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Dyspnea in a patient with melanoma

from Clinical Practice and Cases in Emergency Medicine

A 50-year-old woman with widely metastatic melanoma presented to the emergency department with dyspnea. She was found to be tachypneic, hypoxic, tachycardic, and hypotensive. A non-rebreather oxygen mask was placed and her oxygen saturation improved mildly. Emergency staff obtained a semi-erect chest radiograph followed by chest computed tomography angiography due to concerns for a pulmonary embolism. The CXR revealed a depressed left hemidiaphragm and a left pleural effusion. The CTA revealed a massive left pleural effusion causing left lung atelectasis, rightward mediastinal shift and depression of the left hemidiaphragm. more

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