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Hemithorax white-out due to massive pleural effusion
International Journal of Emergency Medicine volume 16, Article number: 4 (2023)
Abstract
This is a clinical image submission depicting hemithorax white-out due to massive pleural effusion.
A 79-year-old female was sent from the acute rehab facility where she was recovering from pneumonia due to decreased breath sounds on the left. The patient had mild shortness of breath, but otherwise did not have complaints. Her medical history was significant for dementia, atrial fibrillation, hypertension, chronic kidney disease, and congestive heart failure. Imaging revealed a complete opacification of the left hemithorax consistent with a large pleural effusion (Figs. 1, 2, and 3).
AP chest radiograph, and axial and saggital views of chest CT demonstrating left lung white out
Infographic depicting Light’s Criteria explanation of distinguishing transudate and exudate pleural fluid. Designed by Shreya Kolluri on canva.com
Infographic depicting overview of pleural effusion presentation, symptoms, etiology, and treatment. Designed by Shreya Kolluri on canva.com
About 1.5 million Americans experience pleural effusions annually [1]. Pleural effusion is the accumulation of excess fluid in the membrane around the lungs. The pressure of the fluid on the lungs can result in chest pain, dry cough, dyspnea, and orthopnea, while it can also present with little to no symptoms.
It is often diagnosed with chest radiographs and computed tomography (CT) scans. Chest CT can detect pleural fluid as little as 2 mL as well as underlying abnormalities, such as pneumonia, abscess, or malignant masses [2,3,4]. Pleural effusion on radiographs appears as opacity because of fluid accumulation between the lower lung and diaphragm [5]. Additionally, thoracic ultrasonography and pleural fluid analysis can be performed to distinguish between transudative and exudative causes as determined by Light’s criteria.
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Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
References
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Kearney SE, Davies CW, Davies RJ, Gleeson FV. Computed tomography and ultrasound in parapneumonic effusions and empyema. Clinical radiology. 2000;55:542–7. https://doi.org/10.1053/crad.1999.0480.
Raasch BN, Carsky EW, Lane EJ, O'Callaghan JP, Heitzman ER. Pleural effusion: explanation of some typical appearances. 1982;139:899–904. https://doi.org/10.2214/ajr.139.5.899.
Acknowledgements
This research was supported (in whole or in part) by the HCA Healthcare and/or an HCA Healthcare-affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of the HCA Healthcare or any of its affiliated entities.
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LG saw the patient and obtained informed consent. SK and LG wrote the manuscript. TS and RK provided edits. SK designed the infographics. All authors read and approved the final version of the manuscript.
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This study was conducted in accordance with the Declaration of Helsinki and exempt by the HCA CARRIE Institutional Review Board (study #2022-902). The requirement for written informed consent was waived as the obtained data was de-identified.
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The patient provided written informed consent for this clinical image submission.
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Kolluri, S., Mangal, R.K., Stead, T.S. et al. Hemithorax white-out due to massive pleural effusion. Int J Emerg Med 16, 4 (2023). https://doi.org/10.1186/s12245-022-00465-x
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DOI: https://doi.org/10.1186/s12245-022-00465-x
Keywords
- Pleural effusion
- Recurrent
- Thoracentesis
- Congestive heart failure
- Chronic kidney disease