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Dr Catherine Hyams (CH), Respiratory Registrar
Presentation to pleural clinic
A 52-year-old Medical Secretary was seen in Pleural Outpatient Clinic as follow-up after hospital discharge from the Surgical team 3 weeks previously. Since discharge, the patient had progressive breathlessness with an exercise tolerance of 10 m (previously unlimited) and noted a mild dry cough. She was a lifelong non-smoker. Fevers, sweats or weight loss were not reported. She had no relevant medical or travel history, with no known exposure to asbestos or other chemical agents. Clinical examination was consistent with a large left-sided pleural effusion, which was confirmed on chest radiograph (figure 1A) and thoracic ultrasound. The chest radiograph also demonstrated infiltrates in the left upper zone.
Previous surgical history
The patient originally presented with abdominal pain and non-bloody diarrhoea 4 months prior to her clinic appointment. Routine blood tests were unremarkable, and she was diagnosed with probable infective colitis. She was discharged home with a plan for outpatient colonoscopy if her symptoms continued. Two months following this, the patient re-presented to the surgical team; however, her pain was now epigastric. An abdominal ultrasound was unremarkable, and she was discharged home and her colonoscopy expedited.
The patient was readmitted 48 hours following this second discharge and was haemodynamically unstable with an acute abdomen. …
Contributors All authors (CH, MHJ, RD, ICH and NAM) contributed to the preparation of this manuscript for publication.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Ethics approval This publication did not require Ethics Approval. Patient consent was sought for publication, and the BMJ Patient Consent Form completed by the patient.
Provenance and peer review Not commissioned; externally peer reviewed.
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