57 y/o man former smoker, presented with pleuritic CP and found to have left loculated effusion. No constitutional sx. no wt loss, fever, chills, cough. Tap 2 weeks later showed it to be bloody, with 57 WBC, 49% PMN and 49% lymphocytes. He is currently asymptomatic.
The effusion was AFB - times 1. The micro and cytology was negatrive. Dopplers of legs negative and V/Q was intermediate or indeterminate (cant remember) and PE-protocol CT was read as negative.
His Pmhx not remarkable except for 2 previous pneumonias. Last was in march and was on the right side. There was a small parapneumonic effusion which has since resolved.
No history of trauma except moving his furniture 1 day before the pleuritic CP, but he did not hit anything per se. No Fmhx of thrmbosis and in fact his Wells criteria is zero.
What would you all do next?
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plant a ppd?
What is the RBC count? If it is greater than 100,000. You can narrow down DDx. Any exposure to asbestos or any recent cardiac sx?
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