A 77-year-old woman was admitted to the hospital for bowel obstruction. A central line was placed in the right subclavian vein to initiate parenteral nutrition in the setting of a non-operative management strategy. On admission day 4, the patient developed acute respiratory failure, requiring ICU admission. Point-of-care pleural ultrasound revealed a complex, non-septated massive right pleural effusion with swirling, punctiform internal echoes (plankton sign) (Fig. 1, Video 1). A chest X-ray prior to drainage insertion confirmed the massive effusion (Fig. 2) and revealed displacement of the tip of the central line, compared to the immediate control after its insertion. A thoracostomy catheter was placed, demonstrating a milky-white output from the pleural space (Fig. 3), with high triglyceride (2503 mg/dL), low cholesterol (<20 mg/dL), and high glucose (682 mg/dL) levels, consistent with nutrithorax. Although uncommon, vascular trauma or direct leakage may cause nutrithorax that may be identified with ultrasound.

Figure 1

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Figure 2

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Figure 3

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