Black pleural effusions are extremely rare and have been reported in patients with infection, malignancy, and hemorrhage. However, no review article has focused on this rare clinical presentation. Previous reports of black pleural effusions were reviewed, and the underlying diseases were classified into 4 entities based on the pathophysiological conditions: infection (Aspergillus niger and Rhizopus oryzae); malignant melanoma, in which cells contain melanin pigment; hemorrhage and hemolysis associated with non-small-cell lung cancer or rupture of a pancreatic pseudocyst; and other cause (charcoal-containing empyema). The differences also were discussed, with special reference to distinguishing between biliopleural fistula and pancreaticopleural fistula, which mimic the color but should be discriminated due to their different management.
[Show abstract][Hide abstract] ABSTRACT: Discrimination between aspergilloma and chronic necrotizing pulmonary aspergillosis (CNPA) based on radiological findings can difficult. We describe a patient with aspergilloma and organizing pneumonia that was possibly caused by Aspergillus niger infection and radiologically mimicked CNPA. A postmortem histological analysis showed diffuse alveolar damage that had originated in peri-cavitary lung parenchyma. Calcium oxalate or Aspergillus niger was located inside, but not outside the cavity in the right upper lobe. Calcium oxalate or other unknown hyphal bioactive components might provoke severe lung inflammation not only adjacent to the cavity, but also on the contralateral side.
[Show abstract][Hide abstract] ABSTRACT: Metastatic melanoma is a rare form of skin cancer, but one that comes with a high mortality rate. Pulmonary involvement is frequently seen in metastatic melanoma with only 2% of malignant melanoma patients with thorax metastasis presenting with pleural effusions. Herein, we report an extremely rare case of black pleural effusion from thoracic metastasis of cutaneous malignant melanoma. A 74-year-old man with known metastatic melanoma presented with a 1-month history of worsening lower back and hip pain and was found to have extensive osseous metastatic disease and multiple compression fractures. The patient underwent an uneventful kyphoplasty; however, the following day, he became acutely hypoxic and tachypneic with increased oxygen requirements. Radiographic evaluation revealed new bilateral pleural effusions. Bedside thoracentesis revealed a densely exudative, lymphocyte-predominant black effusion. Cytological examination showed numerous neoplastic cells with melanin deposition. A diagnosis of thoracic metastasis of malignant melanoma was established based on the gross and microscopic appearance of the pleural fluid. To the best of our knowledge, this is the first reported case of black pleural effusions secondary to metastatic melanoma in the United States. Despite the rarity of this presentation, it is important to determine the etiology of the black pleural effusion and to keep metastatic melanoma as a differential diagnosis.
Case Reports in Oncology 05/2015; 8:222-225. DOI:10.1159/000430907
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