Large pleural effusion

Case contributed by Dr Jeremy Jones

Presentation

Respiratory distress with cough for several weeks, but marked clinical deterioration over 24 hours.

Patient Data

Age: 3 years
Gender: Male
Modality: X-ray

Complete opacification of the left hemithorax with contralateral mediastinal shift consistent with a large pleural effusion exerting positive mass effect.

Modality: Annotated image

The left hemithorax is much more dense than it should be and there is virtually no aerated lung visible.

The midline (dashed line) is identified by looking for the spinous processes. The trachea (shaded) is clearly pushed to the right (away from the dense hemithorax).

Case Discussion

This large left-sided complete white-out demonstrates positive mass effect causing mediastinal shift. 

There are several causes of a hemithorax white-out including lung collapse, consolidation and pleural effusion. Because of the mass effect demonstrated, a large pleural effusion is the most likely cause.

The causes of pleural effusions can be separated into those that cause a transudate and those that cause an exudate. In children, the most likely cause by far is a parapneumonic effusion.

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Case Information

rID: 23789
Case created: 8th Jul 2013
Last edited: 15th Oct 2015
Systems: Paediatrics, Chest
Inclusion in quiz mode: Included

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