An Unusual Intrathoracic Tumour on Pleural Ultrasound for Suspected Effusion

Abstract

A 52-year-old man presented with sudden-onset pleuritic left chest pain and a 2-week history of dry cough. He reported being otherwise well with no prior imaging of the chest. Posteroanterior chest radiograph demonstrated opacification of the left lower zone with obliteration of the left heart border, diaphragm, and left costophrenic angle. Pleural ultrasound revealed a small anechoic effusion adjacent to a mass. Computed tomography with contrast in pleural phase was performed to further define the mass. However, computed tomography showed a large, homogenous, anteroinferior lesion with an average density of 14 Hounsfield units, suggestive of a loculated pleural effusion. Thoracocentesis with real-time ultrasound guidance was performed, and again showed a small volume of anechoic fluid adjacent to an echogenic mass-like lesion. Both substances were sampled, yielding haemoserous fluid and a haemogelatinous material, respectively. Laboratory analysis of both samples was nondiagnostic. Diagnostic VATS demonstrated a 600 mL haemoserous effusion and a large haematocystic mass in the oblique fissure, abutting the pericardium medially and compressing the lower lobe. Biopsy yielded a spindle-cell tumour, which was subsequently resected via thoracotomy. Radiological, intraoperative, and histopathology images are presented. We believe this case demonstrates both an unusual intrathoracic pathology and the utility of pleural ultrasound in diagnostic imaging of the chest.