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Dyspnoea and a subcutaneous swelling
  1. H Ansari1,
  2. R Bell2
  1. 1Department of Endocrinology, University Hospital, Coventry And Warwickshire
  2. 2University Hospital, Coventry And Warwickshire
  1. Correspondence to:
 Dr Ansari; 

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Answers on 245.

An 81 year old electrician was admitted with exertional dyspnoea and weight loss. His exercise tolerance was decreased to 50 yards. He did not smoke, and denied chest pain or haemoptysis. On examination there were decreased movements of the left hemithorax, decreased left sided air entry and was dull to percuss.


  1. What does the initial radiograph show (fig 1)?

  2. What does the radiograph after the chest drain demonstrate (fig 2)?

  3. What is its significance?

  4. What is shown on the chest photograph (fig 3)?

  5. What is the unifying diagnosis?

Figure 1

Presenting chest radiograph.

Figure 2

Radiograph after chest drain.

Figure 3

Site of chest drain.

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