TITLE:
Ultrasound Value in the Management of Parapneumonic Pleural Effusions in a Limited-Resource Setting: A Case Report
AUTHORS:
Joseph-Francis Nwatsock, Ambroise-Merci Seme Engoumou, Maggy Mbede, Christopher Vagoda Sinbaï, Christopher Vagoda Sinbaï, Amos Ela Bela, Emilienne Guegang Goujou
KEYWORDS:
Chest Ultrasound, Ultrasound-Guided Pleural Puncture, Parapneumonic Effusion
JOURNAL NAME:
Open Journal of Radiology,
Vol.13 No.3,
August
1,
2023
ABSTRACT: Pleural effusion is a common complication of acute lung infection, with rising morbidity and mortality. If poorly treated, parapneumonic effusion evolves to the fibrino-purulent stage wherein antibiotic therapy alone becomes inadequate. Chest CT is the gold standard diagnostic imaging tool, however, in a resource-limited context, it may not be performed. Chest ultrasound can therefore be an alternative for drainage and intermittent follow-up of complicated parapneumonic pleural effusions. We report the case of a 4-year-old child who presented with cough, breathing difficulties and fever for over two weeks and in whom an initial chest X-ray revealed a left hemithorax white-out with an air-fluid level. Chest ultrasound revealed a left pleuropulmonary massive fluid collection with an encysted empyema. It also allowed ultrasound-guided pleural effusion drainage of a fibrino-purulent liquid which tested positive for Kocuria kristinae, a bacterium sensitive to gentamycin, vancomycin, norfloxacin and clindamycin. The next follow-up ultrasound checks showed improvement and the control chest X-ray performed one month later demonstrated pulmonary functional recovery. This case highlights the importance of ultrasound in the management and follow-up of this chest pathology in resource-limited settings.