Investigating a unilateral pleural effusion: A tale of a medical error and diagnostic delays

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Author(s)
Welagedara, Suminda
Swe, Tokyo Moe
Sriram, Krishna Bajee
Year published
2017
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We report the case of an elderly Asian man where a medical error and diagnostic delays obscured the diagnosis of pleural tuberculosis (TB). The patient was hospitalized for evaluation of a unilateral pleural effusion. Initially, the patient was subjected to a pleural aspiration on the wrong side due to a lack of bedside ultrasound guidance. Subsequently, the patient underwent several investigations but not a blind closed pleural biopsy (BCPB) due to a lack of equipment. Furthermore, the patient was deemed to be too sick to undergo a thoracoscopic pleural procedure. Eventually, a bronchoscopy was performed, and washings from ...
View more >We report the case of an elderly Asian man where a medical error and diagnostic delays obscured the diagnosis of pleural tuberculosis (TB). The patient was hospitalized for evaluation of a unilateral pleural effusion. Initially, the patient was subjected to a pleural aspiration on the wrong side due to a lack of bedside ultrasound guidance. Subsequently, the patient underwent several investigations but not a blind closed pleural biopsy (BCPB) due to a lack of equipment. Furthermore, the patient was deemed to be too sick to undergo a thoracoscopic pleural procedure. Eventually, a bronchoscopy was performed, and washings from the right upper lobe were cultured, which established the diagnosis of TB. This case highlights the need to use bedside ultrasound in the investigation of pleural effusions, the role of BCPB especially in frail patients and finally the utility of bronchoscopy in establishing a diagnosis of pleural TB.
View less >
View more >We report the case of an elderly Asian man where a medical error and diagnostic delays obscured the diagnosis of pleural tuberculosis (TB). The patient was hospitalized for evaluation of a unilateral pleural effusion. Initially, the patient was subjected to a pleural aspiration on the wrong side due to a lack of bedside ultrasound guidance. Subsequently, the patient underwent several investigations but not a blind closed pleural biopsy (BCPB) due to a lack of equipment. Furthermore, the patient was deemed to be too sick to undergo a thoracoscopic pleural procedure. Eventually, a bronchoscopy was performed, and washings from the right upper lobe were cultured, which established the diagnosis of TB. This case highlights the need to use bedside ultrasound in the investigation of pleural effusions, the role of BCPB especially in frail patients and finally the utility of bronchoscopy in establishing a diagnosis of pleural TB.
View less >
Journal Title
Lung India
Volume
34
Issue
1
Copyright Statement
© The Author(s) 2017. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0) License (http://creativecommons.org/licenses/by-nc-sa/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited. If you alter, transform, or build upon this work, you may distribute the resulting work only under a licence identical to this one.
Subject
Cardiovascular medicine and haematology
Cardiovascular medicine and haematology not elsewhere classified
Immunology