To the Editor.
—The following case report further illustrates the observation by Brown et al1: "recognition that myxedema can cause pleural effusions may save a patient a lengthy and costly" diagnostic evaluation.
Report of a Case.
—A 65-year-old man was referred for a thoracoscopy following a thorough evaluation for a protein-rich effusion (protein, 5.8 g/100 mL) by a pulmonary physician at another hospital. The patient originally had anasarca, but following treatment with diuretics was referred because of a persistent, right-sided pleural effusion. The patient was a heavy smoker and his sputum contained cells suspicious for malignant neoplasms. Hoarseness and a paretic vocal cord lent credence to the suspected diagnosis of bronchogenic carcinoma, but multiple thoracenteses, pleural biopsies, and a fiberoptic bronchoscopic examination had been nondiagnostic. Coccidioidin and tuberculin skin tests were positive, but bronchial washings showed no organisms on fungal and acid-fast preparations.
—Thoracoscopy failed to demonstrate any