Article Text

Download PDFPDF

Left pleural effusion in a woman with coronary artery by-pass grafting
  1. O Kayacan,
  2. D Karnak,
  3. S Beder,
  4. D Köksal
  1. Ankara University School of Medicine, Chest Diseases Department, Cebeci 06100, Ankara, Turkey
  1. Correspondence to:
 Dr Kayacan

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Answers on p 370.

A 74 year old woman presented with dyspnoea on exertion. She had been hypertensive for 25 years and underwent triple coronary by-pass grafting (CABG) with saphenous vein and left internal mammary artery through a median sternotomy 14 days previously. She was on diuretics and digitalis. Physical examination revealed a sternotomy scar and decreased breath sounds at the left lung base. Vital signs and other systems were normal. Chest radiography and thoracic computed tomography are shown in figs 1 and 2. She had a high white blood cell count 15 × 109/l, neutrophilia (78%), lymphopenia (10.6%), a high erythrocyte sedimentation rate (68 mm/hour) and a low serum albumin level (33 g/l). Diagnostic pleural tap yielded turbid milky fluid consisting 0.045 g/l protein, 226 IU lactic dehydrogenase, 11.6 mmol/l triglycerides, and 3.7 mmol/l cholesterol. Lymphoscintigraphy showed lymphatic leakage to the mediastinum.

Figure 1

 Chest radiograph.

Figure 2

 Computed tomogram.


  1. Describe the chest radiograph and thoracic computed tomography findings.

  2. What is the most likely diagnosis?

  3. What is the most likely mechanism of the disorder?

  4. What do you recommend for the treatment?

Linked Articles