A 64-year-old Malay man presented with wheezing, shortness of breath on exertion, chest pain on inspiration, abdominal pain, and low-grade fever for two weeks. Chest X-ray showed a homogeneous radio-opaque area in the right lung extending to the upper zone, with the presence of a meniscus layer. The trachea was shifted to the right and there was mediastinal shift. The diagnosis was a right massive pleural effusion.

1. 64 years old Malay man complained of wheezing and Shortness of breath on exertion for 2/7
associated with chest pain on inspiration, abdominal pain and low grade fever.
Questions
2) Radiology feature
1) Outline the pathophysiology of the chest - Homogenous radio opaque at the
pain on inspiration and shortness of right lung extending up to upper
breath zone. Presence of meniscus layer
2) Describe the radiological feature - Trachea shifted to the right
3) What is your radiological diagnosis? - Mediastinal shift.
4) How do you classify the condition in (3)
and give example for each condition. 3) Right massive pleural effusion.
5) Clinical sign that you would look for
4) Based on nature of the effusion
Answer
- Exudate (lung carcinoma)
1) Pathophysiology - Transudate Cardiac failure)
Pleuritic chest pain: sharp or stabbing - Empyema (Empyema thoracis)
pain especially during deep inspiration - Hemorrhagic (Hemothorax)
due to irritation of pleural surface. - Chylous formation (Chylothorax)
Transudative effusion usually does not
cause direct pleural irritation as 5) Clinical sign
compared to exudative type. - Reduce movement on the affected
site
Shortness of breath: due to the distortion - Trachea deviation to affected site
of diaphragm and chest wall during - Stony dull on percussion
respiration rather than causing by - Reduce vocal resonance and breath
hypoxemia sound at the affected site