An Unexpected Discovery

On Feb 28, 2024, I decided I need to visit an urgent care clinic to determine if this was something serious. I had just walked a relatively short distance back to my car...maybe a few hundred yards and I was quite winded. That is highly unusual for me. I work out three times per week and don't have any issues with stairs, hiking, or walking long distances. This was something new and I knew it would be unwise to simply ignore it. I had been dealing with this shortness of breath for about 5 days. I initially thought it was just sore ribs or some other muscle issue in my chest, after multiple days that theory just didn't seem as plausible.

At the clinic they took my vitals and asked about my reasons for visiting. I learned something firsthand here...if you are over 40 and mention you are struggling with chest pain, medical attention is provided quite rapidly.

The doctor came in and I greatly appreciated her candor. She said that given my age and overall good health that the likely answer was some form of muscle issue in my chest, but they couldn't rule out more serious issues like pulmonary embolism. She said that if I were her family member, she would want me to go to the emergency room just to be certain and that is exactly what I did.

I went to the ER and to make a long story a bit shorter, they tested me for multiple things. EKG on my heart was normal and healthy. Blood work was normal. Vitals were normal and healthy. In order to test for pulmonary embolism which was the primary concern at that time, they did a contrast CT Scan of my chest. This is what changed the course of the investigation. The ER doctor, who was amazing, came in and said I didn't have a pulmonary embolism but then showed me the CT images of how 60% of my left lung appeared collapsed because of a build up of fluid in the space where my lung should be.

This condition is called Pleural Effusion. The pleura is the space in which your lungs reside so they don't touch any other organs when they are expanding and contracting. Apparently, my left pleura was filling up with fluid and had already displaced 60% of my left lung. This was the cause of my shortness of breath...no doubt. The big remaining question was why was it filling with fluid.

One additional thing to note here was that a shape was clearly evident in the CT Scan results--a circular mass of about 3-4 cm and uniform in density residing about half way up my left lung. This was a big first clue, but still several possibilities existed to explain the pleural effusion (fluid in my chest). Infection was the most likely from a statistical perspective, but malignancy was on the list of course.

The ER doctor consulted with the pulmonary specialist on call about how best to proceed. At that time, the specialist did not believe I had cancer given all the other data. I was presented with some options, but in the end I chose to have the ER doctor perform a thoracentesis which is just the medical term for a giant needle in your back which goes all the way into the pleural space to drain the fluid. It was a bizarre sensation, but the only painful part was the needle with the numbing medication. That seemed quite ironic to me.

In the end, they drained 1300ML from my chest. Another surprise occurred here. The fluid was bloody. That is not a good sign. All of this was sent for further testing. The doctor made a statement which I remember quite clearly, "You don't ever want to be interesting to a doctor and right now you are very interesting."

I got dressed and went home, able to breath slightly easier with over a liter of fluid removed from my chest but still no clear answer. We knew a few things that it wasn't but the remaining possibilities were likely more serious.

-Jeremy