be removed. The cavity will eventually fill with fluid, just like a pneumonectomy cavity.

There is marked emphysema in the left lung. Incidentally, this patient also has a small left effusion which is chronic and unrelated to the procedure.

Case 51 Read More »

Case 36

ICU/Surgery, Infectious/Inflammatory, Lines/Tubes/Devices / Age <30, Central Venous Catheter, CVC, Empyema, Endotracheal Tube, Enteric Tube, Nodule (Cavitary), Pleural Effusion, Portable, Septic Embolism

This radiograph demonstrates typical findings of septic emboli. There are multiple bilateral nodules, many with cavitation. Metastatic disease would be within the differential for this finding, though in practice the clinical history is typically quite useful to distinguish between these two entities; In this case, the patient is young with a history of drug abuse (suggesting endocarditis as a source) and presents with sepsis. In addition, this patient has medium bilateral pleural effusions. In the setting of septic emboli this is concerning for empyema. CT is usually confirmatory.

Support devices include a central venous catheter in the right internal jugular vein, an endotracheal tube in the mid trachea, and an enteric tube entering the stomach and terminating inferiorly beyond the border of the study.

Case 36 Read More »

Case 34

Emergency & Trauma / Age <30, Atelectasis (Compressive/Passive), Central Venous Catheter, CVC, Kerley B Lines, Pleural Effusion, Portable, Pulmonary Edema

This radiograph demonstrates typical findings of pulmonary edema. The vessels are hazy with indistinct margins. Kerley B lines are seen peripherally. There are bilateral layering pleural effusions creating a gradient of opacification extending from the bases. Bibasilar opacities are silhouetting the diaphragm and the right heart border, representing a combination of pleural effusions and associated atelectasis.

A dual-lumen central venous catheter is also in place.

Case 34 Read More »

Case 17

Infectious/Inflammatory / Age 31-60, Consolidation, Parapneumonic Effusion, Pleural Effusion, Pneumonia

This radiograph demonstrates patchy mixed ground-glass and consolidative airspace opacities in the left lung with an associated moderate pleural effusion. In this patient with a cough and a white count, this appearance is consistent with pneumonia with parapneumonic effusion.

Case 17 Read More »