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Myxedematous Effusions

Yossef Aelony, MD
Arch Intern Med. 1984;144(4):857-861. doi:10.1001/archinte.1984.00350160227043.
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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.

Comment.  —Thoracoscopy failed to demonstrate any


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