18.7.2 Diagnosis

•Symptoms: cough, coarseness, dyspnea, orthopnea, possibly anxiety, confusion, fatigue, headache, distorted vision, lethargy. Aggravated symptoms in supine position. Physical examination: Swelling, plethora of face, neck, and upper extremities, wheezing and stridor, edema of conjunctiva. Veins on chest wall may be prominent. Possibly pleural effusion and/or pericardial effusion

•Radiology: chest X-ray, further diagnostic steps after consultation with oncology, andanesthetic,andintensivecaredepartments(CT-angiography,MR-angiography, venography)

•Laboratory analysis: complete blood count with differential count

•Sodium, potassium, calcium, magnesium, urea, creatinine, phosphorus, uric acid, LDH

18.7.3 Treatment

•Possibly intensive care

•Treatment of the primary disease

•Consider thrombolysis

18.8 Pleural and Pericardial Effusion

18.8.1 General

• Transudate (low concentration of proteins, specific gravity less than 1.015, few cells) or exudate (high concentration of protein, often more than 0.25 g/l, specific gravity more than 1.015, high cellularity)

• Small pleural and pericardial effusion often asymptomatic

18.8.2 Diagnosis

•Symptoms: variable, asymptomatic – respiratory insufficiency. Painful respiration and cough, mainly if pleura is involved, paradoxical pulse

•Radiology: chest X-ray, ultrasound (pericardial effusion)

•Laboratory analysis: complete blood count with differential count. Thoracentesis or pericardiocentesis after consultation with oncologist (cellularity, cytology, microbiology, concentration of protein, specific weight, LDH)

•ECG

18.8.3 Treatment

•Possibly intensive care

•Treatment of primary disease