Clinical image
A 67-year-old male smoker presented with a 3-day history of severe
progressive acute respiratory distress (pulse, 120 beats/min,
respiration, 40 breaths/min, and oxygen saturation, 72%). Physical
examination revealed left tracheal deviation, decreased right chest wall
movement, and diminished breath sounds. We suspected tension
pneumothorax and scheduled an emergency needle decompression.
Pre-procedural lung ultrasound showed fluid accumulation in the right
chest; chest radiography revealed large pleural effusion without
pneumothorax (Fig. 1a); and chest computed tomography showed massive,
loculated pleural effusion with gas (Fig. 1b). What is your diagnosis?