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  Indian J Med Microbiol
 

Figure 2: (a-f) Show images from a 64-year-old male who was earlier diagnosed with squamous cell carcinoma of the buccal mucosa and has undergone surgical excision and radiotherapy for the same 2 years ago. He presented now with acute onset dyspnea of 2-week duration. (a) Chest X-ray shows right massive pleural effusion with contralateral mediastinal shift. (b) Chest X-ray taken after therapeutic thoracentesis of 1 L in the absence of pleural manometry. There appears to be no significant change in the size of the effusion. (c) Chest X-ray taken the same day after aspirating 2400 ml of pleural fluid under pleural manometry. Nodular lesions are seen in the underlying right lung now. Interestingly, a nodule is also seen peripherally in the left mid zone which was not noticeable in the earlier chest X-ray. (d) Pleural elastance curve showing a pleural pressure of −8 cm H2O after the removal of 2400 ml of fluid. The procedure was stopped as the patient complained of chest pain. (e) Chest X-ray taken 4 days later shows no significant reaccumulation of effusion. (f) Computed tomogram chest at the level of left secondary carina shows bilateral lung nodules. Biopsy of the large right pleural based nodule showed metastatic malignancy whereas pleural fluid did not show malignant cytology. He was started on chemotherapy and has not required further therapeutic thoracentesis since 5 months

Figure 2: (a-f) Show images from a 64-year-old male who was earlier diagnosed with squamous cell carcinoma of the buccal mucosa and has undergone surgical excision and radiotherapy for the same 2 years ago. He presented now with acute onset dyspnea of 2-week duration. (a) Chest X-ray shows right massive pleural effusion with contralateral mediastinal shift. (b) Chest X-ray taken after therapeutic thoracentesis of 1 L in the absence of pleural manometry. There appears to be no significant change in the size of the effusion. (c) Chest X-ray taken the same day after aspirating 2400 ml of pleural fluid under pleural manometry. Nodular lesions are seen in the underlying right lung now. Interestingly, a nodule is also seen peripherally in the left mid zone which was not noticeable in the earlier chest X-ray. (d) Pleural elastance curve showing a pleural pressure of −8 cm H<sub>2</sub>O after the removal of 2400 ml of fluid. The procedure was stopped as the patient complained of chest pain. (e) Chest X-ray taken 4 days later shows no significant reaccumulation of effusion. (f) Computed tomogram chest at the level of left secondary carina shows bilateral lung nodules. Biopsy of the large right pleural based nodule showed metastatic malignancy whereas pleural fluid did not show malignant cytology. He was started on chemotherapy and has not required further therapeutic thoracentesis since 5 months