"Breathing is the key that unlocks the whole catalog of advanced biological function and

development. Is it any wonder that it is so central to every aspect of health? Breathing is the first
place, not the last, one should look when fatigue, disease, or other evidence of disordered
energy presents itself. Breathing is truly the body’s most basic communication system.”

Stephen Hendler, MD

A pleasant morning to everyone, welcome to the Group 5 subgroup A’s case presentation
entitled DROWNING INSIDE

The objectives of this case presentation are as follows:

 To present a case of pleural effusion in a 39-year old male

 To discuss the approach to a patient with dyspnea

 To discuss the approach to a patient with pleural effusion

 To discuss on the pathophysiology of the condition, types of pleural fluid and its
corresponding causes

 To discuss the management of patient with pleural effusion

Presenting a case of of JL, a 39-year old male, Filipino, Roman Catholic, married, unemployed,
from Talisayan, Misamis Oriental who is admitted for the first time in this institution with a chief
complaint of dyspnea.

For the history of present illness, 1-month PTA, patient had onset of cough, intermittent, non-
productive, associated with body malaise, night-sweats and weight-loss of about 2 kg. No
associated shortness of breath, fever, or chest pain. Patient self-medicated with Carbocisteine,
1 capsule three times a day for one week, without relief of signs and symptoms. No consult
done.

During the interim, patient noted persistence of cough with minimal, whitish sputum, and
body malaise.

3 weeks PTA, patient had persistent cough now productive of yellowish, non-blood-
tinged sputum, and new onset of dull pain on the right postero-inferior chest upon inspiration,
radiating toward the shoulder blades, with pain score of 5/10, associated with dyspnea when
lying supine which was relieved by side-lying, easy-fatigability, and further weight-loss of around
4 kg. Thus, patient sought consult at Iligan Sanitarium Hospital wherein chest x-ray revealed
pleural effusion on the right estimated at 120ml. Patient was managed as a case of Community-
Acquired Pneumonia, and was then prescribed with unrecalled antibiotics and Furosemide
(Lasix) 40 mg, both taken with good compliance for a week, which temporarily relieved the
condition. During the interim, patient experienced worsening of back pain upon breathing,
difficulty of sleeping at night due to dyspneic episodes, constant fatigue and dry cough.
However, condition was tolerated, thus no consult done.
 Morning PTA, patient had sudden onset of shortness of breath and persistent back pain
predominantly on the right lower area which was aggravated by breathing. There was no
associated fever or chest pain. Patient consulted at Talisayan - Misamis Oriental Provincial
Hospital wherein chest-xray was done revealing right-sided pleural effusion about 560cc with
passive atelectasis of right lower lung, thus was subsequently referred to this institution, hence
this admission.

For the past medical history, patient is non-hypertensive, nondiabetic and non-asthmatic.
Patient denies receiving any treatment for PTB. No history of any hospitalization, surgery, or
injury. Patient has no known drug and food allergies.

For the family history, patient’s mother is a known hypertensive, while his father is a
diagnosed case of PTB and is currently undergoing treatment for two months. He denied
presence of diabetes mellitus, asthma, and cancer in the family.

For the personal and social history, patient is married for 11 years with two children, and
is currently living with his parents. He is a non-smoker, non-alcoholic beverage drinker and
denies use of illicit drugs. Patient is a previous construction worker, currently unemployed.
Patient had multiple sexual partners.

For the Review of Systems, pertinent negatives were hemoptysis, orthopnea, and paroxysmal
nocturnal dyspnea. The rest were unremarkable.