Left sided pleural effusion, an unusual presentation of a detrimental pathology 

Left sided pleural effusion, an unusual presentation of a detrimental pathology | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Left sided pleural effusion, an unusual presentation of a detrimental pathology Jibin James, Akhil Paul, Nivediya Venugopal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7167540/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract We report a rare presentation of a left-sided painless pleural effusion, initially suspected to be due to malignancy or tuberculosis based on clinical history and preliminary findings. However, detailed evaluation and imaging revealed the underlying etiology to be a dissecting aortic aneurysm. This case highlights the importance of considering vascular causes in the differential diagnosis of unexplained pleural effusions, particularly when classical symptoms are absent. Early identification of such atypical presentations is crucial for timely intervention and improved patient outcomes. Figures Figure 1 Figure 2 Figure 3 Introduction Acute pleural effusions are commonly caused by trauma, congestive cardiac failure, malignant disease and pulmonary embolism ( 1 ) . But as a rare cause, ruptured descending thoracic aortic aneurysm can also present as acute pleural effusion. Aortic dissection can present with the symptoms similar to pleural effusion along with radiating pain in back, chest or abdomen ( 1 ) . Out of all aortic aneurysms only 19% present with imaging evidence of pleural effusion ( 2 ) . Risk factors for aortic aneurysm include genetic conditions (Marfan and Ehlers–Danlos syndromes), bicuspid aortic valve, and various inflammatory and infectious processes. Early diagnosis of aortic dissection by computed tomography is essential, because mortality is 40% at presentation and increases by 1–2% per hour thereafter ( 1 )( 3 ) . We hereby present a case where an aortic aneurysm was presented as a large pleural effusion. Case A 56 year old lady presented to casualty with a history of breathlessness, two episodes of fainting, fever for two weeks which was low grade and intermittent, and dry cough for two weeks. It was not associated with wheeze or hemoptysis. There was no history of weight loss or anorexia. She was a known case of dyslipidemia and BPPV. There was no history of systemic hypertension, diabetes mellitus, tuberculosis, or obstructive airway disease. On examination, her axillary temperature was 37.2°C, pulse was 112 beats per minute, respiratory rate was 26 breaths per minute, blood pressure was 110/60 mmHg and oxygen saturation measured by pulse oximetry was 92% on room air. She was pale. There was no clubbing, pedal oedema, icterus or lymphadenopathy. Trachea was shifted to the right side, with decreased chest expansion of the left hemi thorax. On percussion, the left mammary, infra axillary and inter and infra scapular regions were stony dull and the breath sounds were absent in these regions. No adventitious sounds were heard bilaterally. The remaining systemic examination was unremarkable. Differential diagnosis of Tuberculosis or malignancy presenting with a left sided pleural effusion were considered. Routine blood investigations revealed a haemoglobin level of 7.4 g/dl, and total leukocyte count of 18,870 cells/mm3 with a differential count of 72% neutrophils, 20% lymphocytes, 2% monocytes, 2% eosinophils and 1% basophils, platelet count was 2,30 000 cells/mm3. Renal function tests, electrolytes and liver function tests were normal. ECG was unremarkable. Chest radiograph was suggestive of a massive left sided pleural effusion with mediastinal shift to right. USG Chest was done which showed a moderate pleural effusion with floating particles. Pleural fluid aspiration was done which showed hemorrhagic effusion, which was lymphocytic exudative. Pleural fluid ADA was 32U/L and hematocrit was less than 50% of the serum hematocrit. Therapeutic drainage of the pleural effusion was planned as the patient was in distress. Considering the differential diagnosis of Tuberculosis and malignancy, it was decided to convert the procedure into a Medical Thoracoscopy. Hemorrhagic effusion with blood clots were removed via the thoracoscope. Against the expectations based on the clinicoradiological findings, thoracoscopy revealed a narrow pleural space with significant mass effect from the mediastinum. Later CECT chest was taken which showed ascending (size 6.4cm) and descending aortic (4.2cm) aneurysm with eccentric mural thrombus in the descending aorta - Type IIIa descending thoracic aortic dissection. Left moderate pleural effusion noted with hyperattenuating contents within which was suggestive of hemothorax. There was collapse of the left lung with mild sparing of the apical segment. One unit of packed red cell was transfused. Cardiothoracic consultation was sought. But the patient went into cardiac arrest and succumbed to death while waiting for further procedures. Discussion Aortic dissection usually presents with severe tearing chest pain, with sudden onset breathlessness, sweating, fainting etc, patient may also gives history of associated comorbidities like uncontrolled high blood pressure, aortic aneurysm, bicuspid aortic valve, aortic coarctation, giant cell arteritis, or any inherited diseases like Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome. Patients may give a history of cocaine use, high-intensity weightlifting. In this case though the patient gave a history of fainting episodes, it was attributed to her previous history of similar episodes due to BPPV. Also she didn't have any classical symptoms like tearing chest pain, sweating, or previous risk factors like hypertension, connective tissue disorders or genetic disorders. With the history of fever and cough and absence of typical findings of aortic dissection it was not considered as one of the differential diagnoses at presentation. The low hematocrit of the pleural fluid was attributed to the time duration between the onset of hemothorax and the point of intervention. The classic presentations of acute aortic dissection may not always be present which often lead to missed diagnoses. Often, aortic dissection is missed in the casualty, only 15–43% cases are accurately diagnosed at first presentation. But the disease carries a high mortality of about 40 to 50% at initial presentation itself. Conclusion Aortic dissection is a catastrophic event that is commonly associated with severe pain, massive hemorrhage, and high mortality ( 4 ) . In this report, we present the case of a 56 year-old lady whose initial clinico radiological evaluation was suggestive of a massive pleural effusion with significant mediastinal shift. Further investigation revealed a Type IIIa descending thoracic aortic dissection. Whenever a patient presents with hemorrhagic pleural effusion, we recommend that aortic aneurysm be included in the differential diagnosis even in the absence of the classic features of aortic dissection, such as chest pain, advanced age, or history of hypertension. Declarations Ethics Approval and Consent to Participate Ethical approval was not required for this case report, as per institutional policies for single patient case reports. Written informed consent was obtained from the patient for participation and for the use of clinical data. Consent for Publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the signed consent form is available for review by the journal’s editorial office upon request. Data Availability All relevant data supporting the findings of this case report are included within the article. Additional details are available from the corresponding author upon reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. References Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease. Circulation 2010;121:e266–369 DOI: 10.1161/CIR.0b013e3181d4739e Nienaber CA, Fattori R, Mehta RH, et al. Gender-related differences in acute aortic dissection. Circulation 2004;109:3014–21 DOI: 10.1161/01.CIR.0000130644.78677.2C Ramanath VS, Oh JK, Sundt TM III., et al Acute aortic syndromes and thoracic aortic aneurysm. Mayo Clinic proceedings. Mayo Clin Proc 2009;84:465–81. DOI: 10.1016/S0025-6196(11)60566-1 Hirst, AE ∙ Johns, VS ∙ Kime, SW. Dissecting aneurysm of the aorta: a review of 505 cases Medicine (Baltimore). 1958; 37:217-279 DOI: 10.1097/00005792-195809000-00003 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7167540","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":494932529,"identity":"f81823fc-cb7c-4ea0-a909-9cd3ea307c13","order_by":0,"name":"Jibin James","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYDCCAwwJhxkMGJjBnA9AzMZOihbGGSAtzIS1MMDVMPOASQI6+G4feHi4oOAOO/+0w4c/2/zaJs/HzMD44WMObi2S5xISDs8weMYscTstTTq377ZhGzMDs+TMbbi1GJwB+oXH4DAzw+0cM+bcntuMQC1szLzEaJG/nf/5s2XPbXvitRjczmGQZvhxO5GgFkmQlhlALYa308wkextuJ7cxMzbj9QvfGZ7kzwV/DifL3U5+/OHHn9u289ubD374iEcLAwNPAohMBrMZ28BkAz71QMB+AETaQTh/CCgeBaNgFIyCEQkA3JJUzZ89DQ4AAAAASUVORK5CYII=","orcid":"","institution":"The Malankara Orthodox Church Medical Mission Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jibin","middleName":"","lastName":"James","suffix":""},{"id":494932530,"identity":"d20cd69d-c188-4d91-baa6-b941bf677fbf","order_by":1,"name":"Akhil Paul","email":"","orcid":"","institution":"The Malankara Orthodox Church Medical Mission Hospital","correspondingAuthor":false,"prefix":"","firstName":"Akhil","middleName":"","lastName":"Paul","suffix":""},{"id":494932531,"identity":"4b5d24c6-3e21-4e4c-9b5a-6e9c00a61623","order_by":2,"name":"Nivediya Venugopal","email":"","orcid":"","institution":"The Malankara Orthodox Church Medical Mission Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nivediya","middleName":"","lastName":"Venugopal","suffix":""}],"badges":[],"createdAt":"2025-07-20 04:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7167540/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7167540/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88411777,"identity":"a621bc45-922a-415a-a1a7-5b2841b06b86","added_by":"auto","created_at":"2025-08-06 08:27:27","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":92585,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure1ChestXray.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7167540/v1/5689c3611870dc99cdf44f89.jpg"},{"id":88411776,"identity":"64c917c8-ec1f-461a-a5fc-4c5c0755f1f7","added_by":"auto","created_at":"2025-08-06 08:27:27","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":37376,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure2Pleuroscopy.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7167540/v1/eb944c5c83aeee2d4c61d345.jpg"},{"id":88411785,"identity":"7074b226-af33-40a9-9705-e057f1710367","added_by":"auto","created_at":"2025-08-06 08:27:27","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":157581,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure3CECT.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7167540/v1/30e17f34f2995260b8f422c1.jpg"},{"id":94623824,"identity":"5147ee29-436a-4f2d-8818-64d5b89b3cd7","added_by":"auto","created_at":"2025-10-29 04:20:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":509679,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7167540/v1/6100e72c-c677-4267-8443-0b89076dfe18.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Left sided pleural effusion, an unusual presentation of a detrimental pathology ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute pleural effusions are commonly caused by trauma, congestive cardiac failure, malignant disease and pulmonary embolism \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e. But as a rare cause, ruptured descending thoracic aortic aneurysm can also present as acute pleural effusion. Aortic dissection can present with the symptoms similar to pleural effusion along with radiating pain in back, chest or abdomen \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e. Out of all aortic aneurysms only 19% present with imaging evidence of pleural effusion \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e. Risk factors for aortic aneurysm include genetic conditions (Marfan and Ehlers–Danlos syndromes), bicuspid aortic valve, and various inflammatory and infectious processes. Early diagnosis of aortic dissection by computed tomography is essential, because mortality is 40% at presentation and increases by 1–2% per hour thereafter\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e. We hereby present a case where an aortic aneurysm was presented as a large pleural effusion."},{"header":"Case","content":"\u003cp\u003eA 56 year old lady presented to casualty with a history of breathlessness, two episodes of fainting, fever for two weeks which was low grade and intermittent, and dry cough for two weeks. It was not associated with wheeze or hemoptysis. There was no history of weight loss or anorexia. She was a known case of dyslipidemia and BPPV. There was no history of systemic hypertension, diabetes mellitus, tuberculosis, or obstructive airway disease.\u003c/p\u003e\u003cp\u003eOn examination, her axillary temperature was 37.2°C, pulse was 112 beats per minute, respiratory rate was 26 breaths per minute, blood pressure was 110/60 mmHg and oxygen saturation measured by pulse oximetry was 92% on room air. She was pale. There was no clubbing, pedal oedema, icterus or lymphadenopathy. Trachea was shifted to the right side, with decreased chest expansion of the left hemi thorax. On percussion, the left mammary, infra axillary and inter and infra scapular regions were stony dull and the breath sounds were absent in these regions. No adventitious sounds were heard bilaterally. The remaining systemic examination was unremarkable. Differential diagnosis of Tuberculosis or malignancy presenting with a left sided pleural effusion were considered.\u003c/p\u003e\u003cp\u003eRoutine blood investigations revealed a haemoglobin level of 7.4 g/dl, and total leukocyte count of 18,870 cells/mm3 with a differential count of 72% neutrophils, 20% lymphocytes, 2% monocytes, 2% eosinophils and 1% basophils, platelet count was 2,30 000 cells/mm3. Renal function tests, electrolytes and liver function tests were normal. ECG was unremarkable.\u003c/p\u003e\u003cp\u003eChest radiograph was suggestive of a massive left sided pleural effusion with mediastinal shift to right.\u003c/p\u003e\u003cp\u003eUSG Chest was done which showed a moderate pleural effusion with floating particles.\u003c/p\u003e\u003cp\u003ePleural fluid aspiration was done which showed hemorrhagic effusion, which was lymphocytic exudative. Pleural fluid ADA was 32U/L and hematocrit was less than 50% of the serum hematocrit.\u003c/p\u003e\u003cp\u003eTherapeutic drainage of the pleural effusion was planned as the patient was in distress. Considering the differential diagnosis of Tuberculosis and malignancy, it was decided to convert the procedure into a Medical Thoracoscopy. Hemorrhagic effusion with blood clots were removed via the thoracoscope. Against the expectations based on the clinicoradiological findings, thoracoscopy revealed a narrow pleural space with significant mass effect from the mediastinum.\u003c/p\u003e\u003cp\u003eLater CECT chest was taken which showed ascending (size 6.4cm) and descending aortic (4.2cm) aneurysm with eccentric mural thrombus in the descending aorta - Type IIIa descending thoracic aortic dissection. Left moderate pleural effusion noted with hyperattenuating contents within which was suggestive of hemothorax. There was collapse of the left lung with mild sparing of the apical segment.\u003c/p\u003e\u003cp\u003eOne unit of packed red cell was transfused. Cardiothoracic consultation was sought. But the patient went into cardiac arrest and succumbed to death while waiting for further procedures.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAortic dissection usually presents with severe tearing chest pain, with sudden onset breathlessness, sweating, fainting etc, patient may also gives history of associated comorbidities like uncontrolled high blood pressure, aortic aneurysm, bicuspid aortic valve, aortic coarctation, giant cell arteritis, or any inherited diseases like Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome. Patients may give a history of cocaine use, high-intensity weightlifting.\u003c/p\u003e\u003cp\u003eIn this case though the patient gave a history of fainting episodes, it was attributed to her previous history of similar episodes due to BPPV. Also she didn't have any classical symptoms like tearing chest pain, sweating, or previous risk factors like hypertension, connective tissue disorders or genetic disorders. With the history of fever and cough and absence of typical findings of aortic dissection it was not considered as one of the differential diagnoses at presentation. The low hematocrit of the pleural fluid was attributed to the time duration between the onset of hemothorax and the point of intervention.\u003c/p\u003e\u003cp\u003eThe classic presentations of acute aortic dissection may not always be present which often lead to missed diagnoses. Often, aortic dissection is missed in the casualty, only 15\u0026ndash;43% cases are accurately diagnosed at first presentation. But the disease carries a high mortality of about 40 to 50% at initial presentation itself.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAortic dissection is a catastrophic event that is commonly associated with severe pain, massive hemorrhage, and high mortality\u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e. In this report, we present the case of a 56 year-old lady whose initial clinico radiological evaluation was suggestive of a massive pleural effusion with significant mediastinal shift. Further investigation revealed a Type IIIa descending thoracic aortic dissection. Whenever a patient presents with hemorrhagic pleural effusion, we recommend that aortic aneurysm be included in the differential diagnosis even in the absence of the classic features of aortic dissection, such as chest pain, advanced age, or history of hypertension.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics Approval and Consent to Participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was not required for this case report, as per institutional policies for single patient case reports. Written informed consent was obtained from the patient for participation and for the use of clinical data.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for Publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the signed consent form is available for review by the journal\u0026rsquo;s editorial office upon request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Availability\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data supporting the findings of this case report are included within the article. Additional details are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease. Circulation 2010;121:e266\u0026ndash;369 DOI: 10.1161/CIR.0b013e3181d4739e\u003c/li\u003e\n\u003cli\u003eNienaber CA, Fattori R, Mehta RH, et al. Gender-related differences in acute aortic dissection. Circulation 2004;109:3014\u0026ndash;21 DOI: 10.1161/01.CIR.0000130644.78677.2C\u003c/li\u003e\n\u003cli\u003eRamanath VS, Oh JK, Sundt TM III., et al Acute aortic syndromes and thoracic aortic aneurysm. Mayo Clinic proceedings. Mayo Clin Proc 2009;84:465\u0026ndash;81. DOI: 10.1016/S0025-6196(11)60566-1\u003c/li\u003e\n\u003cli\u003eHirst, AE ∙ Johns, VS ∙ Kime, SW. Dissecting aneurysm of the aorta: a review of 505 cases Medicine (Baltimore). 1958; 37:217-279 DOI: 10.1097/00005792-195809000-00003\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7167540/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7167540/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe report a rare presentation of a left-sided painless pleural effusion, initially suspected to be due to malignancy or tuberculosis based on clinical history and preliminary findings. However, detailed evaluation and imaging revealed the underlying etiology to be a dissecting aortic aneurysm. This case highlights the importance of considering vascular causes in the differential diagnosis of unexplained pleural effusions, particularly when classical symptoms are absent. Early identification of such atypical presentations is crucial for timely intervention and improved patient outcomes.\u003c/p\u003e","manuscriptTitle":"Left sided pleural effusion, an unusual presentation of a detrimental pathology ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 08:27:22","doi":"10.21203/rs.3.rs-7167540/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"41c9b304-b3cd-400f-a4a0-73328f6e2497","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-29T04:19:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-06 08:27:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7167540","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7167540","identity":"rs-7167540","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}