CXR Case 089
A 56 year old lady is referred to the medics with gradually worsening dyspnoea and weight loss.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is a large right sided pleural effusion filling the entire hemithorax.
Left lung field and pleura is clear.
Large gastric bubble. Bilateral nipple rings.
A large unilateral pleural effusion is very likely to be malignant.
The other most common cause would be parapneumonic effusion, although you would expect severe sepsis for this size of effusion.
Cytological examination of the fluid for malignant cells is a mandatory next step.
The diagnostic yield from this varies depending on tumour type, which is due to different proportions of malignant cells shed into the pleural fluid.
Prof Fraser Brims Curtin Medical School, acute and respiratory medicine specialist, immediate care in sport doc, ex-Royal Navy, academic| Top 100 CXR | Google Scholar | ICIS Course ANZ