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Acute chest pain and breathlessness in a haemodialysis patient

Sze Shyang Kho, Swee Kim Chan, Vui Eng Phui, Siew Teck Tie
Breathe 2019 15: e62-e68; DOI: 10.1183/20734735.0352-2018
Sze Shyang Kho
1Division of Respiratory Medicine, Dept of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
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  • ORCID record for Sze Shyang Kho
  • For correspondence: bzk99@hotmail.com
Swee Kim Chan
1Division of Respiratory Medicine, Dept of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
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Vui Eng Phui
2Division of Nephrology, Dept of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
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Siew Teck Tie
1Division of Respiratory Medicine, Dept of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
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    Figure 1

    Chest radiograph.

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    Figure 2

    Left loculated pleural collection with hilar overlay sign.

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    Figure 3

    a) CT of the thorax showing loculated pleural effusion and b) transthoracic ultrasound revealing hyperechoic pleural collection anteriorly.

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    Figure 4

    a) Chest radiograph post-pleural catheter insertion anteriorly; b) insertion of the pleural catheter under real-time ultrasound guidance; c) visualisation of the pleural catheter by flushing with agitated saline (white arrow).

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    Figure 5

    Pleural fluid demonstrated reducing haemorrhagic component over time with intrapleural streptokinase instillation.

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    Figure 6

    a) Complete resolution of pleural collection after intrapleural fibrinolytic; b) Ultrasound of the hemithorax revealed only residual pleural thickening with normal lung sliding.

Tables

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  • Table 1

    Pleural catheter drain output chart

    Treatment dayHaemodialysisIntrapleural fibrinolytic24-h drain output mLCumulative drain output mL
    1Haemodialysis 00
    2 Streptokinase x 1100100
    3Haemodialysis0100
    4 Streptokinase x 150150
    5 Streptokinase x 1100250
    6Haemodialysis100350
    7 Streptokinase x 2200550
    8Haemodialysis100650
    9 0650
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Vol 15 Issue 2 Table of Contents
Breathe: 15 (2)
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Acute chest pain and breathlessness in a haemodialysis patient
Sze Shyang Kho, Swee Kim Chan, Vui Eng Phui, Siew Teck Tie
Breathe Jun 2019, 15 (2) e62-e68; DOI: 10.1183/20734735.0352-2018

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Acute chest pain and breathlessness in a haemodialysis patient
Sze Shyang Kho, Swee Kim Chan, Vui Eng Phui, Siew Teck Tie
Breathe Jun 2019, 15 (2) e62-e68; DOI: 10.1183/20734735.0352-2018
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