Transudative pleural effusion of malignant etiology: Rare but real

• Main Authors: Lindsey Johnson, MD, Hafiz Abdul Moiz Fakih, MD, Salim Daouk, MD, Shaheera Saleem, Ali Ataya, MD
• Format: Article
• Language: English
• Published: Elsevier 2017-01-01
• Series: Respiratory Medicine Case Reports
• Subjects: Light's criteria; Pleural effusion; Transudate; Cytology; Immunohistochemistry
• Online Access: http://www.sciencedirect.com/science/article/pii/S2213007117300370

A 62-year-old female presented to the emergency room with one-month history of epigastric abdominal pain, nausea and vomiting. She endorsed progressive dyspnea over two weeks. CT of the abdomen demonstrated bilateral pleural effusions and pancreatic inflammation, so the working diagnosis was pancreatitis. A diagnostic thoracentesis was performed and the pleural fluid analysis was classified as transudate by Light's criteria. Given the atypical features in history and concern for malignancy, fluid was sent for cytological examination and immunohistochemistry which suggested a mucinous malignancy. EGD revealed poorly differentiated signet ring cell adenocarcinoma of stomach. Patient underwent placement of indwelling pleural catheters for symptomatic improvement and was discharged to hospice. The decision whether to routinely send transudative effusions for cytological evaluation remains controversial. This case demonstrates the importance of using clinical judgement to guide that decision.