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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Article Info
Publication History
Published online: April 15, 2013
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: This work is original and all authors meet the criteria for authorship, including acceptance of responsibility for the scientific content of the manuscript.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Black Pleural EffusionThe American Journal of MedicineVol. 126Issue 12
- PreviewSaraya 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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