Bilateral pleural effusions

Chest x-ray Bilateral pleural effusions and cardiomegaly Echocardiogram EF = 35%... 

A 60-year-old woman took dexamethasone 4 mg 8-hourly for dyspnea due to a precursor T lymphoblastic lymphoma-leukemia with bilateral pleural effusions and a large mass in the anterior mediastinum (130). She developed acute renal insufficiency and laboratory evidence of the metabolic effects of massive cytolysis. She received vigorous hydration, a diuretic, allopuri-nol, and hemodialysis. She recovered within 2 weeks and then underwent six courses of CHOP chemotherapy. The mediastinal mass regressed completely. She remained asymptomatic until she developed full-blown acute lymphoblastic leukemia, which was resistant to treatment. 

Bilateral pleural effusions have been associated with alprostadil (4). 

A 78-year-old man became short of breath. He had been taking rosiglitazone 8 mg/day for 6 months. He had renal insufficiency, atrial fibrillation, hypertension, and congestive heart failure, with pitting edema and bilateral pleural effusions. He was refractory to intravenous furosemide and metolazone. Withdrawal of rosiglitazone and administration of bumetanide gave a net fluid output of 9.5 litres and the edema resolved. 

Respiratory Effects. Case reports of humans who died after ingesting chromium(VI) compounds have described respiratory effects as part of the sequelae leading to death. A 22-month-old boy who ingested an unknown amount of sodium dichromate died of cardiopulmonary arrest. Autopsy revealed pleural effusion, pulmonary edema, severe bronchitis, and acute bronchopneumonia (Ellis et al. 1982). Autopsy of a 17-year-old male who committed suicide by ingesting 29 mg chromium(VI)/kg as potassium dichromate revealed congested lungs with blood-tinged bilateral pleural effusions (Clochesy 1984 Iserson et al. 1983). Respiratory effects were not reported at nonlethal doses. 

It was noted that she had gram-negative rods on her blood smear her blood culture grew penicillin-sensitive Streptococcus pneumoniae, in 6 hours. At autopsy, she was noted to have Streptococcus pneumoniae endocarditis of the right ventricle, focal ischemia of the left ventricle, bilateral pleural effusions, hepatic congestion with thrombosis, renal congestion, bilateral adrenal hemorrhage, and necrosis. Death was due to septic shock from Streptococcus pneumoniae. 

A 21-year-old man with paranoid schizophrenia was treated with zuclopentixol, which was withdrawn because of extrapyramidal adverse effects, He was given clozapine 300 mg/day, and from day 43 developed breathlessness and complained of pain in his shoulders on deep inspiration. A chest X-ray showed an enlarged cardiac silhouette and bilateral pleural effusions. An echocardiogram showed pericardial and pleural effusions with no compromise of cardiac function. Clozapine was withdrawn and all the symptoms resolved within 2 weeks. 

Boot E, De Haan L, Guzelcan Y, Scholte WF, Assies H. Pericardial and bilateral pleural effusion associated with clozapine treatment. Eur Psychiatry 2004 19 65-6. 

Stanislav SW, Gonzalez-Bianco M. Papular rash and bilateral pleural effusion associated with clozapine. Ann Pharmacother 1999 33(9) 1008-9. 

A chest X-ray showed diffuse interstitial and alveolar infiltrates and small bilateral pleural effusions. A high-resolution CT scan of the chest showed diffuse ground-glass attenuation and patchy peripheral opacities, consistent with an acute hypersensitivity pneumonitis, and other diagnoses were ruled out. He responded to gluco-corticoids. 

A 73-year-old man who had taken pergolide 1.5 mg/day for 4 months developed dyspnea, bilateral pleural effusions, and severe edema of the legs up to the scrotum (5). There was no pleural thickening or any evidence of cardiac failure or nephrotic syndrome. These chnical features were resistant to diuretic therapy but resolved completely within a month of withdrawal of pergohde. The mechanism of this type of very rare reaction is totally unknown. 

Varsano S, Gershman M, Hamaoui E. Pergolide-induced dyspnea, bilateral pleural effusion and peripheral edema. Respiration 2000 67(5) 580-2. 

Bouchama A, Chastre J, Gaudichet A, Soler P, Gibert C. Acute pneumonitis with bilateral pleural effusion after talc pleurodesis. Chest 1984 86(5) 795-7. 

After administration of vinorelbine, chest pain occurs in up to 5% of patients. However, subsequent analysis showed that most patients had underlying cardiovascular disease or a tumor in the chest, making interpretation difficult (2,20). Three patients developed acute cardiopulmonary toxicity after vinorelbine therapy (25). The symptoms mimicked acute cardiac ischemia, but with no electrocardiographic changes or raised cardiac enzymes. In two patients, tachypnea, rales, wheezing, and severe dyspnea responded to inhaled salbutamol. One patient developed pulmonary edema and bilateral pleural effusions, which contained no malignant cells when drained. 

A 69-year-old man developed dyspnea, hypoxia, and heart failure 4 days after starting to take tretinoin 70 mg/day. His highest white blood cell count was 72 X 109/1. A plain chest X-ray showed two pulmonary opacities, increased attenuation in the left lower lobe, and bilateral pleural effusions, but a chest CT also showed multiple irregular-shaped opacities localized in the centrilobular and subpleural regions. He improved over 10 days with prednisolone (total dose 5750 mg) and daunorubicin (total dose 360 mg). 

Ten days later she developed a persistent fever. A chest X-ray and a CT scan showed bilateral pleural effusions and interstitial infiltrates, but no pulmonary embolus. Tretinoin was withdrawn and she was given intravenous dexamethasone 10 mg every 12 hours. Her fever disappeared within 24 hours and her respiratory distress gradually improved during the next 24-48 hours. A chest X-ray 7 days later showed total resolution. 

Fig. 10.23a,b. Ovarian cancer recurrence. Coronal CT scans (a, b) in a patient with advanced recurrent clear cell cancer show multiple, predominantly cystic peritoneal implants throughout the abdomen and pelvis. The liver surface is compressed by surface implants (asterisk) (a, b). Multiple enlarged lymph nodes are seen in the right pelvis and root of the mesentery (b). Associated findings in this case include bilateral pleural effusion and a thrombus in the left femoral vein... 

Fig. 26.12a,b. Acute interstitial pneumonia (AIP) in a 58-year-old patient, a Axial CT image shows bilateral ground-glass opacities in a geographic distribution (arrow). Consolidation is seen in the more dependent lung (arrowheads). Small, coexisting bilateral pleural effusions are present, b (see next page)... 

Bilateral pleural effusions and respiratory distress have also been reported [56 ]. 

Figure 4 Idiopathic acute eosinophilic pneumonia. CT scan of the chest demonstrating diffuse ground-glass opacities, poorly defined nodules, and bilateral pleural effusion.

Figure 5 Churg-Strauss syndrome. CT scan of the chest showing bilateral pleural effusion (related to cardiac eosinophilic involvement) and small-size airspace consolidation corresponding to eosinophilic pneumonia.

Respiratory Bilateral pleural effusions in a neonate on TPN has been reported [114 ]. 

Fig. 6.1.14a,b. Haematogenous spread from a gastric carcinoma. The extensive tumour together with thrombus in the splenic vein is shown on (a), whereas (b) demonstrates tumour thrombus in the portal vein as well as a liver metastasis. Note bilateral pleural effusions... 

ScHULMAN et al. (1997) published two cases of pulmonary tuberculosis, both 3 months after bilateral lung transplantation, and found radiographically a narrowing of the middle lobe bronchus of the right lung caused by an endobronchial granulomatous mass (n=l) and a focal cluster of small nodules in the upper lobe of the left lung and small bilateral pleural effusions (n=l). 

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