A 32 yr old female who sought consult bcz of non productive cough 1 week duration associated with orthopnea, takes 4-5 pillows while sleeping at back. 3days back she had cbc done from some doctor she got prescription of cefuroxamine. Which promped no relief. One day bfr she had fever and took pcm 500mg which afforded partial lysis of fever. P.E- 110/70 , 107 pulse , O2 99% Chest sound decreased. No sound on left lung. Diagnosis and treatment?

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Massive left side pleural effusion.. Patient needs immediate relief.. Drain approximately 1.5 litre per day to provide the patient adequate relief.. Send the pleural fluid for cell type and count.. Protein sugar LDH.. ADA level.. Malignant cells.. Afb to diagnose the cause of effusion... Treat accordingly..

Reexpansion pulmonary edema The incidence is less than 1%, mortality up to 20%. The greatest risk affects young patients with extensive pulmonary collapses due to pneumothorax or pleural effusion of more than 7 days' duration. The pathophysiological mechanisms are not yet totally clarified. The main hypothesis is that after pulmonary re-expansion, there is an acute inflammatory response that includes damage to the alveolarcapillary membrane and changes in the pulmonary lymphatic vessels and in the surfactant resulting from various factors, including reperfusion of a previously collapsed lung. So to be on safe side remove, at the most, 1500 mL of pleural fluid But procedure should be interrupted if there is spontaneous cessation of fluid drainage or if the patient experiences chest discomfort or persistent cough. These symptoms have been recognized as correlating with a reduction in pleural pressure. So signals immediate stopping the aspiration procedure.

looking like acase of massive left side pleural effusion pleural tappping and send the fluid for analysis to rule out Pulmonary tuberculosis and malignancy Treat with antibiotics for 15 days and repeat the chest xray supprtive and symptomatic treatment to releive dyspnoea with bronchodilators, mucolytics,and nebulization

@Dr.Poddar sir, can u pls explain about Re Expansion Pulmonary edema...can it be sequel to tapping large amount of fluid??How much we have to drain maximum per each sitting??

@Dr. K N Poddar sir plz explain this question.. Even i wanted to ask this !

massive left Pleural effusion. requires Both diagnostic & pleural tapping. look for pneumonia, TB . Do CBC, RFT,LFT,ESR,Pleural fluid analysis (sugar,protein,C/S, ADA,cell count, cell type). till then treat with higher antibiotics viz ceftriaxone or piptaz . avoid fluoroquinolones as suspecting TB.

Echo also required to rule out CCF, though unlikely as there is no previous history of any cardiac disease. other causes include - malignancy -pulmonary embolism -viral disease LESS COMMON CAUSES - rheumatologic/collagen vascular disease -hepatic cirrhosis -hepatic hydrothorax -pancreatitis -oesophageal rupture -lymphatic obstruction -SLE -trauma/surgery

Massive left sided plural effusion with medistinal shift to opposite side, tap plural fluid for analysis , on gross examination if you find fluid to be turbid put intercostal drainage tube, otherwise aspirate around 1 to 1.5 liter of fluid in a setting keeping in mind re-expansion pulmonary edema, and send entail fluid for analysis which will helpful for pathologist to look for malignant cell in better way. take history of contact with tuberculosis , most likely it turned out to be tuberculosis which is more common exudative plural effusion in India next to it is malignant plural effusion.

Massive left plural effusion .do diagnostic and THEURAPEUTIC pleuro centesis . Till then give IV antibiotics. Establish ETIOLOGY of pleural effusion bacterial vs kochs

left pleural effusion

Agree with Dr. Poddar, Dr. Khan, Dr. Patil, Dr. Devi and Dr. Jaiswal.


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