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  Indian J Med Microbiol
 

Figure 1: The “swinging mediastinum.” (a, b, d, and e) Show chest X-ray anteroposterior view images of a 70-year-old female presenting with acute dyspnea. She was diagnosed with right upper lobe adenocarcinoma (computed tomogram-guided biopsy) with paramalignant pleural effusion a year ago and was on palliative care. At that time, she developed a hydropneumothorax following intercostal chest drain insertion. Intercostal chest drain was removed after a week. She required 2 hospital visits in the last year for therapeutic thoracentesis to relieve dyspnea. (a) Chest X-ray shows right massive pleural effusion with contralateral shift of mediastinum. (b) Mediastinum is at the center after aspirating 2100 ml of pleural fluid (final 1100 ml guided by pleural manometry). The patient's dyspnea had reduced. Right hemithorax appears radio-opaque due to residual effusion and underlying lung mass. (c) Pleural elastance curve shows pleural pressure of −27 cm H2O after removing 2100 ml of fluid, which coincided with the development of chest pain. (d) Chest X-ray taken 2 days later showing increase in right pleural effusion with contralateral mediastinal shift. The patient started to develop worsening dyspnea. (e) Chest X-ray taken postemergency intercostal chest drain insertion 3 days after the earlier chest X-ray. Over 2 L of pleural fluid drained. The mediastinum has now shifted to the same side as the effusion. The patient became hypoxemic after intercostal chest drain insertion and was later intubated. She died a week later

Figure 1: The “swinging mediastinum.” (a, b, d, and e) Show chest X-ray anteroposterior view images of a 70-year-old female presenting with acute dyspnea. She was diagnosed with right upper lobe adenocarcinoma (computed tomogram-guided biopsy) with paramalignant pleural effusion a year ago and was on palliative care. At that time, she developed a hydropneumothorax following intercostal chest drain insertion. Intercostal chest drain was removed after a week. She required 2 hospital visits in the last year for therapeutic thoracentesis to relieve dyspnea. (a) Chest X-ray shows right massive pleural effusion with contralateral shift of mediastinum. (b) Mediastinum is at the center after aspirating 2100 ml of pleural fluid (final 1100 ml guided by pleural manometry). The patient's dyspnea had reduced. Right hemithorax appears radio-opaque due to residual effusion and underlying lung mass. (c) Pleural elastance curve shows pleural pressure of −27 cm H<sub>2</sub>O after removing 2100 ml of fluid, which coincided with the development of chest pain. (d) Chest X-ray taken 2 days later showing increase in right pleural effusion with contralateral mediastinal shift. The patient started to develop worsening dyspnea. (e) Chest X-ray taken postemergency intercostal chest drain insertion 3 days after the earlier chest X-ray. Over 2 L of pleural fluid drained. The mediastinum has now shifted to the same side as the effusion. The patient became hypoxemic after intercostal chest drain insertion and was later intubated. She died a week later