Abstract
Introduction: Black pleural effusion is a rare condition usually associated with bile ducts or pancreatic cysts fistula. The most common neoplasic cause is melanoma. It is rarely associated with lung cancer. Less than 20 cases have been described, in all causes.
Case Report: A 86-year-old man with a history of stroke and myocardial infarction enters the Emergency Department for dyspnoea on exertion with recent worsening. There was no lung sounds on the left field. The chest X-ray showed a left homogeneous opacity compatible with pleural effusion. Diagnostic thoracentesis revealed a black-coloured pleural fluid (PF). It was, analytically, a complicated exudate: elevated proteins and LDH, decreased glucose. Pleural bilirubin was elevated (total of 7 mg/dL, direct fraction of 0.9 mg/dL in PF and total of 0.5 mg/dL in serum). PF haematocrit was low (6%). Liquid cytology revealed lung adenocarcinoma. The thoracic CT showed two lung nodules, bilateral lymphangitis, bilateral mediastinal adenopathies, pleural thickening and the previously known pleural effusion. The patient maintained good general condition but refused pleurodesis or chemotherapy. He was kept in an outpatient clinic, but died three months later due to disease progression.
Conclusion: In the present case, the black stain most likely results from intrapleural haemolysis following haemorrhage. Pleural fluid bilirubin may be useful in evaluating pleural effusion, especially if black.
Footnotes
Cite this article as: European Respiratory Journal 2018 52: Suppl. 62, PA4113.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2018