Cardiovascular System | Higher Education | Investigative Techniques | Medicine and Health Sciences | Respiratory System
Ultrasound-guidance has become the standard of care for bedside thoracentesis. This manuscript describes the importance of utilizing point-of-care-ultrasound (POCUS) and color Doppler in avoiding an unusual, but potentially catastrophic aortic puncture during thoracentesis. The case describes a 70 year-old man who presented with one week of shortness of breath. He was found to have a large left-sided pleural effusion on imaging studies. During a bedside POCUS examination, he was found to have a hyperechoic linear structure in his posterior left hemithorax. Ultrasound application of color Doppler revealed a pulsatile flow, confirming visualization of the aorta. The site of needle insertion for thoracentesis was placed more laterally to avoid aortic puncture. The thoracentesis was performed successfully with removal of about 1000ml of sanguinous fluid. This clinical case demonstrates the importance of considering anatomic variants when performing a thoracentesis. As in this patient’s case, ultrasonography and color Doppler during thoracentesis can be useful in avoiding a potentially life-threatening puncture of the aorta.
Doppler; Ectasia; Hyperechoic; Jellyfish Sign; Plankton Sign; Pleural Effusion; Thoracentesis; Thoracic Aorta
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Choi, M., Roettger, J., , Smith, C. J. Preparing for the Unexpected: Recognizing a Tortuous Thoracic Aorta During Ultrasound-guided Thoracentesis. Graduate Medical Education Research Journal. 2023 Jun 30; 5(1).