# 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.

## Key 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.