Pleural effusion presenting as mediastinal widening
A 55-year-old female presented with low grade fever, dry cough and chest discomfort. There was no history of chest pain. She was having psoriasis since 15 years. Patient was on azathioprine 50 mg since 1½ years. She developed diabetes mellitus 6 months back and her blood sugar levels were under control. She had toothache (left side molar area) due to periodontal infection associated with discharge of pus from the cheek since 15 days. Pus culture showed Staphylococcus aureus. Patient was given injection ampicillin, gentamycin and metronidazole. Her total leukocyte count was 20,400 with 88% neutrophils.\nShe visited us for chest discomfort and dry cough with chest radiographic abnormality of mediastinal widening []. To explore the cause of mediastinal shadow, contrast enhanced computed tomography (CECT) thorax was carried out and it showed two large loculated pleural effusions (mean Hounsfield unit of 8) along left anterior and left posterolateral chest wall []. Larger collection was of size 9 cm × 8 cm. Both collections had communication with each other and the fluid accumulated medially.\nIntercostal drain was inserted in left 5th intercostal space in midaxillary line. About 800 ml of pus was drained. Pus culture was sterile and negative for acid fast bacilli. Patient was continued on same antibiotics. Chest radiograph improved gradually []. Ultrasound chest showed the collection of less than 50 ml fluid. Intercostal tube drain was removed and patient discharged in a stable condition.