Question

Patient with liver disease presents with dyspnea, fever, and the following ultrasound? What's the diagnosis? (Hint: there are two)?

 

Answer

Answer: Complex pleural effusion and ascites

The take away point from this case is to always place the diaphragm in the center of the screen in order to distinguish peritoneal from thoracic fluid. Fluid in both compartments will sometimes be present (as in this case).

Complex pleural effusions

• Ultrasound can help differentiate simple versus complex effusions
• Simple effusions tend to be consistent with:
  • Acute volume overload from resuscitation
  • Heart failure
  • Conditions with low oncotic pressure (e.g., nephrotic syndrome)
  • Hepatic hydrothorax
• Complex effusions tend to be consistent with:
  • Hemothorax
  • Empyema
  • Malignancy 

References

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