Case 123 Medical History A 65-year-old male patient complains of progressive dyspnea associated with intermittent fever for the last eight weeks. He has a 60-year-pack smoking history and is a heavy alcohol drinker (consumption of half liter of spirits each day). He is tachypneic and presents diminished breath sounds, dullness to percussion and decreased tactile vocal fremitus on the left hemithorax. His breath sounds are normal on the right side. No alterations are found in blood tests performed to evaluate hepatic and renal function or in urinalysis. However, the hemogram reveals normochromic normocytic anemia. Chest radiography is requested and he undergoes a thoracentesis. Image 1: Posteroanterior chest radiography. Question:Based on the clinical history and image presented, which of the following statements is NOT correct? On the chest radiography, it might be observed a homogenous opacity on the left hemithorax with deviation of the trachea to the right. It is probably an exudative pleural effusion, which might be confirmed by fluid analysis using the Light´s criteria. Water-seal drainage is the prompt treatment of choice. Definitive treatment should be provided after establishing the underlying condition. Tuberculosis and neoplastic diseases are the most probable diagnoses. Thus, Ziehl-Neelsen-stained smears and cytologic examination of the pleural fluid should be the method of choice for determining the exact diagnosis. Time is Up! Time's up
