PMC10220409_01
Computed tomography of the chest (coronal view) showing a right upper lobe cavitation and endobronchial spread of pulmonary tuberculosis diagnosis, 7 years prior to presentation.
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A 74-year-old male with a history of tuberculosis with known cavitary lesion (Fig. 1) and 75 pack-year smoking history presented to a local emergency department with a one-week history of dyspnea on exertion and unintentional weight loss.
Chest x-ray demonstrating a large, right lung 'white out' consistent with tension hydrothorax with tracheal deviation and mediastinal shift.
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A chest x-ray (CXR) was notable for complete opacification of the right hemithorax (Fig. 2).
Computed tomography of the chest (axial view) showing mediastinal shift with right atrial compression.
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Point of care ultrasound (POCUS) prior to 14-Fr tube thoracostomy revealed right atrial and ventricular collapse during cardiac cycle and a large volume complex-homogenous pleural effusion with inverted right diaphragm (Fig. 3, Fig. 4A, Suppl 1,2).
A; bedside ultrasonography showing homogenously complex pleural effusion (green) compressing the right ventricle (red). B; bedside ultrasonography demonstrating the right ventricle (red) post thoracostomy tube placement. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Additionally, point of care cardiac ultrasonography immediately post-drainage demonstrated normalization of the pleural fluid compromising right ventricular function (Fig. 4B, Suppl 4).