Pleural Effusion in Sub-Saharan Africa
AS, a 55-year-old female housekeeper, presents to the local clinic with complaints of progressively worsening shortness of breath and pleuritic chest pain on the left side for the past month.
AS reports that her symptoms started gradually, initially with mild shortness of breath on exertion. Over the past month, she has developed increasing difficulty breathing, especially when lying flat. She also experiences sharp chest pain on the left side, worsened with deep breathing or coughing. She denies any fever, cough, or recent trauma.
AS lives in a densely populated urban area with her husband. She has worked as a housekeeper for several years, involving moderate physical activity. Access to healthcare services is relatively good in her urban setting.
- General: Appears tired and slightly distressed
- Vitals: BP 140/90 mmHg, HR 90 bpm, RR 22 breaths/min, SpO2 92% on room air, temperature 37.0°C
- Respiratory: Decreased breath sounds and dullness to percussion over the left lower lung field
- Cardiovascular: Regular rhythm, no murmurs
- Abdomen: Soft, non-tender, no organomegaly
- Chest X-ray: Left-sided pleural effusion with blunting of the left costophrenic angle
- Thoracentesis: Yellowish pleural fluid aspirated, sent for analysis
- Blood Tests: Normal complete blood count (CBC), renal and liver function tests
Left-sided Pleural Effusion, likely secondary to underlying aetiology
- Thoracentesis and Fluid Analysis: To confirm the aetiology of the pleural effusion (infectious, malignant, or other).
- Empiric Therapy: Initiation of antibiotics or antitubercular therapy pending fluid analysis results, if infectious aetiology is suspected.
- Symptomatic Management:
- Pain management with analgesics for pleuritic chest pain.
- Oxygen therapy if hypoxemia is present.
- Underlying Cause Treatment: Depending on fluid analysis results, further management tailored to the underlying cause (e.g., antibiotics for pneumonia, chemotherapy for malignancy).
- Patient Education: Counselling on the nature of pleural effusion, adherence to treatment, and follow-up care.
The prognosis for pleural effusion varies widely depending on its underlying cause. Prompt diagnosis and appropriate management are crucial for optimizing outcomes and preventing complications.
This case provides an example of the clinical presentation, diagnostic approach, and initial management considerations for pleural effusion in a patient from an urban area in sub-Saharan Africa.
A). Fever and cough
B). Shortness of breath and pleuritic chest pain
C). Abdominal pain
D). Headache
A). Echocardiogram
B). Chest X-ray showing blunting of the left costophrenic angle
C). Urinalysis
D). Blood glucose test
A). Immediate discharge with oral antibiotics
B). Initiation of empiric antibiotics or antitubercular therapy pending fluid analysis
C). Referral for surgical resection
D). Administration of antiviral medications
A). High protein level and low glucose level
B). Clear fluid with no leukocytes
C). Elevated pH
D). Normal protein and glucose levels
