Questions

1) Outline your findings in the CXR 2) What is your radiological diagnosis 3) Give three investigation you would like

to perform 4) Principles of management

Answer

1) Radiograph shows - Homogenous radio opaque of the left

lung field occupy the whole lung field.

- Heart is displaced to the right side. - Contra lateral tracheal shift

** Happen in massive pleural effusion.

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

4) Principles of management 1) Triage the patient based on priority

from asymptomatic to life threatening respiratory and cardiac problem. Secure the ABC.

2) SPO2 monitoring, ABG. 3) Therapeutic pleural tap if patient is

symptomatic 4) Control the symptoms (analgesic,

oxygen) 5) Find the underlying cause and treat

accordingly Blood investigation: FBC, ABG, RFT/LFT Radiology: CT Thorax Aspiration/ Biopsy: pleural tap, pleural biopsy, fibre optic bronchoscopy.

A 72 Years old Chinese Lady presented with shortness of breath