Statistics from Altmetric.com
Amy Gray (Junior Doctor): An 88-year-old man with a background of transitional cell bladder cancer diagnosed in 2012 was referred to the ambulatory care clinic with a 1-month history of increasing breathlessness. He had constitutional symptoms of fatigue, reduced appetite and weight loss for the past 4 months. There was no history of cough, fever or night sweats. His bladder cancer had been resected in 2013 with pathology confirming this as a G3 pT1 transitional cell cancer (TCC), and there was no evidence of recurrence on surveillance flexible cystoscopies. He had been on maintenance intravesical BCG therapy since this time, last given 8 months previously. Of note, his last BCG instillation had been traumatic with haematuria postprocedure. He was an ex-smoker of 25 years and had worked within manufacturing and sales in the wallpaper industry. He had no known exposure to asbestos or TB and no animal exposure.
He had a chest X-ray, which showed a left-sided pleural effusion taking up 50% of the hemithorax (figure 1). A CT chest was then performed, which confirmed a moderate left-sided pleural effusion and also showed a spiculated 16 mm nodule in the left upper lobe and a spiculated 23 mm nodule in the right upper lobe. These were not present on a previous CT in 2014.
Ian Fairbairn (Respiratory Consultant): In summary, this elderly man with a background of bladder TCC presents with a large left-sided pleural effusion and pulmonary nodules. A unilateral effusion in the presence of pulmonary nodules is more likely to be exudative than transudative in nature, …
Contributors The authors of this paper, AN, AG, AP, JMK and IF, were all involved in the care of the patient, the interpretation of results, and the writing and revision of the paper and are accountable for the accuracy and integrity of the work.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.