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We prospectively examined 26 patients who were referred for ultrasound-guided thoracentesis, following at least one unsuccessful, clinically guided attempt. Sonographically guided thoracentesis was successful in obtaining fluid in 88% of patients. In addition, ultrasonography proved useful in suggesting or defining the cause for the initial unsuccessful attempt. Patients who have undergone an unsuccessful clinically guided thoracentesis and are referred for sonographic assistance represent a selected group who may have complicating factors not typically present during routine thoracentesis. Awareness of these potential complicating factors may facilitate the performance of ultrasound-guided thoracenteses.

Interstitial or cornual pregnancy is an uncommon form of ectopic pregnancy that can be difficult to diagnose both clinically and sonographically. Although infrequent, interstitial ectopic pregnancy carries a greater mortality risk than common forms of tubal ectopic pregnancy. The authors present a case of an interstitial ectopic pregnancy diagnosed sonographically, and they review the associated literature.

Diverticula of the bladder are commonly found in patients with chronic elevated bladder pressure. The sonographic appearance of bladder diverticula is relatively straightforward in the majority of cases, especially if the point of communication between the diverticulum and bladder is demonstrated.' Occasionally, however, this point of communication may be difficult to demonstrate with gray-scale images. We describe a case in which the diagnosis of a bladder diverticulum was not obvious on gray-scale images but was definitively shown with the use of color Doppler interrogation. Case 1A 5-year-old boy with a history of Chiari I1 malformation, myelomeningocele, and associated neurogenic bladder dysfunction was seen for an ultrasound examination of the urinary tract. A ventriculoperitoneal shunt had been placed for the hydrocephalus and was apparently functioning well. Ultrasound examination of the upper urinary tract was normal. Evaluation of the bladder revealed irregularity of the bladder wall with moderate mural thickening. A 1.5 cm x 1.8 cm x 1.4 cm sonolucent collection was seen adjacent to the right lateral bladder wall, and the possibility of a bladder diverticulum or CSF collection within the lower peritoneal cavity was raised. Further evaluation of this fluid collection failed to show definite communication with the bladder, and the origin of the collection remained uncertain.

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