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A-Previously-Healthy-Man-in-His-30s-With-Worsening
A-Previously-Healthy-Man-in-His-30s-With-Worsening
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A man in his 30s was transferred to a tertiary care hospital with progressive shortness of breath, initially diagnosed with bilateral pulmonary emboli and a right lower lobe infarct. He was administered anticoagulation therapy, and subsequent evaluations revealed a leukocyte count of 290,000/mL with 69% blasts, leading to a diagnosis of M4 subtype acute myeloblastic leukemia. Following a bone marrow biopsy, treatment involved leukapheresis and induction chemotherapy. A deep vein thrombosis (DVT) was confirmed in the left leg, and the patient experienced intermittent fevers.<br /><br />On the third day at the hospital, he developed right-sided chest pain, dyspnea, and hypoxia, with decreased breath sounds observed in the right lower lung field. A chest X-ray suggested mild congestion and moderate right pleural effusion. By the fourth day, his condition worsened, showing tachycardia and hypoxia, alongside absent breath sounds in the entire posterior right hemithorax. Blood tests revealed a decrease in hemoglobin and hematocrit levels, attributed to chemotherapy effects, and multiple blood and platelet transfusions were administered.<br /><br />Ultrasounds and a diagnostic needle sampling revealed a complex, exudative pleural effusion characterized by echogenic debris, fibrin strands, and septae suggesting hemothorax. The hematocrit sign within the ultrasound indicated a high probability of hemothorax, supported by swirling movements of cellular debris (plankton sign). This diagnosis was achieved noninvasively and efficiently, circumventing further imaging like CT scans.<br /><br />Following the ultrasound-based diagnosis, the anticoagulation therapy was halted, an inferior vena cava filter was placed, and surgical intervention proceeded with thoracotomy, pleural decortication, and chest cavity lavage. The case highlights the utility of ultrasound in diagnosing hemothorax, emphasizing timely and accurate bedside assessment and intervention that guided treatment without additional imaging.
Keywords
acute myeloblastic leukemia
bilateral pulmonary emboli
hemothorax diagnosis
pleural effusion
ultrasound utility
tertiary care hospital
anticoagulation therapy
leukapheresis
deep vein thrombosis
thoracotomy
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