CHEST Guidelines-An-87-Year-Old-Woman-With-Pleural-Effusion-and-Tor

An-87-Year-Old-Woman-With-Pleural-Effusion-and-Tor

Pdf Summary

An 87-year-old woman with pre-existing health conditions was admitted to the hospital due to worsening shortness of breath and a cough. Initial examinations revealed a pleural effusion in the lower left lung area. Further tests, including a CT scan, confirmed the presence of pleural effusion but also revealed an aberrant right subclavian artery and an unusually positioned, tortuous aorta. Given the atypical anatomy, a pulmonary consultation was sought for treatment.<br /><br />To assess the pleural effusion more accurately, thoracic ultrasound with two-dimensional (2-D) imaging was originally used. However, this imaging mistakenly appeared to show pleural effusion near the chest wall, which was later clarified as the aorta due to its pulsatile flow. Thus, color flow Doppler imaging was employed, revealing that the observed fluid was actually blood within a vessel and not standard pleural fluid. This modality allowed clinicians to avoid inappropriate thoracentesis in the identified area, thereby preventing potential complications.<br /><br />The case highlighted the usefulness of color flow Doppler ultrasound, which shows the movement of fluid and can distinguish between stationary pleural fluid and flowing vascular fluid. It suggests that when dealing with potential pleural effusion and unusual anatomical presentations, reliance solely on 2-D imaging may be insufficient. Incorporating Doppler imaging as a routine component of pleural evaluation can enhance procedure safety, reducing risks associated with misinterpreting vascular fluid as pleural effusion, especially in patients with unusual anatomy. The case underscores the evolving practice standards in thoracic ultrasonography, advocating for color flow imaging to complement traditional 2-D methods. This approach can help avoid diagnostic and procedural errors in similar clinical scenarios.

Keywords

pleural effusion

color flow Doppler

thoracic ultrasound

pulmonary consultation

aberrant right subclavian artery

tortuous aorta

imaging techniques

diagnostic accuracy

procedure safety

unusual anatomy