Diagnostic Ultrasound in the Management of Persistent Pleural Opacities

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Abstract
Determining whether an opacity on a chest roentgenogram represents pleural fluid is a common diagnostic problem. Standard roentgenograms do not always provide a definitive answer, and thoracentesis may be difficult due to loculation. We present a case of persistent, loculated pleural effusion in which ultrasound helped to solve these problems. Report of a Case.—A 6½-year-old girl was admitted to the Yale-New Haven Hospital with a respiratory rate of 60 with marked retractions, a temperature of 38.3 C, moderate hepatosplenomegaly, and absence of breath sounds over the whole left side of the chest. Chest roentgenograms (Fig 1) demonstrated a large left-sided pleural effusion. Thoracentesis yielded 90 ml of seropurulent fluid containing 23,000 WBCs and Gram-positive diplococci. The WBC count was 5,200/cu mm with 4% segmented forms and 84% band forms. After thoracentesis, there was substantial relief of respiratory distress. Arterial blood analysis revealed a Pco2 of 27 mm, a

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