Role of ward-based pleural ultrasound. Dr R Teoh Department of Respiratory Medicine Castle Hill Hospital. Reason for study: To assess position of right chest drain inserted into the eighth intercostal space, but is projecting over the right upper quadrant on the abdominal x-ray. Report:
Dr R Teoh
Department of Respiratory Medicine
Castle Hill Hospital
To assess position of right chest drain inserted into the eighth intercostal space, but is projecting over the right upper quadrant on the abdominal x-ray.
In the abdomen the chest drain has been inserted through the lower right hemidiaphragm into the right lobe of the liver.
This crosses through the right lobe of the liver to the left lobe avoiding both main branches of the portal vein.
It exits the left lobe through its inferior surface and runs anterior to the distal stomach and terminates just anterior to the hepatic flexure of the colon.
The drain is not passing through the pleural cavity.
Puncture site identified:
No puncture site identified:
US - Site found:
US - No site found:
8: Insufficient fluid
12: Liver or spleen
USS identified accurate site in 20/25 (80%)
Diacon et al. Chest 2003; 123: 436-441
Weingardt JP etl al. J Clin Ultrasound, 1994; 22: 419-426.
Jones et al, Chest 1990; 123: 418-423
Grogan et al, Arch Intern Med 1990; 150: 873-877
Kohan JM et al. Am Rev Respir Dis 1985; 133: 1124-26.
Normal lung & rib shadow
Diaphragm, liver & pleural effusion
Consolidation with air bronchograms
Small pleural effusion
Yu CJ et al. Am Rev Respir Dis, 1993: 147: 430-434
Pleural effusion present: 88
Clinical detectable: 63/88
Clinically undetectable: 25/88
No pleural effusion present: 14
Thoracentesis: 8/88 (9%)
US guided chest drain: 7/88 (8%)
US guided chest drain 41/88 (47%)
Adapted from Tsai et al, Curr Opin Pulm Med 2003; 9: 282-290
James Cook Hospital
19 June 2009
Royal Preston Hospital
St. James’s University Hospital, Leeds
St. George’s Hospital