Q J Med 2014; 107:481 doi:10.1093/qjmed/hct214
Advance Access Publication 22 October 2013
Clinical picture Jelly-like pleural effusion Case report
Photographs and text from: J.-S. Liu and C.-Y. Tu; T.-C. Shen, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chu Shang Show Chwan Hospital, Nantou, Taiwan. email: [email protected] Conflict of interest: None declared.
References 1. Chang LC, Hua CC, Liu YC, Chu CM, Chen HJ, Lee N. Pleural fluid viscosity may help identifying malignant pleural effusions. Respirology 2008; 13:341–5.
Figure 1. Jelly-like pleural effusion.
2. Friedberg JS, Cengel KA. Pleural malignancies. Semin Radiat Oncol 2010; 20:208–14.
! The Author 2013. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on March 26, 2016
A 50-year-old woman presented with insidiously onset of shortness of breath for several months. Physical examination revealed dull percussion and reduced breath sounds over left lung filed. Computerized tomography revealed a huge loculated pleural effusion. Ultrasonography revealed fluid color sign within a well-defined, homogeneously echoic lesion. Subsequently, thoracentasis was performed; however, the effusion fluid was difficult to aspirate owing to its high viscosity. Finally, a 12-F pigtail catheter was inserted using negative pressure; the sticky ‘jelly-like’ effusion fluid was then slowly drained out (Figure 1). The results for cell counts, differential and all biochemistry tests were inconclusive. Cytology of the specimen revealed no malignant cells. Finally, diagnosis of metastatic adenocarcinoma of cervical origin was confirmed by pleural biopsy. Pleural fluid viscosity is influenced by cellular constituents and macromolecule composition, whose major component is protein. Malignant pleural effusions demonstrate high expression of mucin, thus increasing pleural fluid viscosity.1
In addition, synthesis of hydrated mucin glycoproteins observed in the metastatic cervical adenocarcinoma may contribute to this condition.2 As we know, cell count, differential and tests for biochemistry are critical to determinate the nature of a pleural effusion. It is hard to evaluate the effusion fluid inconclusive to above tests. We suggest that histopathology, in combination with a targeted history, physical examination, chest imaging, allows the physician to make a definitive diagnosis.
Advance Access Publication 22 October 2013
Clinical picture Jelly-like pleural effusion Case report
Photographs and text from: J.-S. Liu and C.-Y. Tu; T.-C. Shen, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chu Shang Show Chwan Hospital, Nantou, Taiwan. email: [email protected] Conflict of interest: None declared.
References 1. Chang LC, Hua CC, Liu YC, Chu CM, Chen HJ, Lee N. Pleural fluid viscosity may help identifying malignant pleural effusions. Respirology 2008; 13:341–5.
Figure 1. Jelly-like pleural effusion.
2. Friedberg JS, Cengel KA. Pleural malignancies. Semin Radiat Oncol 2010; 20:208–14.
! The Author 2013. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on March 26, 2016
A 50-year-old woman presented with insidiously onset of shortness of breath for several months. Physical examination revealed dull percussion and reduced breath sounds over left lung filed. Computerized tomography revealed a huge loculated pleural effusion. Ultrasonography revealed fluid color sign within a well-defined, homogeneously echoic lesion. Subsequently, thoracentasis was performed; however, the effusion fluid was difficult to aspirate owing to its high viscosity. Finally, a 12-F pigtail catheter was inserted using negative pressure; the sticky ‘jelly-like’ effusion fluid was then slowly drained out (Figure 1). The results for cell counts, differential and all biochemistry tests were inconclusive. Cytology of the specimen revealed no malignant cells. Finally, diagnosis of metastatic adenocarcinoma of cervical origin was confirmed by pleural biopsy. Pleural fluid viscosity is influenced by cellular constituents and macromolecule composition, whose major component is protein. Malignant pleural effusions demonstrate high expression of mucin, thus increasing pleural fluid viscosity.1
In addition, synthesis of hydrated mucin glycoproteins observed in the metastatic cervical adenocarcinoma may contribute to this condition.2 As we know, cell count, differential and tests for biochemistry are critical to determinate the nature of a pleural effusion. It is hard to evaluate the effusion fluid inconclusive to above tests. We suggest that histopathology, in combination with a targeted history, physical examination, chest imaging, allows the physician to make a definitive diagnosis.
