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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.
Contributors ACB, EI and NAM conceived the idea for the article. AJE provided the radiology images and wrote the corresponding text. EI supplied the photo in figure 2 and wrote the text regarding the surgical procedure. RD supplied the histological pictures and wrote the corresponding text. ACB wrote the rest of the article, with input and guidance from NAM. All authors reviewed and approved the final manuscript.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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