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5. Ultrasound-guided thoracentesis
Initiating a new course of antibiotic therapy is premature, given that broad-spectrum antibacterial medications have already been administered and nothing in the patient’s presentation or imaging thus far strongly indicates the presence of a fungal infection. The process identified at chest radiography and ultrasound is primarily pleural in location, suggesting that bronchoscopy with bronchoalveolar lavage will be of little use. Some parenchymal lung disease may be present, but as yet requires more investigation before further invasive approaches are entertained. Transthoracic echocardiography would be of no value for the assessment of the right pleural space process. While decubitus radiography can be valuable for determining whether or not mobile pleural fluid is present, and deciding whether or not to attempt percutaneous sampling of any such fluid, this information has already been obtained with the transthoracic ultrasound procedure.
Right-sided transthoracic ultrasound was performed. Approximately 250 cc of cloudy, yellow, slightly malodorous fluid was obtained from the right pleural space, but despite various maneuvers, no more fluid could be withdrawn owing to the complex, viscous nature of the fluid.
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