This Thursday, we restarted our join teaching conferences with our partners in Maputo, Mozambique! We discussed a case of an 83-year-old man who presented with several months of progressive shortness of breath, dry cough, and weight loss. On exam, he had absence of breath sounds over the right hemithorax with dullness to percussion and absent tactile fremitus. His chest radiograph demonstrated unilateral white out, and we considered two possibilities for this finding: a large pleural effusion or a mainstem bronchial obstruction causing lung collapse.
Our expert discussant, the legendary VA pulmonologist Dr. Judd Landsberg, guided us through the CXR interpretation and why it was consistent with an effusion: large spacing between ribs and tracheal deviation away from the affected hemithorax.
A thoracentesis was performed and was consistent with an exudate by Light’s criteria. We formed a differential for exudative effusion and discussed why two possibilities were most likely for this particular patient: malignancy and Tuberculosis. Unfortunately, the patient’s thoracentesis was followed by the discovery of a pneumothorax. We considered the mechanism and management of this complication and how to proceed in case where the pneumothorax is increasing: placement of a chest tube.
Thank you to Dr. Landsberg for all of his clinical pearls and the Maputo residents for their participation!