Malignant pleural effusion

Case contributed by Craig Hacking
Diagnosis certain


SOBOE and tachypnea. Poor historian. Weight loss.

Patient Data

Age: 75 years
Gender: Female

There is a large left-sided pleural effusion, which is causing mediastinal shift to the right. Multiple pulmonary nodules throughout the right lung measuring up to approximately 5 mm in size. Assessment of left lung parenchyma is limited due to overlying pleural effusion. No destructive osseous lesion detected.

Given the mastectomy for presumed breast cancer, CT chest is advised to investigate for possible malignant pleural effusion.


Previous right-sided mastectomy. No mass in the underlying chest wall to suggest recurrent or residual disease. No bone lesion.

Mild enlargement of the subcarinal and precarinal lymph nodes. Smaller nodes at the right hilum and anterior mediastinum. No axillary nodal enlargement.

Multiple nodules of varying size are seen throughout both lungs. The largest measures up to 7mm at the apex of the left lower lobe. A large left-sided pleural effusion is associated with compressive atelectasis in the underlying left lung, predominantly involving the left lower lobe which is almost completely collapsed. Mild nodularity at the mediastinal pleura superiorly, which raises concern for pleural metastatic disease.

The adrenal glands are normal. Ill-defined hepatic low density adjacent to the falciform ligament likely relates to steatosis.


Large left-sided pleural effusion. Innumerable nodules throughout both lungs with nodularity along the left mediastinal pleura superiorly. Associated mediastinal lymphadenopathy. Overall features are of diffuse metastatic disease.

Case Discussion

The patient had a history of breast cancer and a pleural tap confirmed the presence of metastatic carcinoma in the left hemithorax. She was palliated due to multiple comorbidities and passed away peacefully several days later.

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