Today we discussed a case of malignant pleural effusion causing complete opacification of a hemithorax. We learned the framework for subacute-chronic dyspnea, discussed the physical exam finding of clubbing, reviewed Light’s Criteria and discussed transudates and exudates. Here is a recap:

Subacute-Chronic Dyspnea DDx:

• Pulmonary (malignancy falls into all of these categories)
  • Airway
    • bronchitis
    • COPD
    • Asthma
    • Bronchiectasis
    • Foreign body
  • Parenchyma
    • PNA
    • edema
    • atelectasis
    • ILD
  • Vasculature
    • PE
    • pHTN
    • AVMs (HPS can cause these)
  • Pleura
    • Pleural effusion
    • PTX
• Cardiac
  • Arrhythmia
  • Ischemia
  • Valvular disease
  • Tamponade
  • Constrictive pericarditis
  • Myocarditis
• Other
  • Anxiety
  • Anemia
  • Reduced PiO2
  • Hypoventilation
  • compensation for metabolic acidosis
  • pregnancy
  • Thyrotoxicosis

DDx for Clubbing:

• 80% with underlying respiratory disorders
• 10-15% with miscellaneous disorders
• Congenital cyanotic heart disease, liver cirrhosis, chronic diarrhea, subacute endocarditis
• 5-10% hereditary or idiopathic clubbing

Lights Criteria and Pleural Effusions (see this previous blog post for an excellent review)

https://scvmcmed.com/2017/04/17/am-report-32217-pleural-effusion/

DDx For Complete Opacification of a Hemithorax

• Trachea pulled toward opacified side
  • Pneumonectomy
  • Total lung collapse
  • Pulmonary agenesis
  • Pulmonary hypoplasia
• Trachea pushed away from the opacified side
  • Pleural effusion
  • Diaphragmatic hernia
  • Large pulmonary mass
• Trachea remains central in position
• Consolidation
• ARDS/pulmonary edema
• Pleural mass
• Chest wall mass