But would any of the effusions cause increased WBC? Increased WBC points to infection
Can't pneumonia be the cause of an effusion though in some cases?
That's true! I didn't think of that!
Yes, especially if it's malignant. Without a fever and classic PNA symptoms I suspect less likely to be infectious, but possible.
Ah ok that's good to know! I was just going with pneumonia because there was a large shadow on the chest X-ray so I immediately went with pneumonia but the shadow I guess was the effusion right?
W/ possible pneumothorax on left side
Effusion vs pneumonia with pericardial air vs small #Pneumothorax.
I might consider #Empyema as well.
Pneumothorax with pneumonia?
What other Hx is available? Any cardiac, renal, hepatic, etc?
What are physical exam findings?
Her prior history only includes hypothyroidism. Her sodium was 122, pro-bnp was 2898, lactate 1.7, and sats were 94% on room air.
What did CT show?
Wish I knew. They didn't do one. This rural hospital (my other, other job) didn't have the CT functioning this weekend.
Sodium is a little low, BNP isn't excessively high, lactate is slightly elevated, sats are marginal on RA...the high WBC and pretty low sodium makes me think effusion or #Empyema of neoplastic origin.
Empyema suspected due to leukocytosis. This left pleural effusion needs urgent CT thorax followed without delay by diagnostic thoracentesis.
Did someone drain the effusion? If yes, did you guys send it to analysis and culture? The leukocytosis makes me consider empyema.
Small rural hospital. Radiology said pneumonia versus #Empyema. We shipped to the level one hospital I usually work at 😉. So we didn't tap the lung.
Pleural effusion secondary to pneumonia or other infection (ex:PTB but this is rare)
Empyema secondary to pulmonary CA
And left pneumothorax.
Empyema secondary to hypothyroidism is a rare condition. Probably the empyema is secondary to Community pneumonia or Cancer. This is great empyema (Class 3 or 4). I believe that will be necessary medical and surgical treatment. If there is not resources in this place, then, if possible, the patient shall be sent for a hospital with resources
Please don't forget, with the elderly and pneumonia they don't show classic signs of infection because their body Temps are lower. With that being said, if O2 sats are 94% on RA with SOB I doubt it is just pneumonia. There is infection somewhere.
Chest radiograph,reveals diffuse radiopacity involving the right middle and lower lobe obscuring right cardiac border and right hemidiaphragm.Left hemithorax also reveals radiopacity in the lower zone.trachea is centrally located, no bronchus cut off sign, no mediastinal shift,no hilar tickening, cardiac size cannot be appreciated, both left and right costophrenic angle is obscured. Dx=P.Effusion
Right pleural effusion, likely para-pneumonic. An empyema thoracis is a close differential.
Rt pelural effusion ..
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