No abstract

No abstract

No abstract

A 36-year-old man who was undergoing longterm hemodialysis was hospitalized with a twoday history of increasing dyspnea on exertion. He stated that he did not have cough, orthopnea, or night sweats.On examination, he was found to be in mild respiratory distress, with a blood pressure of 156/68 mm Hg, a respiratory rate of 22, a pulse of 80 per minute, and a temperature of 38.3°C (100.9°F). The site of entry of a right subclavian dialysis catheter appeared unremarkable. There was edema of the left hand and an audible bruit over an arteriovenous shunt in the left forearm. The heart and right lung were normal on examination, but the entire left hemithorax was dull to percussion, with decreased breath sounds. There was no ascites or pedal edema.A chest film revealed a massive, left-sided pleural effusion (Fig. 1). The blood urea nitrogen level was 73 mg per deciliter (26 mmol per liter), the serum creatinine level was 11.3 mg per deciliter (999 µmol per liter), and the hemoglobin level was 10.6 g per deciliter. Serum levels of potassium, sodium, and bicarbonate were normal. In arterial blood, the pH was 7.33, the partial pressure of carbon dioxide was 41 mm Hg, and the partial pressure of oxygen was 84 mm Hg.The New England Journal of Medicine Downloaded from nejm.org at HELSEBIBLIOTEKET GIR DEG TILGANG TIL NEJM on August 13, 2015. For personal use only. No other uses without permission.