One morning early this year, a 42-year old male patient presented to our Emergency Department due to dyspnea and hypotension.
He used to be healthy and has never visited any hospital until four months prior when he was admitted for Superior Vena Cava Syndrome (SCVS) due to mediastinal mass which turned out to be a poorly differentiated adenocarcinoma of unknown primary. The cancer has spread to lymph nodes, skin, liver and bone. Within weeks of the diagnosis all the treatments planned were palliative. And by the time we saw the patient that morning he was so emaciated he could not gather strength to move his hands when he attempted to scratched his back. His wife, at bedside, did it for him.
Once the CXR was ordered, it showed what we already knew what was causing his symptoms: Pleural Effusion.
Would you do a palliative pleural tap on this patient?