The CXR shows a dense homogeneous whiteout of almost the entire left hemi-thorax associated with a shift of mediastinum to the right, consistent with a massive left pleural effusion. Collapse and previous pneumonectomy may cause a similar appearance except that the mediastinum is shifted to the ipsilateral side. All patients with unilateral pleural effusion should be considered for thoracocente-sis to determine the cause of the effusion. The commonest cause of a massive pleural effusion is involvement from lung cancer. In this patient, thoracocentesis yielded frank pus due to an empyema. CT thorax (Fig. 41.2) shows enhancement of both the parietal and visceral pleura, also called the split pleura sign. This results from intense inflammation of the pleura.
Case 42. This elderly male presented with left-sided persistent chest pain and loss of weight for the past few months. He used to work as an electrician on-board a ship for many years. This was his CXR (Fig. 42.1).
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