A young patient with a history of sarcoma presents with shortness of breath.
What does this clip show?
- There is a very large left sided pleural effusion.
- It is causing complete collapse of the lung, and flattening of the diaphragm.
- There are irregular solid deposits on the visceral and parietal pleural surfaces.
- The fluid contains fine echogenic debris.
- The differential diagnosis of echogenic debris within a pleural effusion includes:
- Pus – Empyema
- Blood – Haemothorax
- Chyle (lymphatic material) – Chylothorax
- Proteinaceous debris – Exudate of other cause (e.g. malignancy)
- Differentiating solid appearing malignant pleural deposits from blood clot or dependent debris can be difficult. History and clinical examination are invaluable in the differentiation.
- Malignant deposits will be fixed to the pleural surfaces and one may be able to demonstrate arterial flow within them using colour Doppler.
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