An 88-year-old man with a history of transitional cell carcinoma of the bladder who had undergone a cystectomy with ileal conduit diversion was admitted for persistent fever, leukocytosis, and hypoxia. Physical examination showed he had decreased breath sounds over the right posterior chest. Chest x-ray and computed tomography (CT) scanning of the thorax revealed a moderate-sized right pleural effusion. A diagnostic and therapeutic thoracentesis was performed, which revealed 450 cc of serosanguinous fluid. The patient tolerated the procedure without hemodynamic compromise. A postprocedural chest x-ray (Figure 1) and contrast-enhanced CT scan of the abdomen/pelvis (Figure 2) were ordered.

What's the Diagnosis?

• Pneumothorax
• Liver puncture
• Bowel perforation
• Traumatic rupture of the diaphragm