Case

An 83-year-old woman presented with a recurrent, right-sided pleural effusion. She had undergone three large volume thoracentesis in the past 2 years, which revealed a ‘clear appearing’ transudative effusion. She had a remote history of haemothorax, a complication from dual chamber pacemaker placement. A chest radiograph (figure 1A) showed a moderate sized, right pleural effusion. Pleural ultrasonography revealed an anechoic fluid collection. Approximately 1.2 L of yellow fluid was removed during thoracentesis. Pleural manometry performed during the thoracentesis revealed a biphasic pressure-volume (P-V) curve showing a steep increase in pleural space elastance at the terminal stages of drainage suggesting an unexpandable lung (figure 2). An air-contrast chest CT scan (figure 1B) showed abnormal visceral pleural thickening consistent with a …