LAUSR

G. J. Krejs, MD, AGAF, MWGO ( ) Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria [email protected] taking hormonal therapy (progesterone/lynestrenol) because of endometriosis for the last 2 years. Her pulmonologist referred her to the emergency room (ER) of Graz University Medical Center because of rapidly progressive dyspnea and suspected pulmonary embolism. A mass had been detected in the retroperitoneum and biopsied in a hospital in another state 2 months prior to admission. Results of the biopsy were not available. Physical examination on admission was unremarkable except for complete dullness over the right lung on percussion. Blood pressure was 120/80mmHg, heart rate (HR) 138 beats per minute (bpm), temperature 36.0 °C, oxygen saturation at ambient air 95%. Electrocardiogram showed sinus tachycardia (HR 117bpm), S1Q3 type, and P waves and PQ interval were unremarkable. Transthoracic echocardiography revealed normal aortic, mitral and tricuspid valves. The pulmonic valve was not assessable, tricuspid annular plane systolic excursion was reduced at 0.8cm. When moving the sonography sensor to the abdomen, no ascites was seen. Laboratory tests: leukocytes 15.36× 10^9/L (normal: 4.4–11.3× 10^9/L), hemoglobin 16.8g/dL (normal: 12–15.3g/dL), hematocrit 50.3% (normal: 35–45%), gamma-glutamyl transferase 63U/L (normal: <38U/L), C-reactive protein (CRP) 7.5mg/L (normal: <5.0mg/dL), D-dimer 2.18mg/L (normal: <0.5mg/L). X-ray and computed tomography (CT) of the chest revealed a massive pleural effusion on the right side. Immediate paracentesis in the ER yielded 1 L of a white turbid effusion. Detailed analysis see Table 1. A diagnostic test was performed and specific treatment was initiated.