Pleural effusion

A 67-year-old man visited for cough and sputum lasting for 5 months. He was a current smoker with a history of 40 pack-year smoking and had coronary arterial disease. Right pleural effusion was seen in a chest X-ray. The character of pleural effusion was exudates with many lymphocytes and a low level of adenosine deaminase. A consolidation was seen in computed tomography (CT) after the effusion had been drained, and no endobronchial lesion was found on the left upper lobe in chest CT.

Bronchoscopy was performed to differentiate the causes of the right lung lesion. There was no endobronchial lesion in the right bronchial tree. Incidentally, mucosal nodularity was observed in the left upper lobe bronchus and was diagnosed with squamous cell carcinoma with biopsy. Pulmonary wedge resection and pleural biopsy were performed to evaluate right lower lobe and pleural lesions through video-assisted thoracoscopic surgery. The results were chronic organizing pneumonia and subpleural fibrosis with chronic inflammation. The lesions of the right lower lobe and right pleura remained without progression until the last follow-up radiologic examination. Lymph node involvement and distant metastasis were not observed in the staging workup.