Chest X-ray ward round

Series 1: Case 3a Questions

Case 3a:

60-year-old man with a history of prostate cancer presents with increased SOB

Chest CXR (Click to enlarge)

Questions:

What does the X-ray show?

Large right sided pleural effusion
Apical lesion

What is the diagnosis and differentials?

Transudate: cardiac, renal, hepatic causes
Exudate: malignancy, infection, haemothorax, chylothorax

What is the management?

Thoracic USS
Diagnostic/ therapeutic aspiration +/- intercostal chest drain insertion
Pleural fluid for biochemistry (LDH and protein for Light's criteria), microbiology, cytology and pH
CT chest, abdomen and pelvis

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