Case history
Case history #1
A 70-year-old woman presents with slowly increasing dyspnea. She cannot lie flat without feeling more short of breath. She has a history of hypertension and osteoarthritis, and she has been taking nonsteroidal anti-inflammatory drugs with increasing frequency over the previous few months. On physical examination, she appears dyspneic at rest, her blood pressure is 140/90 mmHg, and pulse is 90 bpm. Her jugular venous pressure is elevated to the angle of the jaw. The left lung field is dull to percussion with quiet breath sounds basally. Crackles are heard in the right lung field and above the line of dullness on the left. Lower extremities have pitting edema to the knee.
Case history #2
A 56-year-old man has pain in his right chest with deep inspiration and is short of breath at rest and with exertion. He has felt feverish for 1 week and complains of a productive cough with foul-smelling and -tasting sputum. He regularly drinks alcohol and was inebriated and vomited 1 week before his symptoms began. Past medical history and family history are unremarkable. On physical examination, he is febrile at 100.7°F (38°C), blood pressure is 130/78 mmHg, and pulse is 110 bpm. He looks ill and has poor dental hygiene. Breath sounds are quiet over the right lower lobe with dullness to percussion and decreased tactile fremitus in the lower half of the lung field.
Other presentations
Pleural effusions can result from a wide range of causes, and the patient's presentation will reflect the underlying cause. A patient with a malignant effusion may present with weight loss, cachexia, malaise, and dyspnea. Pleural effusions can result from rheumatoid pleuritis, and a patient may present with dyspnea and an arthritis flare.
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