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

Abstract

Background: Pleural effusion is characterized by excessive fluid collection in the pleural cavity. Black pleural effusion (BPE) is a rare entity with only limited scientific data. We aimed to review the current literature on black pleural effusion to characterize demographics, etiology, clinical presentation, pathological findings, available treatment strategies, and prognosis of this rare condition.Methods: We performed a systematic review of case reports and series and synthesized data on demographics, manifestations, management, and outcomes of patients with BPE. We searched Cochrane Library, PubMed, SCOPUS, and Google Scholar for any date until January 10, 2021. All studies (n = 31) that reported black pleural effusion in patients were added to the review. Prospective Register of Systematic Reviews registration number: CRD42020213839. Summary and descriptive analysis was performed on Jamovi version 1.2.Results: The mean age of 32 patients with BPE was 53 years, with male predominance (69%). The commonest risk factor was smoking (n = 9) followed by alcohol intake (n = 8). Dyspnea was the commonest symptom (n = 24, 75%). Pleural fluid was mostly exudative (n = 21). The commonest associated diagnosis was malignancy (n = 14), with 50% secondary to metastatic melanoma. The commonest intervention was therapeutic thoracocentesis (n = 25, 78%), and the effusion recurred in half of the cases where recurrence was reported (n = 13). In our review, we found the mortality rate to be at 20.8% (n = 20.8%). 58.3% of the patients were successfully treated and discharged home (n = 14). Conclusion:Although rare, BPE appears to be a relevant symptom as it seems to be frequently associated with modifiable risk factors and underlying malignancy. Our systematic review substantiates a vital research gap as observational research is imperative to characterize BPE further and form a basis for designing tailored diagnostic, preventive, and therapeutic strategies for BPE.Abbreviations: BPE = black pleural effusion, PNSCC = pulmonary non-small cell carcinoma, PROSPERO = Prospective Register of Systematic Reviews.

Assessment of computed tomography for the diagnosis of exudative and transudative pleural effusion

“…Similarly, the maximum number of PE cases was seen in the age group of 55–65 and 65–75 years. This is in accordance with studies by Abramowitz et al 3 , Saha et al 24 , and Yousaf et al 25 , which also showed similar sex and age distribution.…”

Black pleural effusion caused by a pancreaticopleural fistula associated with autoimmune pancreatitis: A case report

“…Treatment of black pleural effusion requires management of the underlying disease, such as chemotherapy for cancer or antifungal agents for fungal infections. [10] In the present case, steroid therapy for autoimmune pancreatitis resolved the pleural effusion without recurrence. Patients with autoimmune pancreatitis receive steroid therapy, which is effective in many cases.…”

“…To date, 9 cases of black pleural effusion caused by pancreaticopleural fistulae have been reported. [10] Of those, 8 cases were caused by alcoholic pancreatitis, while the remaining case was induced by idiopathic pancreatitis. [2][3][4][5][6][7][8][9]15] Almost all (99%) pancreaticopleural fistulae associated with a pancreatic pseudocyst are caused by alcoholic pancreatitis.…”

“…Black pleural effusion is a rare condition; thus far, only 33 cases of black pleural effusion have been reported. [10,11] Causes of black pleural effusion include malignant melanoma, pancreaticopleural fistula, fungal infections with Aspergillus niger and Rhizopus oryzae, lung cancer, benign malformation species, rheumatoid pleurisy, use of crack cocaine, and charcoal-containing empyema. [12][13][14] Black pleural effusion due to a pancreaticopleural fistula is the consequence of intrathoracic hemorrhage and hemolysis by the pancreatic juice.…”

Black Pleural Effusion as a Complication of Acute Pancreatitis

“…Black pleural effusions are extremely rare presentations and have been reported previously in only a handful of patients with lung malignancy, metastatic melanoma, pancreatic-pleural fistula, rupture of the pancreatic pseudocyst, biliopleural fistula, fungal infections of Aspergillus niger and Rhizopus oryzae [ 1 , 2 ]. Identifying the etiology of the pleural effusion and initiating appropriate management are crucial to preventing fatal complications such as respiratory failure and recurrent accumulation of pleural effusions.…”