Black Pleural Effusion: When Lung White(out) Turns Black

Abstract

An 80-year-old female presented to the Emergency Department with two weeks' duration of dyspnoea, loss of voice and weight loss. She denied fever, night sweats, gastrointestinal or joint symptoms. She also did not have ocular symptoms such as flashes, floaters or visual field defects. Significant medical history included diabetes mellitus, hypertension, hyperlipidaemia, osteoporosis, and early dementia. On arrival, tympanic temperature was 36.8ºC, blood pressure was 87/60mmHg, heart rate was 60/min and oxygen saturation was 98% on room air. Physical examination revealed stony dullness percussion note associated with reduced air entry of the left hemi-thorax. There are no naevi noted on the patient's body or conjunctiva. Chest radiograph showed a complete whiteout of the left hemithorax with mediastinal shift to the contralateral side (Figure 1 Panel A). Computed tomography (CT) scan of the thorax, abdomen and pelvis showed a massive left effusion with mediastinal compression, as well as a gastric fundal mass (Figure 1 Panel B). Bedside thoracostomy drained 1.5 litres of black pleural effusion (Figure 2). Pleural fluid study

Etiology, pathological characteristics, and clinical management of black pleural effusion

“…Data of 32 patients with black pleural effusion patients extracted and reported from 31 eligible articles are summarized in Tables 1 and 2 concerning demographics and admission to hospital diagnosis [6–9,12–38] . The flow of information through the different phases of our systematic review is depicted in Fig.…”

“…The causes of black pleural effusion (BPE) range from infection, rheumatoid arthritis, pleuroperitoneal fistula, and malignancy [5] . Given the paucity of literature and the rare occurrence of BPE, we aimed to perform a systematic review to characterize the manifestations, underlying diagnosis, and outcomes related to BPE to guide clinicians in managing this condition [5–9] …”

“…[5] Given the paucity of literature and the rare occurrence of BPE, we aimed to perform a systematic review to characterize the manifestations, underlying diagnosis, and outcomes related to BPE to guide clinicians in managing this condition. [5][6][7][8][9] 2. Methods…”

Three cases of black pleural effusion

“… Author Age/Sex Diagnosis Management Outcome Watanabe et al [ 10 ] 57/M Pancreaticopleural fistula; Acute on chronic alcoholic pancreatitis Tube thoracostomy Effusion resolved Ye, J. et al [ 11 ] 64/M Pancreaticopleural fistula; Suspected IgG4 Disease Thoracentesis; Endoscopic pancreatic duct stenting Effusion resolved Arumairaj, A.J. et al [ 12 ] 48/M Pancreatic pleural effusion Tube thoracostomy Effusion resolved Miyadera, K. et al [ 13 ] 59/F Pancreaticopleural fistula/Autoimmune pancreatitis Endoscopic pancreatic sphincterotomy and pancreatic duct stent placement/Systemic steroids Effusion resolved Nikiforov et al [ 14 ] 27/M Severe acute pancreatitis Tube thoracostomy Effusion resolved Tanaka, T. et al [ 15 ] 55/M Boerhaave syndrome Thoracentesis; Surgical repair Effusion resolved Jagganath et al [ 16 ] 24/M Pancreaticopleural fistula; Pancreatic pseudocyst Tube thoracostomy, somatostatin analogue; Open cystogastrostomy Effusion resolved Newman et al [ 17 ] 34/M Crack cocaine Thoracentesis Unknown Ng, Z. et al [ 18 ] …”