Threatened Aorta During Right Thoracentesis: Chest Ultrasound Please

Malignant pleural effusions are among the most common causes of pleural diseases, affecting thousands of people each year worldwide [1]. Thoracic ultrasound (TUS) has become the standard of care for the evaluation of pleural effusion and is considered to be an essential tool for pulmonologists [2]. We present here a case of a threatened aorta visualized during a right thoracentesis.A 72-year-old nonsmoking woman with a history of a right shoulder-blade bone tumor treated with surgery and cobalt radiation therapy in childhood developed severe thoracic vertebral deformity. She was suffering from a post-radiotherapy induced right lung adenocarcinoma. Clinical presentation showed a woman with shortness of breath and cough. A chest computed-tomography scan reported an anatomical variation of the descending thoracic aorta, with a large portion in the right hemithorax (Fig. 1a, b, white arrow), and a moderate pleural effusion (white asterixis). TUS showed an unrolled right-side aorta at only 4 cm from the skin, within the effusion (Fig. 1c, d, white arrow). A thoracentesis was performed (2-mm needle -, Novatech – La Ciotat – France) under ultrasound guidance and removed 500 mL of bloody fluid. This atypical case of thoracic aorta in a right malignant pleural effusion emphasizes the major role of TUS to guide any diagnostic and therapeutic pleural maneuvers.This case report received the agreement of the Ethics Committee of the APHM Marseille France (RGDP Registration number and compliance: PADS22-3). Written informed consent was obtained from the patient for publication of this case report and any accompanying images.The authors have no conflicts of interest to declare.No funding is associated with the manuscript.J.G. and P.A. are the guarantors for this manuscript. J.G., S.L., H.D., and P.A. made substantial contributions to the design of the case, the acquisition and analysis of the data, draft of the manuscript and approved the final version of this manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.