Clinical Case: Empyema

A 47 year old gentleman presents to the emergency department with fevers, shortness of breath and productive cough. He is tachycardic and is requiring supplemental oxygen. You hear crackles and decreased breath sounds at the base of the right lung.

You perform a bedside lung ultrasound which reveals the following image:

This is an example of a loculated pleural fluid which can be detected on ultrasound. These loculations occur in complicated parapneumonic effusions and empyema. Utrasonography plays a key role in both the diagnoses and management of these effusions. Identifying loculations on ultrasound changes management, since a thoracentesis is required in this circumstance. Also, ultrasound-guided thoracentesis allows you to identify a pocket of fluid that is attainable for sampling.