THE DARKNESS WITHIN: A CASE SERIES OF BLACK PLEURAL EFFUSIONS

Abstract

TYPE: Case Report TOPIC: Disorders of the Pleura INTRODUCTION: Black pleural effusions are extremely rare with a limited number of etiologies including fungal infections, hemorrhage/hemolysis, and biliopleural/pancreatico-pleural fistulas. This series involves two Caucasian females with differences in their medical history, pathophysiology, and medical outcome. CASE PRESENTATION: Case 1: A 44-year-old female presented with a 3-month history of worsening exertional dyspnea. Past medical history was significant only for pancreatitis 2 years prior. Computed Tomography of the chest showed a large left-sided pleural effusion with complete left lung collapse and a pancreatic pseudocyst. A 14F pigtail chest tube was placed, producing 300mL of black fluid (Figure 1). Laboratory testing indicated amylase levels >6000 U/L. ERCP confirmed pancreatic-pleural fistula. Decortication and washout were performed after discovery of fibrothorax during thorascopic surgery. She was discharged 16 days after admission with re-expansion of the left lung. Case 2: A 36-year-old female presented with abdominal and chest pain in septic shock. Her past medical history was significant for Marfan syndrome, metastatic neuroendocrine tumor with liver metastasis, infective endocarditis, polysubstance abuse, and several abdominal surgeries. Chest CT indicated right-sided pleural effusion and potential esophageal perforation. A 14F chest tube was placed and 200mL of black fluid was drained. Pleural fluid cultures were significant for Enterococcus faecium and Candida glabrata. Despite aggressive management, the patient continued to decompensate and eventually expired. DISCUSSION: These cases highlight differences in presentation and the pathophysiology causing black pleural effusions and adds to the differential. CONCLUSIONS: The black color in these cases is likely due to pleural fluid bilirubin; and hemolysis with infection, respectively. DISCLOSURE: Nothing to declare. KEYWORD: pleural fistula