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The value of sound waves and pleural manometry in diagnosing a pleural effusion with the dual diagnosis
  1. Amit Chopra1,
  2. Rahul Argula2,
  3. Christopher Schaefer3,
  4. Marc A Judson1,
  5. Terrill Huggins2
  1. 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, Albany, New York, USA
  2. 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3Department of Medicine, Albany Medical College, Albany, New York, USA
  1. Correspondence to Dr Amit Chopra, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208-3479, USA; chopraa1{at}mail.amc.edu

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Case

An 83-year-old woman presented with a recurrent, right-sided pleural effusion. She had undergone three large volume thoracentesis in the past 2 years, which revealed a ‘clear appearing’ transudative effusion. She had a remote history of haemothorax, a complication from dual chamber pacemaker placement. A chest radiograph (figure 1A) showed a moderate sized, right pleural effusion. Pleural ultrasonography revealed an anechoic fluid collection. Approximately 1.2 L of yellow fluid was removed during thoracentesis. Pleural manometry performed during the thoracentesis revealed a biphasic pressure-volume (P-V) curve showing a steep increase in pleural space elastance at the terminal stages of drainage suggesting an unexpandable lung (figure 2). An air-contrast chest CT scan (figure 1B) showed abnormal visceral pleural thickening consistent with a …

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