López CY, Pérez MLB, Vizcaíno OD, Molina LA

Language: Spanish
References: 0
Page: 141-142
PDF size: 221.17 Kb.

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56-year-old man with a history of double valve replacement surgery (mitral-aortic) 16 years earlier, with permanent pacemaker implantation due to high grade atrioventricular block, who in recent years had develop a dilated cardiomyopathy, with dilatation of the ascending aorta and the aortic arch and pulmonary arterial hypertension, came to the doctor’s office with signs and symptoms of congestive heart failure with dyspnea at rest, orthopnea, abdominal distension and swelling of the lower limbs. Studies showed the presence of ascites and a moderate right pleural effusion. After several days of treatment with high doses of diuretics, no clinical improvement was noticed and it was decided to perform a pleurocentesis in which some 1200 ml of clear fluid (transudate) were extracted. The patient was discharged, asymptomatic, 24 hours after the procedure. Four days later he was readmitted to hospital with a dyspnea similar to that of the previous hospitalization. The posteroanterior chest radiograph, with the patient standing (Panel A), which was repeated to rule out the possibility of any artifact, showed a big right pleural effusion with two air-fluid levels of different radiopacity (arrows).