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Roentgenogram of the Month |

Treatment of a Right-Sided Pleural Effusion in a Patient With Liver Cirrhosis*

Susanne Buchholz, MD; Vladimir Kaplan, MD; Markus Hauser, MD, FCCP
Author and Funding Information

*From the Departments of Internal Medicine (Drs. Buchholz and Kaplan) and Medical Radiology (Dr. Hauser), University Hospital Zurich, Switzerland.

Correspondence to: Vladimir Kaplan, MD, Department of Internal Medicine, Zurich University Hospital, Raemistrasse 100, CH-8091 Zurich, Switzerland; e-mail: vladimir.kaplan@dim.usz.ch



Chest. 2000;117(1):248-250. doi:10.1378/chest.117.1.248
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Extract

A 72 -year-old white woman presented with progressive dyspnea, orthopnea, and a weight gain of 10 lb over a period of 2 weeks. The patient’s history was remarkable for coronary heart disease for which she underwent percutaneous transluminal coronary angioplasty of a filiform circumflex artery stenosis 1 year before admission, and for a chronic hepatitis C evolving to cirrhosis with recurrent variceal hemorrhage requiring endoscopic sclerotherapy.

On admission, the patient had tachypnea with a respiratory rate of 30 breaths/min. The heart rate was 100 beats/min with a regular rhythm. The BP was 110/70 mm Hg. There were no murmurs, nor was there a third heart sound. The jugular veins were not distended. A right-sided dullness on thoracic percussion was noted. A chest radiograph revealed a large right-sided pleural effusion but no evident cardiomegaly (Fig 1 ). Thoracentesis was performed, and 2,000 mL of clear fluid with a protein level of 1 g/dL and a lactate dehydrogenase of 180 U/L were removed. The WBC count was 200/μL. Results of fluid cultures and cytologic studies remained negative. An ultrasound of the abdomen showed minimal perihepatic ascites. Echocardiography revealed a normal left ventricular function. The patient was started on furosemide, 80 mg qd, and spironolactone, 200 mg qd. Over the next week, the pleural effusion and dyspnea recurred. With repeated thoracentesis, an additional 2,000 mL of fluid were aspirated. Diuretics were discontinued because symptomatic arterial hypotension developed. A therapeutic procedure was performed (Fig 2 ).

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