Case 41 Massive Left Pleural Effusion

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.

Empyema Thorax
Fig. 42.1

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).

Ship Electrician Board
A Disquistion On The Evils Of Using Tobacco

A Disquistion On The Evils Of Using Tobacco

Among the evils which a vitiated appetite has fastened upon mankind, those that arise from the use of Tobacco hold a prominent place, and call loudly for reform. We pity the poor Chinese, who stupifies body and mind with opium, and the wretched Hindoo, who is under a similar slavery to his favorite plant, the Betel but we present the humiliating spectacle of an enlightened and christian nation, wasting annually more than twenty-five millions of dollars, and destroying the health and the lives of thousands, by a practice not at all less degrading than that of the Chinese or Hindoo.

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