Get Answer: Preoperative Diagnosis Pleural Question Guide

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Original Question

Preoperative diagnosis: Pleural fluid, unknown cause. Postoperative diagnosis: Loculated pleural effusion with removal of 40 cc of bloody pleural fluid. Procedure performed: Diagnostic thoracentesis. On ultrasound, the areas were loculated by that method as well as by attempting to draw out fluid. I had to do four different sticks to get 40 cc of fluid and that was about the extent of each pocket. There were four different pockets I entered just in the one general area that was marked by ultrasound. This, of course, was done after marking it with ultrasound, rubbing the area with swabs to sterilize the area, and then using 20 cc of 1% lidocaine for local anesthesia. With a one-pass maneuver, we were able to get into some fluid. At first actually, we did not get any fluid. We moved over about 1 inch, and then we were able to get 10 cc of fluid before the pocket petered out. The next one we got 5 cc, and I had to go to a different pocket to get that. Then in the fourth pocket we were able to get two syringefuls with 10 cc to get at least 40 cc of fluid. As this was such a tenuous area, I did not put a chest tube in to drain it because I did not think we would get anything that would amount to anything with the small chest tube I had at my command. I think we might need thoracoscopy to break up adhesions and drain it right. Of course, the differential of bloody pleural fluid includes tuberculosis, trauma, cancer, and pulmonary embolus. A V/Q scan would probably be pointless in this particular effort. I think I would wait to see what the cultures are before I went down the pulmonary embolus tree. I will have to get ahold of Dr. Marrot about CT surgery. Pathology report later indicated: CPT: ICD-10-CM

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