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E. Thampy, S.V. Cherian, Black pleural effusion, QJM: An International Journal of Medicine, Volume 109, Issue 11, November 2016, Page 761, https://doi.org/10.1093/qjmed/hcw150
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Case report
A 58-year-old man was admitted with shortness of breath and vague chest pain. Chest X-ray followed by CT scan revealed a left pleural effusion (red arrow) with pleural thickening (blue arrow) and collapse of left lung (Figure 1A). Thoracentesis was performed which revealed black pleural fluid (Figure 1B) that was exudative based on total protein 4.2 g/dl, LDH 2805 U/l and glucose <1 mg/dl. Cytologic evaluation of pleural fluid did not reveal any malignant cells. Bronchoscopy with trans-bronchial needle aspiration of subcarinal and paratracheal lymph nodes revealed mucinous adenocarcinoma of lung. Further workup revealed lytic bone lesions consistent with metastatic spread. The patient was started on palliative chemotherapy and underwent placement of a left sided pleurx catheter.
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Black pleural effusion is a very rare entity, with <10 cases reported in world literature. It has been reported in fungal infections (secondary to Aspergillus niger and Rhizopus oryzae), malignancies such as metastatic melanoma and adenocarcinoma of the lung, rupture of pancreatopleural fistula, esophageal perforation during activated charcoal treatment for a drug overdose. Black color of the pleural fluid in our case was likely the result of hemolysis associated with bleeding into the pleural space.1
