A 55-year-old man on ICU with ARDS has been ventilated for 7 days. He develops a fever and a new right-sided chest opacity on CXR that could be either...

Question

A 55-year-old man on ICU with ARDS has been ventilated for 7 days. He develops a fever and a new right-sided chest opacity on CXR that could be either pneumonia or an empyema/parapneumonic effusion. Bedside ultrasound shows a complex echogenic fluid collection with septations. What feature on ultrasound distinguishes an empyema from a simple parapneumonic effusion?

Accepted Answer

An empyema typically appears as a complex collection with internal septations, echogenic debris, and sometimes a "split pleura sign" (thickened, enhancing visceral and parietal pleura separated by fluid); a simple parapneumonic effusion appears as an anechoic homogeneous collection

Answer

Ultrasound cannot distinguish between them

Answer

Simple effusions always have septations

Answer

Empyemas are always anechoic

Answer

Colour Doppler signal within the fluid indicates empyema

uk-fficm MCQ (SBA): Empyema - Ultrasound Features