A 69-year-old man comes to the hospital for worsening shortness of breath and cough. He has sharp right-sided chest pain that worsens on inspiration and coughing. He has coronary artery disease and hypertension and takes his medications regularly. He drinks 4 cans of beer daily and has smoked 2 packs of cigarettes daily for 20 years. His temperature is 38.5°C (101.3° F), pulse is 110/min, respirations are 29/min, and blood pressure is 110/65 mmHg. On physical examination, heart sounds are regular. Lung examination reveals decreased tactile fremitus over the lower right lung along with dullness to percussion. Which of the following is the most likely diagnosis?

Question

A 69-year-old man comes to the hospital for worsening shortness of breath and cough. He has sharp right-sided chest pain that worsens on inspiration and coughing. He has coronary artery disease and hypertension and takes his medications regularly. He drinks 4 cans of beer daily and has smoked 2 packs of cigarettes daily for 20 years. His temperature is 38.5°C (101.3° F), pulse is 110/min, respirations are 29/min, and blood pressure is 110/65 mmHg. On physical examination, heart sounds are regular.  Lung examination reveals decreased tactile fremitus over the lower right lung along with dullness to percussion.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: Fluid in the pleural space acts to insulate sound vibrations that originate in the airways; therefore, pleural effusion causes decreased tactile fremitus and decreased intensity of breath sounds.  The high density of pleural fluid compared to normal lung tissue also causes dullness to percussion.

A 69-Year-Old Man Comes to the Hospital for Worsening Shortness