February 2013 Critical Care Case of the Month: Thoracentesis Through the Looking Glass
Clement U. Singarajah MD
Jay E. Blum
Allen R. Thomas MD
Henry Luedy MD
Elijah Poulos MD
Tonya Whiting DO
Phoenix VA Medical Center
Phoenix, AZ
Critical Care Case of the Month CME Information
Members of the Arizona, New Mexico and Colorado Thoracic Societies are able to receive 0.25 AMA PRA Category 1 Credits™. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity.
0.25 AMA PRA Category 1 Credit(s)™
Estimated time to complete this activity: 0.25 hours
Lead Author(s): Clement Singarajah, MD. The author(s)/contributor(s) state that they do not have any financial arrangements that could constitute a conflict of interest. Detailed Information
Learning Objectives:
As a result of this activity I will be better able to:
- Correctly interpret and identify clinical practices supported by the highest quality available evidence.
- Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
- Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
- Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.
Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.
CME Sponsor: University of Arizona College of Medicine at the Arizona Health Sciences Center Credit Designation and Accreditation Statements
Current Approval Period: January 7, 2013 - January 6, 2015
Original Release Date: January 26, 2013
Most Recent Review by Author: January 26, 2013
Most Recent Review by CME Sponsor: January 29, 2013
Financial Support Received: None
History of Present Illness
A 62 year old man was recently diagnosed with Stage 4 squamous cell left lung cancer with metastases to the pleura, brain and mediastinum. He also had known chronic obstructive pulmonary disease (COPD) with a FEV1 = 1.96 L and a known left side pleural effusion (see Figure 1).
Figure 1. Baseline chest radiograph showing left pleural effusion (red arrow).
He was seen as an outpatient for symptomatic shortness of breath and underwent real time ultrasound guided left sided thoracentesis removing 500 ml of straw-colored fluid. The procedure was uneventful except that near the end, the patient started to cough. He denied any symptoms post procedure apart from some minor puncture site pain. A routine post procedure chest x-ray was performed (Figure 2).
Figure 2. Post-thoracentesis x-ray (Panel A) and its negative image (Panel B).
What new abnormality is identified on the post-procedure chest x-ray?
- Left pneumothorax
- Right pneumothorax
- Lung “sliding” on the left
- New pneumonia in the left upper lobe
- Left hilar retraction
Reference as: Singarajah CU, Blum JE, Thomas AR, Luedy H, Poulos E, Whiting T. February 2013 critical care case of the month: thoracentesis through the looking glass. Southwest J Pulm Crit Care. 2013;6(2):63-74. PDF
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