A Reminder of an Important Clinical Lesson: Hypoxaemia in a Pleural Effusion

Avinash Aujayeb

doi:10.3390/reports5010006

Abstract

A 75-year-old male presented with a large pleural effusion and significant hypoxaemia. The hypoxaemia persisted after large-volume pleural drainage, and this prompted further investigations. A CT scan yielded a pleural malignancy and a large pulmonary embolus, which was responsible for the hypoxaemia. We revisit the mechanisms behind dyspnoea and hypoxaemia in pleural effusions, and underly the need to investigate further should hypoxaemia persist after adequate drainage.

Highlights

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Pleural effusions usually necessitate drainage, and all acute care physicians will be trained in thoracentesis and intercostal drain insertion
We summarise the evidence of the lack of hypoxaemia in pleural effusions and recent evidence surrounding this important topic

Summary

Introduction

Afferent signals, efferent signals, and central information processing contribute to dyspnoea [5]. Pleural effusions usually necessitate drainage, and all acute care physicians will be trained in thoracentesis and intercostal drain insertion. The former will usually be the first line of treatment in an acute medical unit. This intervention will usually have the following three aims: diagnostic (by performing well-established tests of protein, lactate dehydrogenase and glucose levels, as well as cytology and microbiology tests), therapeutic (relief of symptoms, notably dyspnoea), and preventative (in the case of a malignant effusion, pleurodesis might be offered) [4].

Case Report

Findings

Discussion