Fractured rib, pleural effusion, and ascites

Abstract

April, 1997, because of sudden onset of left-sided chest pain after turning over in bed. She had lost 5 kg in the previous 4 months, and had developed abdominal distension and mild breathlessness. She had not had a haemoptysis. She was thin (35 kg), not feverish, had a large right pleural effusion, and marked ascites. Haematological and biochemical variables including indices of inflammation were normal. Blood and urine cultures were negative. A chest radiograph showed a right-sided pleural effusion, with mediastinal shift and a fractured left eleventh rib (figure). Pathological features of pleural and ascitic aspirates were similar; both fluids were heavily blood-stained exudates. Culture and auramine staining were negative. Cytological examination showed abundant lipofuscin with characteristic yellow autofluorescence on a fresh unfixed fluid sample along with haemosiderin-laden macrophages, indicating recent haemorrhage. Mesothelial and occasional groups of atypical epithelial cells were present, although frankly malignant cells were not evident. Contrast-enhanced computed tomography of chest, abdomen, and pelvis showed no other abnormality.