Question of the Week # 343

343)  A 52 year old woman with history of triple-negative, metastatic breast cancer presents to the Emergency Room with increasing shortness of breath.  She received multiple courses of chemotherapy in the past and her cancer has progressed despite initial response to chemotherapy. On examination, she is afebrile,  respiratory rate is 24/min, Blood pressure 120/70 mm Hg and Heart Rate 106/min. Breath sounds are decreased on right side of the chest and there is dullness to auscultation. A chest X-ray shows collapsed right lung and  massive right sided pleural effusion. A  thoracentesis is performed followed by thoracostomy tube is placement and about 2000 ml fluid is drained. About one houar after the procedure, the patient develops severe shortness of breath and cough with pink and foamy sputum. A pulse oximetry shows Sa02 at 86%. Which of the following most likely explains her newly developed symptoms?

A) Alveolar Hemorrhage

B) Lymphangiocarcinomatosis

C) Chylothorax due to Thoracic Duct Injury

D) Pulmonary edema

E) Acute Respiratory Distress Syndrome

6 Responses

  1. D) Pulmonary edema – due to sudden re-expansion of the lung

  2. D

  3. C sounds reasonable answer

  4. D

  5. D-re expansion pulmonary edema

  6. D: http://courses.washington.edu/med610/pleuraleffusion/case10answers.html

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