Ann Thorac Surg 2005;80:1941
© 2005 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Active Malignant Pleural Effusion Captured Through the Thoracoscope
Ajay V. Maker, MD
*
,
Dao M. Nguyen, MD
National Institutes of Health, National Cancer Institute, Surgery Branch, Bethesda, Maryland
* Address correspondence to Dr Nguyen, National Institutes of Health, National Cancer Institute, Bldg 10, Rm 2C710, 10 Center Dr, Bethesda, MD20892 (Email: dao-nguyen{at}nih.gov).
A 37-year-old woman diagnosed with malignant melanoma, having received immunotherapy, was examined in the clinic for a routine 6-month follow-up and CT scan. Upon examination a new massive left pleural effusion with an associated mediastinal shift was discovered. The patient was relatively asymptomatic and saturating well on room air. Physical examination revealed tachycardia and markedly diminished breath sounds in the left hemithorax. She underwent video-assisted thorascopic surgery (VATS) for evacuation of the pleural effusion and talc pleurodesis. Frozen sections of nodules from the collapsed lung and parietal pleura confirmed metastatic melanoma. Exploration of the thoracic cavity revealed copious droplets actively exuding from the diseased parietal pleura and dripping into the pleural space (Fig 1). The malignant pleural effusion was evacuated and controlled with talc poudrage. The patient was not eligible for further immunotherapy and is currently receiving systemic chemotherapy. This case captures the physiologic process of active lymphatic exudation in malignant pleural effusions that we often do not have the opportunity to observe.
