eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2021-03-14 9 5 305 307 10.12691/ajmcr-9-5-12 AJMCR20219512 article Hana Manzoor hana.manzoor@beaumont.org 1 Eman El-Sawalhy 1 Wehbi Hnayni 1 Gustavo Tataje Renfigo 1 Anthony G. Ashkar 2 Department of Internal Medicine, Beaumont Hospital, Dearborn, MI Division of Pulmonology and Intensive Care, Internal Medicine Department, Beaumont Hospital, Dearborn, MI Obstructive shock is one of the rarest types of shock. It is caused by the reduction of cardiac output despite normal intravascular volume or cardiac function. In this case report, we present a case of a seventy-four-year-old female, who was sent to our emergency department (ED) for evaluation of one week history of dyspnea and abnormal chest X-ray. Initial Contrast Tomography (CT) scan of the chest showed a large necrotic left upper lobe mass with multiple pulmonary nodules, small left-sided pleural effusion and mediastinal lymphadenopathy. Few days later, she developed worsening dyspnea and hypotension, requiring intubation and vasopressors for hemodynamic support. A repeat CT scan showed large left-sided pleural effusion with rightward mediastinal shift that required thoracostomy tube insertion to immediately improve the underlying obstructive shock. http://pubs.sciepub.com/ajmcr/9/5/12/ajmcr-9-5-12.pdf obstructive shock massive hemothorax pleural effusion non-traumatic