Case 12--Recurrent Pleural Effusion in an Elderly Man

Clinical summary: A 76-year-old man with a history of asbestos exposure was admitted for a left pleural decortication in 4/97. He first noted left-sided chest pain in 1992, and a pleural effusion was diagnosed. Thoracentesis yielded fluid with malignant cells consistent with adenocarcinoma or mesothelioma. The patient refused a surgical procedure for a definitive diagnosis. Reaccumulation of fluid necessitated thoracenteses at 3- to 6-month intervals. He remained stable until early 1997 when he developed increasing dyspnea and dry cough. He denied fever, chills, sweats, or hemoptysis. Three days following a thoracentesis he returned with shortness of breath. A chest film showed a large effusion despite the recent removal of 2 L. A French pigtail drainage catheter was placed, and 7 L of fluid was removed. Fluid continued to drain, and he was admitted 4/7 for pleurodesis. On admission T was 35.4° and BP 140/70. He appeared tired and had some respiratory distress and a dry cough. Examination was unremarkable except for findings of a left pleural effusion. He had a history of smoking but stopped 20 years ago. Decortication and pleurodesis were performed on 4/12. Post-operatively, drainage from the chest tube diminished, and the tube was removed 4/21. He was discharged the next day.

Radiology | Image 1 | Image 2 | Image 3 | Image 4 | Discussion

Table of Contents