Clinical Case of Pleural Effusion with an Interesting Ultrasound Picture

Abstract

We present the case history of a 50-year-old male with mild fever, cough and chest pain. Physical examination and ultrasound documented a loculated left pleural effusion. An exploratory puncture was performed with aspiration of yellow liquid, seen to be rich in lymphocytes. Parasternal ultrasound showed a 12 mm homogeneous, reactive, oval lymph node of the left internal mammary chain. An immediate medical thoracoscopy showed a hyperaemic pleura with dense pink granulations. Multiple pleural biopsies were performed at several points, taking material for both microbiological and histological examination. Histological examination showed the presence of numerous granulomas with focal necrosis; microbiological examination of pleural fluid, fibrin and pleural biopsy was negative for M. tuberculosis on both direct examination and culture.