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A Pleural Effusion of Multiple CausesA Pleural Effusion of Multiple Causes

Edward T. H. Fysh, MBBS; Ranjan L. Shrestha, MBBS; Benjamin A. Wood, MBBS; Y. C. Gary Lee, PhD, FCCP
Author and Funding Information

From the School of Medicine and Pharmacology and Centre for Asthma, Allergy and Respiratory Research (Drs Fysh and Lee), and the Department of Pathology and Laboratory Medicine (Dr Wood), University of Western Australia; and the Department of Respiratory Medicine (Drs Fysh, Shrestha, and Lee), Sir Charles Gairdner Hospital, Perth, WA, Australia.

Correspondence to: Y. C. Gary Lee, PhD, FCCP, University Department of Medicine, G Block, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia; e-mail: gary.lee@uwa.edu.au


Funding/Support: The authors received research grants from the Western Australian Health Department, State Health Research Advisory Council (Dr Lee), The National Health and Medical Research Council (Drs Fysh and Lee), Sir Charles Gairdner Research Funds (Drs Fysh and Lee), the Raine Medical Research Foundation (Dr Lee), the Cancer Council of Western Australia (Dr Lee), the Lung Institute of Western Australia (Dr Fysh), and the University of Western Australia (Drs Fysh and Lee).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(4):1094-1097. doi:10.1378/chest.11-1032
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Multiple medical disorders can lead to the development of pleural effusions. Most effusions are given a single diagnosis in clinical practice. However, the cause of the effusion can change during the disease course, and concomitant yet distinct causes are often underrecognized. We highlight this point by reporting a complex case of recurrent pleural effusions with different predominant causes during the disease course. Five causes for the pleural effusion were diagnosed, namely malignant pleural effusion, empyema, chylothorax, transudative pleural effusion secondary to hypoalbuminemia, and esophagopleural fistula. This case serves as a reminder to clinicians that recurrent pleural effusion, even within the same pleural space, can arise from different causes and, whenever clinically appropriate, reinvestigation of the pleural effusion may be needed.

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