A 72-year-old Chinese lady presented with shortness of breath. Radiograph shows a homogenous radio opaque left lung field occupying the whole lung, displaced heart to the right side, and contra lateral tracheal shift consistent with massive left pleural effusion. Investigations would include pleural tap, pleural biopsy, CT thorax, and fiberoptic bronchoscopy to determine the underlying cause and guide treatment.

1. A 72 Years old Chinese Lady presented with shortness of breath
Questions
4) Principles of management
1) Outline your findings in the CXR 1) Triage the patient based on priority
2) What is your radiological diagnosis from asymptomatic to life
3) Give three investigation you would like threatening respiratory and cardiac
to perform problem. Secure the ABC.
4) Principles of management 2) SPO2 monitoring, ABG.
3) Therapeutic pleural tap if patient is
Answer symptomatic
1) Radiograph shows 4) Control the symptoms (analgesic,
- Homogenous radio opaque of the left oxygen)
lung field occupy the whole lung 5) Find the underlying cause and treat
field. accordingly
- Heart is displaced to the right side. Blood investigation: FBC, ABG,
- Contra lateral tracheal shift RFT/LFT
** Happen in massive pleural Radiology: CT Thorax
effusion. Aspiration/ Biopsy: pleural tap, pleural
biopsy, fibre optic bronchoscopy.
2) Left massive pleural effusion
3) Investigation to be performed
- Pleural tap for protein, albumin,
LDH, glucose, cholesterol and
cytology. Taken together with blood
investigation for same purpose.
- Pleural biopsy
- CT Thorax
- Fibre optic bronchoscopy