On the image below we see fibrinous bands dancing inside a large pleural effusion. His patient had a history of cirrhotic liver disease and hepatic hydrothorax.

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Pleural effusion is an abnormal increase in the volume of pleural fluid. Fluid escapes from the blood vessels and lymphatics of the pleural surface as a result of a pathologic process. Ultrasound is excellent in diagnosing the presence and volume of pleural fluid, and in assessing whether the fluid is amenable to aspiration. Pleural effusions may be characterized as transudates or exudates. Aspiration and chemical analysis of the fluid is needed to differentiate the type of effusion, both will generally appear anechoic on ultrasound. Fluid that contains floating debris or has septations or fibrous strands is typically an exudate. Ultrasound is exceptionally valuable in localizing pleural fluid and in guiding diagnostic or therapeutic thoracentesis.

 

To obtain this image, use the curvilinear (abdominal) probe and place it with the indicator marker towards the patient's head  on the lateral chest wall (as if you are performing a FAST exam).