Right-Sided Chest Pain with Progressive Dyspnea

(Chest 1991; 100:811-12) A 45-year-old housewife was referred for evaluation ofright-sided chest pain with progressive dyspnea of six months’ duration. Three months prior to presentation, she had been treated by her community doctor with 15 days ofantibiotic therapy. Thoracentesis at that time yielded sterile fluid with negative cytologic findings. The patient denied any history of fever, sweating, pedal edema, wheezing, or shock. Clinical examination findings were generally normal. Examination of the respiratory system disclosed a leftward shift of the trachea and mediastinum with welldemarcated signs of fluid and air on the right side. Chest radiographs (Fig 1, 2) revealed right-sided hydropneumothorax. Intercostal drainage was instituted, which gave prompt relief of her symptoms. However, there was no expansion of the lung despite application of low negative pressure for 72 h. Routine examination of blood and urine disclosed normal findings, and the sputum was repeatedly negative for acid-fast bacilli. Fluid from the pleural cavity was sterile, with negative cytologic findings. A diagnostic procedure was performed.