Right Sided Haemorrhagic Pleural Effusion Secondary to Pancreatitis

A 28-year-old male patient, painter by occupation came to the department of pulmonology of Rajarajeswari Medical College, Kambipura, Karnataka, with complaints of right sided chest pain since 4 months, dry cough since one month and loss of appetite with significant weight loss. The patient was a chronic alcoholic and a non-smoker. History revealed that he was admitted in a primary health care centre for one week with similar complaints 3 months back and chest radiographs were taken. The radiograph showed right sided massive pleural effusion for which diagnostic thoracocentesis was done, which revealed haemorrhagic fluid. Pleural fluid analysis showed lymphocytic predominance; there after, repeated thoracocentesis was done in the same primary health centre and up to 5 litres of haemorrhagic pleural fluid was aspirated. Routine blood reports were within normal limits.

Diagnosis and Management of Chronic Cough due to Extrapulmonary Etiologies.

Cough remains one of the chief complaints for which patients seek medical attention. It has been estimated that at least 25% of chronic cough cases are caused by multiple, simultaneous causes. Cough is also an important presenting feature of a number of extrapulmonary conditions, such as cardiac diseases, upper airway diseases, gastroesophageal reflux diseases and neurological/ psychological conditions. The diagnosis of extrapulmonary causes of cough is quite challenging and the management is complicated by poor treatment response if underlying etiological mechanisms are overlooked. The intention of this article is to highlight the importance and consequences of nonpulmonary etiologies of cough such as drug-induced vocal cord dysfunction, gastroesophageal reflux disease, laryngeal reflux and neuropathic disorders and to discuss about management strategies for each etiology.