Right Lung Cavity with Bilateral Pleural Effusions

Yuanjie Mao, MD, PhD and Rupesh Raina, MD

July 13, 2016

A 53-year-old previously healthy man presented with a one-day history of chills and dyspnea. He reported that he had been stung by a bee on the right cheek one week prior to presentation. Chest computed tomography (CT) scan showed bilateral pulmonary nodules, a left pleural effusion, and a 3.7cm by 1.6cm cavity in the apical region of the right lung. Physical examination revealed a fading macule on the right side of his face where he had been stung the week before, and decreased breath sounds on the left side of the chest. Laboratory tests were remarkable for a leukocytosis of 18.7 k/μL with a neutrophil predominance The patient was treated with left decortication, left tube thoracostomy, and broad-spectrum antibiotics. However, he developed spikes of fever after initial improvement. Repeat chest CT showed a new loculated right pleural effusion (Figure 1). 

Biographies: 
Yuanjie Mao is a second year resident in Internal Medicine at Cleveland Clinic Akron General Medical Center, OH. 

Rupesh Raina is an attending physician in Nephrology at Cleveland Clinic Akron General Medical Center, OH.