Endoscopic Ultrasound-Guided Therapeutic Thoracentesis

Diagnostic or therapeutic thoracentesis in patients with mechanical ventilation is typically performed with ultrasound guidance using a posterolateral approach. Recently, the use of endoscopic ultrasound (EUS) for detection and aspiration of pleural effusions and the feasibility of bedside EUS in critically ill patients has been described. We present a case of EUSguided therapeutic thoracentesis performed at the bedside in a critically ill patient on mechanical ventilation. A 69-year-old female was admitted to our hospital with acute liver failure suspected to be secondary to drug toxicity. She was transferred to the intensive care unit because of worsening liver failure, hepatic encephalopathy, atrial fibrillation, fluid overload, and respiratory distress requiring intubation. Chest radiography (Fig. 1) and abdominal computed tomography revealed a large right pleural effusion, pancreatic mass and possible cirrhosis. She was not deemed a candidate for an urgent liver transplant because of the indeterminate pancreatic mass. Furthermore, systemic chemotherapy and radiation were not considered be-