The first thing to diagnose is the presence of bilateral pleural effusions. The right appears loculated and larger than the left and you can actually see trapped aerated lung far field. All effusions should also be closely examined for complexity. Simple, free flowing, anechoic effusions are usually consistent with a transudative etiology. In contrast, echogenic material, with or without septations, represents a complex effusion and is suggestive of an exudative etiology.
This case illustrates very complex, heavily septated bilateral pleural effusions. Given the clinical context of persistent MRSA bacteremia, this is highly suggestive of bilateral empyema which should be managed with tube thoracostomy drainage. In this case as well, the sonographic evidence of extensive septations predicts the need for intrapleural fibrinolytic therapy (tPA/DNase), longer duration of drainage, and potentially, even the need for VATS decortication.
POCUS in this case was able to identify extensive, complex bilateral pleural effusions which were likely driving ongoing bacteremia and sepsis which expedited appropriate management. See the attached articles below for further learning on this!
Soni – Ultrasound diagnosis Management of pleureal effusions