A 19-Year-Old Shooting Victim With Complications

Janice Verham, MD

Disclosures

July 08, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 19-year-old man has developed a loculated pleural effusion after a percutaneous pigtail catheter was inserted into the right side of his chest 5 weeks after polytrauma from multiple gunshot wounds. Minimal output from the chest tube prompted interventional radiology to begin daily tissue plasminogen activator (tPA) administration through the pigtail catheter 2 days ago.

The patient complains of diffuse right-sided chest pain and shortness of breath secondary to pain after the second administration of tPA. He denies leg pain, fevers, chills, or cough.

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