Poster Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2026

Postpartum Pleural Effusion and Elevated Cardiac Biomarkers with Ibuprofen: A Diagnostic Challenge (#135)

Nik Nur Iman Nik Ghazali 1 2 , Adam Morton 1
  1. Obstetric Medicine, Mater Mothers' Hospital, Brisbane, QLD, Australia
  2. Endocrinology and Obstetric Medicine, Cairns Base Hospital, Cairns, QLD, Australia

Introduction:
Pleural effusions are infrequently reported in healthy postpartum women but may be under-recognised. Imaging studies have identified small, self-limiting effusions in up to 44% of asymptomatic women.1-4 When accompanied by elevated cardiac markers, distinguishing physiological adaptation from pathology becomes challenging.

 

Case Presentation:
A 28-year-old primigravida presented on day 5 postpartum with a two-day history of dyspnoea, orthopnoea and pleuritic chest pain. She had been taking regular ibuprofen for analgesia. Examination revealed bibasal lung crackles extending to the midzones and reduced air entry at the right lung base. She was normotensive and afebrile. CT pulmonary angiography showed bilateral pleural effusions and interstitial oedema (Figure 1), high-sensitivity cardiac troponin I was elevated at 33ng/l (<9) and BNP at 3760ng/L (<300). Electrocardiography was unremarkable. Echocardiography demonstrated normal biventricular and valvular function, no regional wall abnormalities and a small pericardial effusion. There was no evidence of preeclampsia or alternative aetiology identified. Her symptoms, signs and cardiac biomarkers resolved with low-dose frusemide and cessation of ibuprofen.

 

Discussion:
Benign postpartum pleural and pericardial effusions may relate to physiological fluid shifts and transient capillary leak.1-5 Elevation of cardiac biomarkers without structural heart disease may reflect myocardial strain or fluid overload.6 Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to promote sodium retention and may contribute to pulmonary congestion in susceptible postpartum women.7-9

 

Conclusion:
This case highlights the diagnostic complexity of postpartum pleural effusion with cardiac biomarker elevation. Recognition of benign versus pathological processes is essential, particularly in the context of NSAID use and biomarker elevation.

 

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