CHEST Guidelines-A-Man-in-His-70s-Presenting-With-Chest-Pain-and-He

A-Man-in-His-70s-Presenting-With-Chest-Pain-and-He

Pdf Summary

A man in his 70s presented to the emergency department with left-sided chest pain, shortness of breath, and hematuria. His medical history included hypertension, and he was taking hydrochlorothiazide. Physical examination showed he was tachypneic and tachycardic, with decreased breath sounds in the left lung, and a chest radiograph revealed a left-sided opacity. A bedside ultrasound suggested a left anterior lung mass and probable malignant left pleural effusion. Given the concurrent hematuria, an abdominal ultrasound was performed, revealing a right-sided renal mass indicative of possible metastasis.<br /><br />The ultrasound findings pointed toward a hypoechoic area with irregular borders, consistent with a mass, rather than pleural effusion or lung abscess. Masses near the pleural surface can be identified using ultrasound and typically necessitate further investigation for malignancy. Compared to pleural effusions, masses have distinct and irregular borders. The presence of a solid renal mass, which often indicates malignancy until proven otherwise, was confirmed through renal ultrasound.<br /><br />A subsequent thoracic ultrasound revealed a left-sided pleural effusion, and a thorough evaluation ruled out deep vein thrombosis as a cause of his respiratory symptoms. A biopsy confirmed the diagnosis of renal cell carcinoma, and a left-sided tunneled intrapleural catheter was placed to relieve his respiratory distress. Final CT imaging corroborated the ultrasound findings.<br /><br />The report underscores the utility of clinical history and physical examination in guiding bedside ultrasound evaluations, highlighting its role in differentiating chest wall lesions and assisting in diagnostic and therapeutic procedures. This case emphasizes the importance of distinguishing between cystic and solid lesions, particularly in renal masses, due to their significant clinical implications.

Keywords

renal cell carcinoma

pleural effusion

lung mass

abdominal ultrasound

tachypneic

tachycardic

hydrochlorothiazide

malignancy

bedside ultrasound

chest radiograph