POCUS thoracic showing a pleural effusion with what looks like ‘worms’, raising suspicion for empyema.
A middle aged male with a history significant for HIV presents with dyspnea and cough for a week. He’s hypotensive, febrile, tachypneic, and tachycardic.
After initiating resuscitation and while waiting for the chest X-ray and blood work to result, Jorge nicely takes a look at the patients lungs. POCUS thoracic showed bilateral pleural effusions with fibrin clots that looked like “worms,” and a large number of well-defined longitudinal septa, suggesting the presence of empyema. In addition to antibiotics, the patient underwent thoracentesis to drain the pus. The patient did well, nice job Jorge!
Sono Pearl: The ‘spine sign’ is when the thoracic spine can be seen cranial to the diaphragm, indicating the presence of fluid, blood, consolidation etc.