Malaysian Family Physician 2012; Volume 7, Number 1 ISSN: 1985-207X (print), 1985-2274 (electronic) ©Academy of Family Physicians of Malaysia Online version: http://www.e-mfp.org/ Case Report Respiratory Clinics MEDIASTINAL SHIFT: A SIGN OF SIGNIFICANT CLINICAL AND RADIOLOGICAL IMPORTANCE IN DIAGNOSIS OF MALIGNANT PLEURAL EFFUSION R Khajotia MBBS(Bom), MD(Bom), MD(Vienna), FAMA(Vienna), FAMS(Vienna) Associate Professor in Internal Medicine and Pulmonology, International Medical University Clinical School, Seremban, Negeri Sembilan, Malaysia. (Rumi Khajotia) Address of correspondence: Dr Rumi Khajotia, Associate Professor in Internal Medicine and Pulmonology, International Medical University Clinical School, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia. Tel: 06-7677 798, Fax: 06-7677 709, Email:
[email protected] Khajotia R. Mediastinal shift: a sign of significant clinical and radiological importance in diagnosis of malignant pleural effusion. Malaysian Family Physician. 2012;7(1):34-36 INTRODUCTION On examination, the patient appeared to be underweight and breathless. His accessory muscles of respiration were active. Mediastinal shift (upper and lower) is a clinical and radiological His pulse rate was 92 beats per minute and the respiratory marker of significant importance, which at times helps to rate was 26 breaths per minute. His blood pressure (BP) determine the aetiological cause of the underlying pathology. was 132/86 mmHg. He was not cyanosed. His finger nails Tracheal shift is an indicator of upper mediastinal shift, while showed nicotine staining, however, there was no clubbing. a shift in the position of the heart indicates a lower mediastinal Cervical and axillary lymph nodes were not palpable. On shift. Since the pleural cavity is confined by the rib cage, in systemic examination of his chest, the trachea was slightly case of a moderately large pleural effusion, the structures in deviated to the right side.