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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

A 62-Year-Old Man With Hypotension and a Large Chest Fluid Collection

Khalil Diab, MD; Karen M. Wolf, MD, FCCP
Author and Funding Information

*From the Department of Medicine, Pulmonary and Critical Care Medicine, Indiana University, Indianapolis, IN.

Correspondence to: Khalil Diab, MD, Fellow, Pulmonary and Critical Care Medicine, Indiana University, Roudebush VA Medical Center, 1481 W Tenth St, 111P-IU, Indianapolis, IN 46202; e-mail: kdiab@iupui.edu


This work was performed at the Indiana University Hospital.

The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(2):558-562. doi:10.1378/chest.08-0912
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Extract

A 62-year-old man was admitted with increased shortness of breath and a cough associated with yellowish sputum production. His symptoms had been progressively worsening over weeks. Pertinent symptoms at presentation included a 10-lb weight loss, dizziness, and low-grade fevers.

The patient was being followed up in pulmonary clinic for a left lung fluid collection shown in Figure 1. A workup had been initiated. Purified protein derivative results and three sputum tests for acid-fast bacilli were negative. Bronchoscopy showed no endobronchial lesions. BAL grew Streptococcus pneumoniae and Stenotrophomonas maltophila. Bronchoscopic mycobacterial and fungal culture findings were negative. No atypical cells were seen. He was treated with trimethoprim-sulfamethoxazole and levofloxacin indefinitely and was referred to the thoracic surgeons. However, he was unavailable for follow-up.

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