Right-Sided Pleural Effusion in a Critically Ill Stroke Patient

TL;DR

A stroke patient developed a right-sided pleural effusion and later an esophageal perforation with cancer, requiring surgical repair.

Contribution

This case highlights the importance of thorough evaluation in critically ill stroke patients with atypical respiratory findings.

Findings

A left middle cerebral artery stroke patient developed a right-sided pleural effusion.

A fluoroscopic examination revealed an esophageal perforation with non–small cell carcinoma.

Surgical repair was performed following the identification of the perforation and cancer.

Abstract

Pleural fluid collections are common in those critically ill. We report the case of a left middle cerebral artery stroke patient who developed respiratory distress and required intubation and mechanical ventilation. Although the patient’s clinical status and oxygenation improved, there was persistence of right-sided opacity in the chest radiograph. Further workup proved a right-sided pleural effusion, which was drained and managed. Following extubation, a swallow study was ordered, which led to a fluoroscopic examination that demonstrated esophageal perforation. Thoracic surgery was consulted and did a primary repair of perforation and noted non–small cell carcinoma on the perforated site.

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