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Lung point-of-care ultrasound in the assessment of pleural effusions
  1. Kevin Andrew Padrez,
  2. Sally Graglia
  1. Emergency Medicine, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Kevin Andrew Padrez, Emergency Medicine, University of California San Francisco, San Francisco, CA 94143, USA; kpadrez{at}

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Case presentation

A 19-year-old man presented to the ED for 1 week of fevers, headache, weight loss, and a non-productive cough. The patient immigrated to the USA from Nepal 3 months previously. Approximately 7 to 10 days prior to presentation, he developed fever, night sweats, frontotemporal headaches and a non-productive cough. He also endorsed right-sided chest pain with inspiration, poor appetite, and unintentional 3 kg weight loss in the past week. He denied haemoptysis, sensory or motor changes, abdominal pain, sick contacts or other significant previous medical history.

On physical examination, he was well appearing with a normal blood pressure (111/67 mm Hg) and a heart rate of 104 bpm. He was afebrile (36.7 C) with a normal respiration rate. His examination was unremarkable aside from diminished breath sounds on the right. He was alert and oriented with no gross neurological deficits. The initial laboratory data were within normal limits aside from mild hyponatraemia (132 mmol/L, reference 136–145) and mild elevation in alanine transaminase (ALT) (93 U/L, reference 10–40) and total bilirubin (1.7 mg/dL, reference 0.1–1.2). A posteroanterior and lateral chest radiograph was performed showing a right lung base opacity and moderate-sized, dense, pleural effusion. A dedicated CT chest was recommended for further evaluation.

What are the indications for lung point-of-care ultrasound (POCUS)?

Three core indications for using POCUS in evaluating the lungs include the identification of pneumothorax (reduced lung sliding and lung point), identification of interstitial syndrome (suggested by bilateral B-lines) and detection of pleural effusion.1–3 Though lung POCUS is a growing field, it has proven beneficial for the evaluation of the patient with undifferentiated dyspnoeia, including for identifying signs of congestive heart failure (CHF), chronic obstructive pulmonary disease, lung consolidation and loculated pleural effusions or empyemas.4–7 The use of POCUS for the evaluation of pulmonary oedema and CHF has been discussed in a prior SONO Case Series.8 When there is …

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  • Handling editor Simon Carley

  • Contributors Both authors contributed to the design, drafting and final revision of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.