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Breathlessness and cough. CT showed high density pleural effusion, possibility of hemorrhagic effusion. Help?

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Practicing since : 2004
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dear sir , my father age 70 year .basically problem arise shortness breathing and cough etc.we consultat dr. chest specialist 2 times ct scan done and cytology report fist ct scan report CT finding reveal a large high density pleural effusion with septas sugest possibility of hemorrhagic effusion . and left lower lobe is completly collapsed. and cytology report --microscopic smear reveals lymphocytes and rbc only . comments no evidence of malgent cell in smear studied.after removing 4 ltr pleural fluid . second CT scan done follo up ct partial evacuation of the hemothorax and there is surgical emphysema along the course of ICD in the lateral chest wall . moderate residual hemothorax isseen with irrgular thickeing of the pleura membranes which also show multiple enhancing deposits . the left lobe stil collaped. overall imaging finding malignant neoplastic disease with pleural deposit as metastases . and cytology report same as before and no acid fast bacilli not seen . plz suggest can treatable or not advice clearly
Posted Sat, 26 May 2012 in Cancer
Answered by Dr. Indranil Ghosh 1 hour later
Thanks for writing in.
I agree with the last CT scan that all the reports suggest malignant disease, most probably a lung cancer. Is your dad a smoker or a former smoker?
Many a times cytology in fluid does not show malignant cells, that does not rule out malignancy. The pleura is showing deposits. We need to biopsy one of those for a definitive diagnosis.
My approach would be to do a video-assisted thoracosopy, take ample biopsies and then administer talc inside the pleural cavity which would prevent further fluid accumulation.
Further treatment would depend upon the diagnosis, condition of the patient, other coexistent illnesses and organ functions. Unfortunately effusion makes it stage IV and no curative treatment options are available. We can however consider chemo or oral drugs to control the disease for some time.
Hope I have answered your query. I will be happy to answer any follow-up queries.
Best Wishes,
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