MedPix® Teaching File - Patient: 11243

Teaching File Case - Patient: 11243
Peer Reviewed and Certified - Approved by: Albert V Porambo - 2007-09-20 17:11:00-04

Submitted by: John Yasmer -
Affiliation: Walter Reed Army Medical Center
Approved By: Albert V Porambo -
Affiliation: Civilian Medical Center

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Demographics: 54 y.o. woman

History & Chief complaint:

54 year old woman, rule out infiltrate or effusion.

Physical exam and Laboratory:

Decreased breath sounds on the left.

Summary of Findings:

Opacification of the left lung with shift of the mediastinal contents to the right. A left chest tube has been inserted. The breast shadow is not seen on the patient's left.

Differential Diagnosis:

Diagnosis:

Tension Hydrothorax, Malignant pleural effusion

Confirmed by: Radiographically and with chest tube placement.

Treatment and Followup:

The patient was hemodynamically stable and did not complain of shortness of breath. Following chest tube placement, approximately 5 liters of fluid were removed from the left chest. This was a malignant pleural effusion.

Patient Specific Discussion: (Also Read the Disease Discussion)

This patient has known metastatic breast cancer with a large liver lesion.

Disease Discussion - Tension Hydrothorax

Tension hydrothorax is an uncommon condition. It occurs when a large pleural effusion causes shift of the mediastinal structures. Predisposing conditions include liver disease, pleural disease, peritoneal dialysis and neoplastic disease.

Hemodynamic compromise can results from compression of the heart and great vessels. Immediate treatment is needle decompression, followed by thoracostomy tube placement.

Radiographic findings include opacification of the lung and shift of the mediastinal structures. This can be seen on plain films as well as CT.

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