A 70 year old man presents with gradually increasing shortness of breath. He has had some weight loss. His CXR shows a very large left side probable pleural effusion. You wonder whether it is consolidation, solid tumour, a simple pleural effusion or a complex pleural effusion.
You put your ultrasound probe on the chest, what is the cause?
Describe and interpret these scans
Image 1 & 2: Left posterior axillary line lower chest wall.
There are multiple solid pleural based lesions, either metastases or primary tumour of the mesothelium. These are on the diaphragm, the parietal and visceral pleural surfaces. There is a moderate amount of relatively anechoic fluid in the pleural space but it is certainly not a simple effusion. No normal lung tissue is seen in these views.
Pleural based metastatic deposits with associated effusion.
Unilateral near white out on a chest x-ray has numerous differentials and ultrasound is an excellent means of differentiating.
First determine the level of the diaphragm. Sometimes an elevated hemidiaphragm is playing a large part in the appearance.
Assess what lies above the diaphragm. Solid tumour, large pleural effusion or consolidation may all have similar appearances on plain x-ray. Ultrasound will differentiate these, which often occur in combination as in this case.