A 61-year-old male with persistent left-sided chest pain

Abstract

A 61-year-old male was referred to the outpatient clinic at the Llandough Hospital (Penarth, UK) with persistent left-sided chest pain and a pleural effusion. Apart from mild exertional dyspnoea, he had no other respiratory symptoms of note. He had a past history of ulcerative colitis and had undergone a total colectomy 10 years previously after a severe exacerbation failed to settle with medical therapy. During the operation, there was significant peritoneal soiling after a sealed perforation in the transverse colon gave way. The patient spent an eventful post-operative course in the intensive care unit, where he required further laparotomies for drainage of subphrenic, subhepatic and pelvic collections. A chest drain was also inserted to treat a left-sided empyema. The patient's condition slowly improved, and he was eventually discharged from hospital 8 weeks later.During the 6 years prior to his current consultation, the patient had been admitted to hospital on a number of occasions, with episodes of pyrexia, rigors and shortness of breath. Each episode was diagnosed as pneumonia and was successfully treated with third-generation parenteral cephalosporins. On each occasion, he was noted to have a left-sided pleural effusion, which was never sampled by thoracocentesis.On clinical examination, he was found to have a dull percussion note at the left base with reduced breath sounds. A chest radiograph revealed a collection at the left base.