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Images in Thorax
Benign pleural schwannoma presenting with a large, blood-stained pleural effusion
  1. Anna C Bibby1,2,
  2. Richard Daly3,
  3. Eveline Internullo4,
  4. Anthony J Edey5,
  5. Nicholas A Maskell1,2
  1. 1Academic Respiratory Unit, University of Bristol, Bristol, UK
  2. 2North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
  3. 3Department of Histopathology, North Bristol NHS Trust, Bristol, UK
  4. 4Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  5. 5Department of Radiology, North Bristol NHS Trust, Bristol, UK
  1. Correspondence to Dr Anna C Bibby, Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol BS10 5NB, UK; anna.bibby{at}bristol.ac.uk

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A previously fit and well 43-year-old man presented with 8 weeks of worsening breathlessness and a dry cough. He was an ex-smoker of 10 pack-years with no history of asbestos exposure, thoracic radiation or recent trauma.

Chest radiograph and CT thorax are shown in figure 1. Pleural aspiration was undertaken and 1.5 L of blood-stained fluid was removed, with symptomatic improvement. The fluid was exudative, with lactose dehydrogenase (LDH) 437U/L (serum 374U/L) and protein 47g/L (serum 77g/L). Infection was excluded by negative microbiological culture and normal inflammatory markers. Cytology revealed numerous red blood cells, scattered lymphocytes and eosinophils, but no malignant cells.

Figure 1

(A) Posterior–anterior chest radiograph showing moderate left-sided pleural effusion and an indistinct opacity at the left hilum with mediastinal shift to the right. (B) Coronal CT images showing a round, encapsulated extrapulmonary mass, with cystic areas within in, surrounded by a pleural effusion. (C) Coronal positron emission tomography-CT images demonstrating high SUV uptake within …

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