A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months
The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest x-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of:
A. Lung cancer
B. Tuberculosis
C. Pneumonia
D. COPD
ANS: A
Dyspnea is the most common symptom associated with pleural effusion, but effusion may be accompanied by cough, pain, and systemic symptoms, such as malaise and fever. Abnormal physical findings become evident as the effusion increases in volume. These include decreased lung sounds, dullness over the effusion, decreased fremitus, egophony, and whispered pectoriloquy. With extremely large effusions, the mediastinum and trachea may shift to the opposite side. The exception involves effusion related to malignancy, in which case the mediastinum and trachea may be pulled toward the malignancy.
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