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16 carcinoma. He developed severe respiratory distress and was brought to the hospital emer- HISTORY: The patient is a 75-year-old male with stage IV gastroesophageal junction gency department and admitted. A large left pleural effusion was noted on CT scan and chest and mechanical ventilation for 25 hours. A chest tube insertion was recommended to relieve X-ray. His condition progressed to acute hypoxic respiratory failure, and he required intubation consented to the procedure. the patient's hypoxic respiratory failure caused by the left pleural effusion, and the patient DESCRIPTION OF PROCEDURE: The patient was placed in the supine position in the medical intensive care unit on propofol drip. His left anterior chest was prepped and draped. One percent plain Xylocaine was administered, and a small incision was made. Using the hemostat, the chest cavity was entered and fluid was returned. Then, using the trocar, the chest tube was placed in the superior portion of the left pleural cavity. There was approxi- mately 1,000 mL of fluid returned. The patient tolerated the procedure well, and the chest tube was sewn in place. A follow-up chest x-ray confirmed good positioning of the tube, and a decrease in the amount of pleural effusion was noted. Cytology examination of the pleural fluid did not show malignant cells. rincipal Diagnosis: 190