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EMGuideWire's Radiology Reading Room: Pleural Effusions

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Pleural Effusion Case Studies
Gabriela Rivera Camacho, MD & Emily Griffith, NP-C
Department of Emergency Medicine
Carolina...

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Disclosures
 This ongoing chest X-ray interpretation series is proudly sponsored by the
Emergency Medicine Residency Prog...

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Process
• Many are providing clinical cases and presentations are then shared with
all contributors on our departmental ed...

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EMGuideWire's Radiology Reading Room: Pleural Effusions

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The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Pleural Effusions and is brought to you by Gabriela Rivera Camacho, MD and Emily Griffith, NP-C.

The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Pleural Effusions and is brought to you by Gabriela Rivera Camacho, MD and Emily Griffith, NP-C.

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EMGuideWire's Radiology Reading Room: Pleural Effusions

  1. 1. Pleural Effusion Case Studies Gabriela Rivera Camacho, MD & Emily Griffith, NP-C Department of Emergency Medicine Carolinas Medical Center & Levine Children’s Hospital Charlotte, North Carolina Michael Gibbs, MD, Faculty Editor The Chest X-Ray Mastery Project™
  2. 2. Disclosures  This ongoing chest X-ray interpretation series is proudly sponsored by the Emergency Medicine Residency Program at Carolinas Medical Center.  The goal is to promote widespread mastery of CXR interpretation.  There is no personal health information [PHI] within, and all ages have been changed to protect patient confidentiality.
  3. 3. Process • Many are providing clinical cases and presentations are then shared with all contributors on our departmental educational website. • Contributors from many Carolinas Medical Center departments, and now… Brazil, Chile, and Tanzania. • We will review a series of CXR case studies and discuss an approach to the diagnoses at hand: PLEURAL EFFUSION.
  4. 4. Visit our website www.EMGuidewire.com for a complete archive of chest x-ray presentations and much more!
  5. 5. Airway Bones Cardiac Diaphragm Effusion Foreign body Gastric Hilum
  6. 6. It’s All About The Anatomy!
  7. 7. 63-year-old with metastatic breast cancer
  8. 8. Malignant Left Pleural Effusion 63-year-old with metastatic breast cancer
  9. 9. 60-Year-Old With Metastatic Ovarian Cancer
  10. 10. 60-Year-Old With Metastatic Ovarian Cancer Metastases To RUL + Bilateral Malignant Left Pleural Effusions
  11. 11. 28-year-old with progressive dyspnea
  12. 12. 28-year-old with progressive dyspnea LLL Pleural Effusion – The lateral view helps define the size of the effusion
  13. 13. 13-month-old being treated for pneumonia in the setting of recent influenza. He developed worsening dyspnea.
  14. 14. Parapneumonic effusion with left to right mediastinal shift 13-month-old being treated for pneumonia in the setting of recent influenza. He developed worsening dyspnea.
  15. 15. Chest tube placed with 500 ml of purulent output 13-month-old being treated for pneumonia in the setting of recent influenza. He developed worsening dyspnea. Parapneumonic effusion with left to right mediastinal shift resolving
  16. 16. Bilateral Pleural Effusions Loss of the normal costophrenic angles Flattened Effusion well seen on lateral
  17. 17. 60-year-old with advanced cirrhosis and encephalopathy
  18. 18. 60-year-old with advanced cirrhosis and encephalopathy Right Pleural Effusion
  19. 19. 72-year-old with metastatic breast cancer
  20. 20. 72-year-old with metastatic breast cancer Malignant Right Pleural Effusion
  21. 21. 43-year-old with metastatic breast cancer
  22. 22. 43-year-old with metastatic breast cancer Bilateral Malignant Pleural Effusions
  23. 23. 65-Year-Old With Dyspnea
  24. 24. Hazy Left Hemithorax – Pleural Effusion Mediastinal Shift 65-Year-Old With Dyspnea
  25. 25. ED Bedside Ultrasound confirms the effusion 65-Year-Old With Dyspnea
  26. 26. ED Bedside Ultrasound confirms the effusion Left Pleural Effusion 65-year-old with dyspnea The relationship of the effusion with the aorta distinguished the pleural space from the pericardial space Pericardial Effusion
  27. 27. Right Pleural Effusion
  28. 28. after pleural drainage
  29. 29. 68-year-old with a history of breast cancer presents with dyspnea Today One year prior
  30. 30. 68-year-old with a history of breast cancer presents with dyspnea Malignant Pleural Effusion
  31. 31. Light’s Criteria Transudate Versus Exudate1,2 Pleural Fluid Protein/Plasma Protein >0.5 Pleural Fluid LDH/Plasma LDH >0.6 Pleural Fluid LDH >200 IU 1In patients with heart failure on diuretics, Light’s Criteria may misclassify a transudate as an exudate up to 25% of the time. 2In heart failure patients, a serum protein 3.1 g/dl higher than the pleural fluid, or a serum albumin 1.2 g/dl higher than the pleural fluid will help correctly identify a transudate.
  32. 32. Parapneumonic Effusions • The most common exudative effusions are those associated with underlying pneumonia. • Mortality is higher among pneumonia patients who have a parapneumonic effusion, compared with those with pneumonia and no effusion. • With the aging of the population, the incidence and mortality due to parapneumonic effusion and empyema continues to rise.
  33. 33. Right Parapneumonic Effusion
  34. 34. Malignant Effusions • The second most common exudative effusions are those associated with underlying malignancy. • Most malignant pleural effusions arise from lung cancer, breast cancer, and lymphoma. • The presence of a malignant pleural effusion is associated with higher mortality and significantly shorter survival.
  35. 35. Lung mass with malignant effusion
  36. 36. Lung mass after effusion drainage
  37. 37. If you have interesting cases of Pleural Effusion, we invite you to send a set of digital PDF images and a brief descriptive clinical history to: michael.gibbs@atriumhealth.org Your de-identified case(s) will be posted on our education website and you and your institution will be recognized!

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