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Respiratory medicine
Could a handheld point-of-care ultrasound system alter the management of patients with pleural infection?
  1. Wan Aireene Wan Ahmed1,2,
  2. Mohd Jazman Che Rahim2,3 and
  3. Mohamed Faisal Abdul Hamid4
  1. 1Department of Radiology, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
  2. 2Hospital Pakar Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
  3. 3Internal Medicine Department, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
  4. 4Faculty of Medicine Universiti Kebangsaan Malaysia, Cheras, Federal Territory of Kuala Lumpur, Malaysia
  1. Correspondence to Dr Mohd Jazman Che Rahim; drjazman{at}usm.my

Abstract

Lung ultrasonography is an essential tool in the management of pleural infection. We report the usage of lung point-of-care ultrasound (POCUS) using a handheld ultrasound system (HHUS), which changed the immediate management of a complex pleural effusion.

A middle-aged diabetic patient presented with fever, dyspnoea and left-sided pleuritic chest pain, suggestive of left pleural infection. Lung POCUS using a HHUS showed a multiloculated pleural effusion with no connections between the locules, and this was confirmed later with CT, along with left empyema necessitans. An upfront video-assisted thoracoscopy was done instead of catheter drainage and intrapleural enzyme therapy. Methicillin-sensitive Staphylococcus aureus was grown from the drained pus. The patient was subsequently discharged with prolonged antibiotic treatment.

Lung POCUS by a trained physician is useful in deciding the immediate management of pleural infection. Modern HHUS provides a practical and reliable method for identifying and characterising pleural effusion.

  • Radiology (diagnostics)
  • Empyema
  • Pneumonia (infectious disease)
  • Pneumonia (respiratory medicine)
  • Ultrasonography

https://doi.org/10.1136/bcr-2024-263279

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    Footnotes

    • X @thoracic

    • Contributors WAWA and MJCR managed the case and prepared the first manuscript. MFAH checked and verified the final manuscript. MJCR is the guarantor.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally 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.