A 47-year-old man with a history of cirrhosis associated with alcohol abuse presented with a 2-day history of shortness of breath. Before this symptom developed, he had been treated with repeated thoracentesis of the right side for cirrhosis-associated hydrothorax. On pulmonary examination, breath sounds were absent on the right side, and a succussion splash was audible in the right upper chest when the patient was gently shaken. Chest radiography showed hydropneumothorax with a collapsed right lung and an adjacent thoracic air–liquid level, which was probably the result of repeated thoracentesis. The patient was treated with chest-tube placement and diuretics. An analysis of the pleural effusion revealed transudative fluid without evidence of infection or cancer. The chest drain was removed 1 week later, after reexpansion of the lung.
NEJM Volume 362:e9 January 21, 2010 Number 3
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