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5. Ultrasound guided thoracentesis

The patient has end-stage kidney disease and so attempting diuresis with furosemide or other diuretics will likely fail. Observation in a patient with shortness of breath seems inappropriate. Both emergent hemodialysis and a thoracic CT scan could be done but seem unnecessary at this juncture.

Ultrasound guided thoracentesis was performed with 2 liters of clear, light yellow fluid removed. A chest x-ray taken after the thoracentesis shows almost total clearing of the pleural fluid (Figure 4).

Figure 4. Chest x-ray taken after thoracentesis showing near total clearing of the lower right lung density (red circle).

However, beginning about 3 hours after the thoracentesis the patient developed increasing dyspnea. A repeat chest x-ray was performed (Figure 5).

Figure 5. Chest x-ray taken about 4 hours after the thoracentesis.

What is the most likely cause of the patient's dyspnea? (Click on the correct answer to move to the next panel)

  1. Reaccumulation of pleural fluid
  2. Re-expansion pulmonary edema
  3. Right lower lobe pneumonia
  4. Right middle lobe pneumonia
  5. Right pneumothorax

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