Thoracic egophony

Specialty: Respiratory.

• goat voice
• voice transmission with nasal or trembling timbre

Why it occurs

• Upper limit of a moderate amount of pleural effusion (the thin layer of pleural fluid filters the low acoustic frequencies of the patient's voice and transmits only the high ones, transforming the sound of the letter "I" pronounced by the patient into a sound similar to an "A" with a nasal or trembling timbre similar to the bleat of a goat)
• Peripheral pulmonary consolidation on which a small amount of pleural fluid accumulates
• Basal compressive atelectasis secondary to massive ascites or giant hepatomegaly (diaphragmatic elevation with compression of the posterior lung parenchyma)
• Lobar pneumonia complicated with incipient parapneumonic effusion
• Pleural mesothelioma in early stages with nodular thickening and associated effusion.

Initial workup

Diagnostic pleural ultrasound (to confirm the presence of fluid, estimate its volume, and guide safe thoracentesis); Chest x-ray in standing and lateral decubitus position with horizontal ray (Fleischner projection); Diagnostic thoracentesis with pleural fluid analysis (pH, glucose, LDH, proteins, cell count, cytology and cultures); Computed tomography (CT) of the chest with contrast.

Standard management

• Definitive treatment usually requires drainage of pleural fluid through therapeutic thoracentesis or placement of a pleural drainage tube.
• Furosemide — 40 mg intravenously if the effusion is transudative due to heart failure
• Piperacillin/Tazobactam (4.5 g intravenously every 6 hours in case of complicated parapneumonic effusion or empyema).