PMC9807956_01
Plain chest X-ray, posteroanterior view, showing a diffuse opacity occupying most of the right-sided chest obscuring the costophrenic and the cardio-phrenic angle, a tracheal deviation to the left side with absence of air bronchogram, and positive meniscus sign.
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FIG1
A tracheal deviation to the left side with the absence of an air bronchogram and positive meniscus sign was also noted (Figure 1).
Plain chest X-ray, right lateral decubitus view, showing a large free fluid level occupying more than 50% of the ipsilateral hemithorax.
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FIG2
Prior findings were highly suggestive of a large right-sided pleural effusion and were further confirmed in the right lateral decubitus view that showed a large free fluid level occupying more than 50% of the ipsilateral hemithorax (Figure 2).
Plain chest X-ray, anteroposterior view, showing a marked resolution of the effusion, thick pleural surface, reduced lung volume on the right side, and potential widened mediastinum.
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FIG3
Surprisingly, the patient showed marked improvement and he was discharged on the third day after the fever resolved with marked improvement on chest X-ray (Figure 3).
Computed tomography (CT) scan, axial view, mediastinal lung window shows a marked right-sided pleural effusion, collapsed lung, thick pleural service, shift of mediastinum to the left side.
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FIG4
A chest CT scan was done and revealed a large right-sided pleural fluid, collapsed right lung, nodular pleural surface, and a potential mediastinal mass (Figures 4, 5).
Computed tomography (CT) scan, axial view, lung window shows a marked right-sided pleural effusion, collapsed lung, thick pleural service, shift of mediastinum to the left side.
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FIG5
A chest CT scan was done and revealed a large right-sided pleural fluid, collapsed right lung, nodular pleural surface, and a potential mediastinal mass (Figures 4, 5).
Thoracoscopy showing multiple nodular pleural surface.
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FIG6
A thoracoscopy was scheduled for inspection and decortication, and a multiple nodular pleural surface was very suggestive of malignant origin (Figure 6).
PMC9807956_02
Plain chest X-ray, posteroanterior view, showing a diffuse opacity occupying the right hemithorax, with more homogeneous opacity in the middle and the lower zones, obscuring the cardiac, costophrenic, and the costo-diaphragmatic angle, and ascent of air bronchogram, trachea deviated to the right side consistent with large left-sided pleural effusion.
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FIG7
Furthermore, increased right intercostal space was noted; however, there was an absent air bronchogram (Figure 7).