A47-02 A Forgotten Wound: Chronic Eosinophilic Pleural Effusion and Lung Entrapment Years After Gunshot Injury

Abstract Introduction Chronic or recurrent exudative pleural effusions usually result from malignancy, infection, autoimmune disease, or post cardiac injury. Trauma related effusions are typically acute and resolve once hemothorax or pneumothorax is evacuated. Delayed pleural fluid accumulation years after injury is exceedingly rare. We present a case of a remote gunshot wound to the chest resulting in a chronic exudative pleural effusion with lung entrapment, representing an uncommon post traumatic sequela. Case Presentation A 41 year old man with a history of gunshot wounds to the chest, back, and occipital region seven years prior presented with exertional left sided chest pain. He denied fever, chills, or dyspnea. He had a five pack year smoking history and daily marijuana use. He was hemodynamically stable and maintained 100 percent oxygen saturation on room air. Examination revealed decreased breath sounds over the left hemithorax. Laboratory studies showed leukocytosis of 15 × 109/L with neutrophilic predominance. Infectious testing including TB, HIV, and viral panel was negative. Chest radiograph showed a large left pleural effusion. CT chest confirmed a large effusion with compressive atelectasis. Thoracentesis removed 400 mL of orange yellow turbid fluid. Analysis revealed WBC 2254 cells/µL (55 percent neutrophils, 42 percent eosinophils), RBC 6080 cells/µL, pH 7.0, albumin 2.35 g/dL, glucose 104 mg/dL, LDH 315 U/L, and serum LDH 99 U/L, consistent with an exudative effusion. Repeat CT showed persistent fluid and left lower lobe entrapment suggesting reaccumulation. The patient remained clinically stable and was discharged with outpatient pulmonology follow up. Discussion Remote thoracic trauma is an underrecognized cause of chronic exudative pleural effusion. Prior intrathoracic injury may cause pleural scarring, fibrin deposition, or microhematoma formation, creating chronic inflammation and remodeling (1). Over time this can lead to recurrent exudative fluid and trapped lung physiology, even years after the initial injury. Eosinophilic predominance, often linked to prior air or blood exposure, may reflect a low grade inflammatory response to an old hemothorax or retained pleural material (2). Similar delayed post traumatic effusions have been reported only rarely (3). Our case highlights remote trauma as an exceedingly rare cause of chronic exudative eosinophilic pleural effusion with lung entrapment. Recognizing this association is important, as prior thoracic injury may lead to delayed pleural inflammation and chronic effusive disease years after the initial insult. Kalomenidis I, Light RW. Curr Opin Pulm Med. 2003;9(4):254-260. Krenke R et al. Arch Bronconeumol. 2011;47(8):410-417.Heidecker J et al. Chest. 2006;129(6):1749-1751. This abstract is funded by: None