Submitted by Dr Tang Kam Shing on 18 March 2009
ICU, Tuen Mun Hospital
A F/40 was admitted for heart failure due to chronic rheumatic heart disease (CRHD) and intubated. CXR showed large right sided pleural effusion. Therapeutic chest tapping was done and most effusion was drained. Repeat CXR showed rapid re-accumulation again after 2 days. USG chest was done. What is the diagnosis?
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Answer: The above image showed a large pleural effusion. However, if you look carefully, the upper part of the effusion is echo free while the lower part is echogenic. In this case, we do a diagostic tap and showed hemothorax. The echogenic layer is likely sedimented blood cells.