92 Year Old Male With Difficulty Breathing

Authored by: Ahad Anjum, Brittany Choe Edited by: SIUH Ultrasound Division

92 y M hx of afib, CLL, Lymphoma pw difficulty breathing and cough. The following was found on bedside sono of the right lung. 

QUESTIONS:

1. What is seen on the above ultrasound image?

2. What disease processes could lead to this ultrasound finding? 

3.  What are the names of the ultrasound signs seen above? 

4. What is Light's Criteria? What would you expect the results to show if you were to aspirate a sample from this finding? 

ANSWERS

1. Pleural effusion with debris (red star), most likely indicative of an exudative effusion 

2.  Malignancy, pneumonia/parapneumonic effusion, lymphoma

3. Tongue Sign (white arrow) showing the lung parenchyma floating in hypo echoic fluid indicating a pleural effusion, Spine sign (black arrow) indicates a fluid filled medium above the diaphragm in which the spine is visualized on ultrasound, which is normally not seen through a regularly aerated lung 

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4. Pleural fluid protein/serum protein >0.5, Pleural fluid LDH/Serum LDH >0.6, Pleural fluid LDH > 2/3 upper limit of LDH