Correct!
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)