PMC9135562_01
Chest radiograph with complete left-sided pleural effusion with a resultant mass effect and significant deviation of the mediastinum to the right.
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A chest radiograph on admission revealed complete opacification of the left hemithorax with a mass effect, including mediastinal shift to the right (Figure 1).
Chest computed tomography showing large right pleural effusion and anterior mediastinal mass with the mass effect.
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Chest computerized tomography (CT) was performed for further evaluation and revealed a large pleural effusion causing rightward shift of the trachea and compression with occlusion of the left lower bronchus, left upper bronchus, and superior lobe and lingual bronchi, as well as an anterior mediastinal mass measuring 8.5 x 4.0 x 6.0 cm with resultant right atrial and ventricular extrinsic compression (Figure 2).
Immediate postchest tube thoracostomy chest radiograph demonstrating resolution of the mass effect and midline trachea.
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An immediate postprocedure chest radiograph showed resolution of the mass effect and contralateral tracheal deviation, but persistent opacification of the left hemithorax (Figure 3).
Chest radiograph showing progressive and complete opacification of bilateral lung fields.
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Due to continued refractory hypotension and serial chest radiographs concerning for progressively worsening lung opacification and chest infiltrates (Figure 4), the patient was placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO).
Chest radiograph before discharge demonstrating resolved pulmonary edema.
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Patient was discharged for outpatient follow-up on hospital day 26, with radiographic and clinical resolution of his RPE (Figure 5).