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  Indian J Med Microbiol
 

Figure 3: (a-f) Show images from a 57-year-old male who presented with progressive dyspnea of 15-day duration. He was diagnosed with right pleural effusion on chest X-ray by a general practitioner, and 900 ml of hemorrhagic pleural fluid was aspirated in the absence of pleural manometry, cytological examination of which revealed atypical cells. (a and b) Contrast-enhanced computed tomogram scan of the chest at levels of left secondary carina and left ventricular outflow tract show massive right pleural effusion with contralateral mediastinal shift and subcarinal lymphadenopathy. There is passive collapse of the underlying lung with no obvious lung abnormality on radiology. (c and d) Chest X-ray taken before and posttherapeutic thoracentesis guided by pleural manometry. Postaspiration, the mediastinum is at the center. (e) Pleural elastance curve shows pleural pressure of −8 cm H2O after aspirating 1100 ml of effusion. The patient developed chest pain and the procedure was terminated. (f) Right intermedius bronchus showing mucosal nodularity during flexible video bronchoscopy with the lumen of the middle lobe (left) and right lower lobe (right) seen. Right upper lobe was completely occluded by extrinsic compression. Mucosal biopsy from intermedius bronchus and transbronchial needle aspiration from subcarinal station showed adenocarcinoma. The patient chose not to proceed with chemotherapy and was discharged. He died 45 days later at home without requirement for repeat therapeutic thoracentesis

Figure 3: (a-f) Show images from a 57-year-old male who presented with progressive dyspnea of 15-day duration. He was diagnosed with right pleural effusion on chest X-ray by a general practitioner, and 900 ml of hemorrhagic pleural fluid was aspirated in the absence of pleural manometry, cytological examination of which revealed atypical cells. (a and b) Contrast-enhanced computed tomogram scan of the chest at levels of left secondary carina and left ventricular outflow tract show massive right pleural effusion with contralateral mediastinal shift and subcarinal lymphadenopathy. There is passive collapse of the underlying lung with no obvious lung abnormality on radiology. (c and d) Chest X-ray taken before and posttherapeutic thoracentesis guided by pleural manometry. Postaspiration, the mediastinum is at the center. (e) Pleural elastance curve shows pleural pressure of −8 cm H<sub>2</sub>O after aspirating 1100 ml of effusion. The patient developed chest pain and the procedure was terminated. (f) Right intermedius bronchus showing mucosal nodularity during flexible video bronchoscopy with the lumen of the middle lobe (left) and right lower lobe (right) seen. Right upper lobe was completely occluded by extrinsic compression. Mucosal biopsy from intermedius bronchus and transbronchial needle aspiration from subcarinal station showed adenocarcinoma. The patient chose not to proceed with chemotherapy and was discharged. He died 45 days later at home without requirement for repeat therapeutic thoracentesis