{"id":4598,"date":"2012-03-26T15:11:16","date_gmt":"2012-03-26T19:11:16","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/im-residency\/?p=4598"},"modified":"2012-03-26T15:11:16","modified_gmt":"2012-03-26T19:11:16","slug":"unilateral-recurrent-pleural-effusion","status":"publish","type":"post","link":"https:\/\/www.bumc.bu.edu\/im-residency\/2012\/03\/26\/unilateral-recurrent-pleural-effusion\/","title":{"rendered":"Unilateral recurrent pleural effusion"},"content":{"rendered":"

Today we discussed a 54 yo M p\/w gradually worsening dyspnea on exertion, pleuritic chest pain and cough which is intermittently productive of greenish sputum. Denies fevers\/ hemoptysis\/ wt loss. Similar symptoms a month ago when he was admitted to a hospital in Cape Verde he was found to have right sided pleural effusion->\u00a01L of cloudy yellowish fluid was drained-> fluid with lymphocytic predominance but neg AFB.\u00a0Given 3 days of ciprofloxacin and discharged.<\/p>\n

On further evaluation here, found to have a recurrent\u00a0right sided pleural effusion (?loculated)\u00a0on CXR with no other focal opacities. CT confirmed this, additionally R hilar lymphadenopathy but\u00a0did not note any parenchymal lesions. PPD was + at 41 mm.<\/p>\n

Teaching points:<\/p>\n

    \n
  1. lymphocytic predominance in fluid with + PPD in patient from endemic area (without any other definitive diagnostic data to indicate TB) -> can be empirically treated as tuberculous pleuritis with 4 drug regimen<\/li>\n
  2. if the above is not treated, 65% will progress to more progressive disease<\/li>\n
  3. sensitivity of AFB in pleural fluid is <30% and pleural biopsy is 40-80% (preferred)<\/li>\n
  4. To rule out trapped lung before performing a therapeutic drainage<\/li>\n
  5. Pleural TB without parenchymal\u00a0involvement\u00a0is considered extra-pulmonary<\/li>\n
  6. Pleural TB is more common in patients >65 yrs of age and US born (although this patient does not fit this profile)<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Today we discussed a 54 yo M p\/w gradually worsening dyspnea on exertion, pleuritic chest pain and cough which is intermittently productive of greenish sputum. Denies fevers\/ hemoptysis\/ wt loss. Similar symptoms a month ago when he was admitted to a hospital in Cape Verde he was found to have right sided pleural effusion->\u00a01L of […]<\/p>\n","protected":false},"author":5942,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[4854],"tags":[4866,4857],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/posts\/4598"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/users\/5942"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/comments?post=4598"}],"version-history":[{"count":0,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/posts\/4598\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/media?parent=4598"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/categories?post=4598"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/tags?post=4598"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}