case_images: PMC9902635_01
case_images: (A) High-resolution computed tomography image of the chest, which was initially read as normal, but upon reexamination, was found to show focal pleural effusion (white arrow), (B) Magnified view of the left anterior chest showing focal pleural effusion (white arrow).
case_images: apm-22182f1.jpg
case_images: PMC9902635_01_apm-22182f1.jpg
case_images: f1-apm-22182
case_images: The patient underwent various examinations, such as cardiac enzyme level determination, EKG, echocardiography, coronary angiography, simple radiologic studies of the chest and bony thorax, lung high-resolution computed tomography (HRCT), esophagogastroduodenoscopy, and bone scan; however, there were no significant findings (Fig. 1).
case_images: An ultrasonographic image of the focal pleural effusion asterisk (*). A long axis view of the anterior intercostal space at T5-6 with 4-18 MHz linear transducer (EPIQ 5, Philips, USA).
case_images: apm-22182f2.jpg
case_images: PMC9902635_01_apm-22182f2.jpg
case_images: f2-apm-22182
case_images: On US examination, a linear transducer (4-18 MHz, eL18-4 Linear Probe, EPIQ 5, Philips, USA) was placed over the two painful areas, and a small pleural effusion was found (Fig. 2).
case_images: An image of the ultrasound-guided intralesional injection. The white arrowhead indicates the needle. A long axis view of the anterior intercostal space at T5-6 with a 4-18 MHz linear transducer (EPIQ 5, Philips, USA). (A) Confirming the focal pleural effusion, a 23-gauge 5 cm needle was inserted using the in-plane technique from the lateral to the medial side of the left anterior chest at a point about 1 cm from the probe. (B) Intralesional injection was administered.
case_images: apm-22182f3.jpg
case_images: PMC9902635_01_apm-22182f3.jpg
case_images: f3-apm-22182
case_images: A mixture of 0.75% ropivacaine hydrochloride (5.5 ml), triamcinolone acetonide (20 mg), and hyaluronidase (1,500 IU), total 6 mL was injected (Fig. 3).