CXR Case 082

There are bilateral moderate pleural effusions.
There is fluid in the horizontal fissure and upper lobe diversion.

Common things are common: bilateral effusions are highly likely to be transudates from heart failure.

This man had a history of type II diabetes and NSTEMI with 2x coronary stents 4 years before presentation.

In the absence of any concerning aspects to the history (weight loss, malignancy, fevers) it would be reasonable not perform a diagnostic tap of the effusions.

Treat the cause (i.e. dry the patient out) and review.

Rarely, in the context of severe respiratory failure a therapeutic tap can improve the respiratory mechanics and oxygenation – but beware anti-platelet and novel oral anticoagulants!