Recent pneumonia, ongoing fevers, lethargy and weight loss as well as some pleuritic chest pain and shortness of breath.
This thoracic ultrasound shows a large pleural effusion.
Of note is that the fluid contains fine echogenic debris. This means it is likely to be an exudate.
In this case aspiration confirmed out clinical and sonographic suspicion of empyema.
Pleural transudates are generally anechoic on ultrasound. This is similar to the way the content of a simple cyst is anechoic whilst an abscess or haematoma is heterogenous and echogenic.
Exudates tend to demonstrate fine echogenic debris. Empyema often has coarse floating debris, may have loculations, and may even have free gas.