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首页> 外文期刊>African Journal of Emergency Medicine >A very complicated pleural effusion
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A very complicated pleural effusion

机译：非常复杂的胸腔积液

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Case report A 33-year-old male attended the emergency department with a three day history of dyspnoea. He had previously completed treatment for pulmonary tuberculosis and was HIV-positive on antiretroviral therapy. On examination, he was tachypnoeic with saturations of 89% on air. He had reduced air entry throughout the right lung and muffled heart sounds. He was afebrile and haemodynamically stable. Plain chest radiograph showed large bilateral pleural effusions, worse on the right. Urgent small-bore catheter drainage of the right lung was performed. Biochemistry showed an exudative effusion. 3.2 litres of fluid was drained within 4 hours, with an improvement in clinical condition. The patient then became increasingly tachypnoeic and rapidly desaturated. Repeat chest radiograph showed partial drainage of the effusion, however now with a 2 cm pneumothorax and oedematous right lung field. Sublingual nitrate, furosemide and an intercostal drain were placed with initial good response. The patient was admitted, but unfortunately died overnight. Discussion Re-expansion pulmonary oedema is a recognised complication of large pleural effusion drainage. The mechanism remains unclear, although reduced left ventricular function, in this case from a possible pericardial effusion, may be a precipitant. To prevent this phenomenon the British Thoracic Society recommends draining a maximum of 1.5 litres of fluid. This case was further complicated by a pneumothorax; again a recognised complication, especially if there is underlying poor compliance of the lung parenchyma. Re-expansion pulmonary oedema has an incidence of 1% and pneumothorax 5%. Their occurrence has not previously been reported simultaneously. Large pleural effusions are commonly encountered in clinical practice in South Africa. The existence of multiple co-morbidities including tuberculosis, HIV and impaired cardiac function may complicate their management. This case highlights the need for close monitoring and controlled drainage of pleural effusions in emergency practice.
机译：病例报告一名33岁的男性因三天的呼吸困难病史进入急诊室。他先前已经完成了肺结核的治疗，并且抗逆转录病毒疗法的HIV阳性。经检查，他呼吸急促，空气中饱和度为89％。他减少了整个右肺的进气，并降低了心音。他病态温和，血液动力学稳定。胸部X线平片显示双侧较大的胸腔积液，右侧更严重。紧急进行右肺小口径导管引流。生物化学显示渗出性积液。在4小时内排出了3.2升液体，临床状况有所改善。然后，患者变得越来越快，并且迅速饱和。重复的胸部X光片显示部分积液引流，但是现在有2 cm气胸和右肺水肿。放置舌下硝酸盐，速尿和肋间引流，初期反应良好。患者入院，但不幸死于一夜。讨论再扩张性肺水肿是公认的大胸腔积液引流并发症。尽管可能是心包积液导致左心室功能降低（在这种情况下），但机制仍不清楚。为防止这种现象，英国胸腔学会建议排出最多1.5升的液体。气胸进一步加重了该病例。同样是公认的并发症，特别是如果肺实质的依从性差。再次扩张性肺水肿的发生率<1％，气胸<5％。以前没有同时报道过它们的发生。大型胸腔积液在南非的临床实践中很常见。包括肺结核，艾滋病毒和心脏功能受损在内的多种合并症的存在可能会使他们的治疗复杂化。该案例强调了在急诊中需要密切监测和控制胸腔积液引流。

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