An elderly man with bronchogenic carcinoma was admitted for shortness of breath. Clinical examination showed the trachea to be deviated to the right side. His right chest was dull on percussion with markedly diminished breath sounds. The air entry in the left lung was normal. There were no signs of cardiac failure. Abdominal examination was normal. A chest x-ray showed a large homogenous opacity on the right side of the chest which the attending doctors interpreted as a right pleural effusion. Pleural tapping was attempted three times but was unsuccessful. An ultrasound guided pleural aspiration yielded 50ml of serosanguinous fluid. The patient was treated with nasal oxygen and intravenous fluids. He gradually improved over a period of four days and was discharged with advice to return for pleural aspiration again if he developed breathlessness.
(Contributed by Azra Kurtovic)
Was this patient’s breathlessness due to his pleural effusion?
Comment
It is easily evident from the available information that his breathlessness was not due to a pleural effusion. It is not reasonable to assume that aspiration of 50ml of pleural fluid could relieve his breathlessness. We can also infer that the opacity seen in the chest x-ray was not due to a pleural effusion as interpreted by the attending doctors. The trachea, which was shifted to the same side as the opacity, tells us that there is volume loss in the right lung – possibly due to some degree of collapse of the lung caused by the cancer compressing a bronchus. The radiological opacity seen on the chest x-ray must therefore be due to a combination of the tumour and the lung collapse. A small amount of pleural effusion cannot be excluded. His improvement in the hospital must have been due to the supplemental oxygen which helped relieve his hypoxia.
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