The Darkness Inside: A Case Report of a Rare Case of Black Pleural Effusion

Abstract

Black pleural effusion (BPE) is an extremely rare entity. This report aims to increase the attention of chest physicians to the differential diagnosis and management of unfamiliar cases of BPE. BPE may occur as a result of fungal Aspergillus niger or Rhizopus oryzae infection, metastatic melanoma, adenocarcinoma, pancreaticopleural fistula (PPF), hemolysis after massive intrapleural bleeding, or other miscellaneous causes. A stepwise approach is needed to evaluate the proper diagnosis including chest X-ray, diagnostic thoracocentesis, cytology and culture of the pleural fluid, thoracic or thoracoabdominal computed tomography, and tissue biopsy for pathological examination. BPE is not a common entity and may hide critical diseases including invasive pulmonary aspergillosis, metastatic melanoma, lung cancer, and PPF, thus awareness of this rare entity is crucial to prevent subsequent complications and to avoid delayed diagnosis of the underlying cause.

Keywords

• bpe
• ppf
• cect