Figures
- Figure 1
Chest radiograph depicting right-sided pleural effusion.
- Figure 2
Chest radiograph depicting right-sided pneumothorax.
- Figure 3
Chest radiograph showing a right-sided chest tube and partial lung re-expansion.
- Figure 4
Chest CT.
- Figure 5
Black-coloured pleural fluid draining from the chest tube.
- Figure 6
Histopathology slides. a) Poorly differentiated tumour arranged in solid sheets (haematoxylin and eosin stain, magnification x100). b) Highly pleomorphic tumour cells with brisk mitotic activity (haematoxylin and eosin stain x400). c) Immunoreactive for CK-7 (immunohistochemistry x100). d) Negative for CK-20 (immunohistochemistry x100). e) Negative for TTF-1 (immunohistochemistry x200). f) Negative for napsin-A (immunohistochemistry x100).
Tables
- Table 1
Pleural fluid analysis
Day 1 (at admission) Day 16 (immediately post-thoracoscopy) Colour Straw-coloured Black Appearance Turbid Black pH 7.46 7.29 Glucose mmol·L−1 4.5 Protein g·L−1 40.2 Serum protein g·L−1 71 Albumin g·L−1 20.6 LDH U·L−1 358 980 Serum LDH U·L−1 271 WBC cells·µL−1 328 1125 Neutrophils % 3 87 Lymphocytes % 93 7 Monocytes % 4 6 RBC cells·µL−1 613 15 375 Gram stain Negative Gram-negative bacilli Culture Negative Pseudomonas aeruginosa and Klebsiella pneumoniae Fungal culture Negative Negative TB PCR, smear, and culture Negative Not done Cytology Abnormal large cohesive cells with nuclear polymorphism and vacuolated cytoplasm suspicious of malignant infiltration Malignant cells present Special characteristics Abundant mesothelial cells present Prominent RBCs# Effusion characterisation Lymphocytic, exudative, malignant effusion Empyema in a malignant effusion LDH: lactate dehydrogenase; WBC: white blood cell; RBC: red blood cell; #: RBC content declined successively over the following days.
- Table 2
Tumour markers
Tumour marker Normal range Value in patient CEA µg·L−1 5.5–6.5 (smoker)
3.8–5 (nonsmoker)6 CA19–9 Units·mL−1 0–27 256 AFP IU·L−1 0–6 4 - Table 3
Previously reported cases of black pleural effusion
Author [ref.] (year) Diagnosis Chhabra et al. [6] (2015) Metastatic melanoma Mohan et al. [7] (2010) Metastatic melanoma Patel et al. [8] (2017) Metastatic melanoma Mishe'el et al. [9] (2016) Metastatic melanoma Sumalani et al. [10] (2019) Metastatic melanoma Liao et al. [11] (2010) Metastatic melanoma Guo et al. [12] (2017) Rupture of pancreatic pseudocyst with pancreaticopleural fistula Ishigaki et al. [13] (2019) Rupture of pancreatic pseudocyst with pancreaticopleural fistula Kaur et al. [14] (2014) Pancreatic pseudocyst with pancreaticopleural fistula Huang et al. [15] (2013) Pancreatic pseudocyst with pancreaticopleural fistula Koide et al. [16] (2012) Pancreatic pseudocyst with pancreaticopleural fistula Mookherjee et al. [17] (2014) Pancreatic pseudocyst with Pancreaticopleural fistula Lai et al. [18] (2006) Rhizopus oryzae empyema thoracis Metzger et al. [19] (1984) Aspergillus niger empyema Koff et al. [20] (2020) Aspergillus niger empyema Jayakrishnan et al. [21] (2015) Adenocarcinoma of pulmonary origin Thampy et al. [22] (2016) Adenocarcinoma of pulmonary origin Fernandes et al. [23] (2018) Adenocarcinoma of pulmonary origin Rojas-Solano et al. [24] (2008) Nonsmall cell carcinoma of the lung Singh et al. [25] (1995) (two cases) Crack cocaine Mitra et al. [26] (2018) Mediastinal cystic teratoma Jacob et al. [27] (2014) Rheumatoid pleurisy Justiniani et al. [28] (1985) Bronchopulmonary fistula Hirsh et al. [29] (2018) Boerhaave hydropneumothorax
