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Black Pleural Effusion

      Abstract

      Background

      Black pleural effusions are extremely rare and have been reported in patients with infection, malignancy, and hemorrhage. However, no review articles appear to have focused on this rare clinical presentation.

      Purpose

      To classify and characterize diseases causing “black pleural effusion” based on the pathophysiological mechanisms involved.

      Methods

      We searched the medical literature to find reports of “black pleural effusion” using the PubMed database.

      Results

      We identified 8 cases and classified the underlying diseases into the following 4 entities based on pathophysiological conditions: 1) infection (Aspergillus niger and Rhizopus oryzae); 2) malignant melanoma, in which cells contain melanin pigment; 3) hemorrhage and hemolysis associated with non-small cell lung cancer or rupture of a pancreatic pseudocyst; and 4) other causes (charcoal-containing empyema). Discrimination between biliopleural fistula and pancreatico-pleural fistula, which also mimicking in color, was easily achieved by focusing on pleural amylase levels, elevation of pleural indirect bilirubin, presence of pleural glycoholic acid, and the predominant site of pleural effusion.

      Conclusion

      Black pleural effusions can be divided into 4 major categories based on the underlying pathophysiological conditions.

      Keywords

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      References

        • Villena V.
        • Lopez-Encuentra A.
        • Garcia-Lujan R.
        • Echave-Sustaeta J.
        • Martinez C.J.
        Clinical implications of appearance of pleural fluid at thoracentesis.
        Chest. 2004; 125: 156-159
        • Metzger J.B.
        • Garagusi V.F.
        • Kerwin D.M.
        Pulmonary oxalosis caused by Aspergillus niger.
        Am Rev Respir Dis. 1984; 129: 501-502
        • Justiniani F.R.
        • Hippalgaonkar R.
        • Martinez L.O.
        Charcoal-containing empyema complicating treatment for overdose.
        Chest. 1985; 87: 404-405
        • Kimmerling E.A.
        • Fedrick J.A.
        • Tenholder M.F.
        Invasive Aspergillus niger with fatal pulmonary oxalosis in chronic obstructive pulmonary disease.
        Chest. 1992; 101: 870-872
        • Lai C.C.
        • Liaw S.J.
        • Hsiao Y.C.
        • et al.
        Empyema thoracis due to Rhizopus oryzae in an allogenic bone marrow transplant recipient.
        Med Mycol. 2006; 44: 75-78
        • Rojas-Solano J.R.
        • Light R.W.
        • Brenes-Dittel A.
        Black pleural fluid [Spanish].
        Arch Bronconeumol. 2009; 45: 103-104
        • Mohan K.M.
        • Gowrinath K.
        Unusual thoracic manifestation of metastatic malignant melanoma.
        Lung India. 2010; 27: 96-98
        • Liao W.C.
        • Chen C.H.
        • Tu C.Y.
        Black pleural effusion in melanoma.
        CMAJ. 2010; 182: E314
        • Koide T.
        • Saraya T.
        • Nakajima A.
        • Kurai D.
        • Ishii H.
        • Goto H.
        A 54-year-old man with an uncommon cause of left pleural effusion.
        Chest. 2012; 141: 560-563
        • Raper K.B.
        Charles Thom, November 11, 1872-May 24, 1956.
        Biogr Mem Natl Acad Sci. 1965; 38: 309-344
        • Kurrein F.
        • Green G.H.
        • Rowles S.L.
        Localized deposition of calcium oxalate around a pulmonary Aspergillus niger fungus ball.
        Am J Clin Pathol. 1975; 64: 556-563
        • Libshitz H.I.
        • North L.B.
        Pulmonary metastases.
        Radiol Clin North Am. 1982; 20: 437-451
        • Chen J.T.
        • Dahmash N.S.
        • Ravin C.E.
        • et al.
        Metastatic melanoma in the thorax: report of 130 patients.
        AJR Am J Roentgenol. 1981; 137: 293-298
        • Murali R.
        • Loughman N.T.
        • McKenzie P.R.
        • Watson G.F.
        • Thompson J.F.
        • Scolyer R.A.
        Cytological features of melanoma in exfoliative fluid specimens.
        J Clin Pathol. 2009; 62: 638-643
        • Sankaran S.
        • Walt A.J.
        The natural and unnatural history of pancreatic pseudocysts.
        Br J Surg. 1975; 62: 37-44
        • Rockey D.C.
        • Cello J.P.
        Pancreaticopleural fistula. Report of 7 patients and review of the literature.
        Medicine (Baltimore). 1990; 69: 332-344
        • Cameron J.L.
        Chronic pancreatic ascites and pancreatic pleural effusions.
        Gastroenterology. 1978; 74: 134-140
        • Kaye M.D.
        Pleuropulmonary complications of pancreatitis.
        Thorax. 1968; 23: 297-306
        • Pottmeyer 3rd, E.W.
        • Frey C.F.
        • Matsuno S.
        Pancreaticopleural fistulas.
        Arch Surg. 1987; 122: 648-654
        • Uchiyama T.
        • Suzuki T.
        • Adachi A.
        • Hiraki S.
        • Iizuka N.
        Pancreatic pleural effusion: case report and review of 113 cases in Japan.
        Am J Gastroenterol. 1992; 87: 387-391
        • Sahn S.A.
        Pleural effusions of extravascular origin.
        Clin Chest Med. 2006; 27: 285-308
        • Rothberg M.L.
        • Klingman R.R.
        • Peetz D.
        • Ferraris V.A.
        • Berry W.R.
        Traumatic thoracobiliary fistula.
        Ann Thorac Surg. 1994; 57: 472-475
        • Anderson R.L.
        Traumatic bronchobiliary fistulae.
        Am Surg. 1961; 27: 431-436
        • Roy D.C.
        • Ravindran P.
        • Padmanabhan R.
        Bronchobiliary fistula secondary to amebic liver abscess.
        Chest. 1972; 62: 523-524
        • Amir-Jahed A.K.
        • Sadrieh M.
        • Farpour A.
        • Azar H.
        • Namdaran F.
        Thoracobilia: a surgical complication of hepatic echinococcosis and amebiasis.
        Ann Thorac Surg. 1972; 14: 198-205
        • Boyd D.P.
        Bronchobiliary and bronchopleural fistulas.
        Ann Thorac Surg. 1977; 24: 481-487
        • Pisani R.J.
        • Zeller F.A.
        Bilious pleural effusion following liver biopsy.
        Chest. 1990; 98: 1535-1537
        • Dasmahapatra H.K.
        • Pepper J.R.
        Bronchopleurobiliary fistula. A complication of intrahepatic biliary stent migration.
        Chest. 1988; 94: 874-875
        • Strange C.
        • Allen M.L.
        • Freedland P.N.
        • Cunningham J.
        • Sahn S.A.
        Biliopleural fistula as a complication of percutaneous biliary drainage: experimental evidence for pleural inflammation.
        Am Rev Respir Dis. 1988; 137: 959-961
        • Clark R.A.
        • Mitchell S.E.
        • Colley D.P.
        • Alexander E.
        Percutaneous catheter biliary decompression.
        AJR Am J Roentgenol. 1981; 137: 503-509
        • Nichols D.M.
        • Cooperberg P.L.
        • Golding R.H.
        • Burhenne H.J.
        The safe intercostal approach? Pleural complications in abdominal interventional radiology.
        AJR Am J Roentgenol. 1984; 142: 1013-1018
        • Dines D.E.
        • Elveback L.R.
        • McCall J.T.
        Zinc, copper, and iron content of pleural fluid in benign and neoplastic disease.
        Thorax. 1972; 27: 368-370
        • Bergman S.
        • Melvin W.S.
        Operative and nonoperative management of pancreatic pseudocysts.
        Surg Clin North Am. 2007; 87 (ix): 1447-1460

      Linked Article

      • Black Pleural Effusion
        The American Journal of MedicineVol. 126Issue 12
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          Saraya et al1 recently published an article that reviewed the possible causes responsible for the development of “black pleural effusions.” Not included in the references was a case report we published describing 2 patients with active crack cocaine (a mixture of cocaine hydrochloride and sodium bicarbonate) use and pleural effusions.2 In both patients, thoracentesis revealed black turbid fluid that on cytologic examination showed dense deposits of carbonaceous material in the macrophage cytoplasm.
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