Curious case of a black pleural effusion: Mediastinal teratoma presenting as massive pleural effusion

• Published in: Lung India Vol. 35; no. 1; pp. 87 - 89
• Main Authors: Mitra, Subhra, Sarma, Mridul Kumar, Das, Anjan Kumar
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01-01-2018; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Calcification; Case Letters; Cysts; Hospitals; Ostomy; Pain; Tumors
• ISSN: 0970-2113; 0974-598X
• DOI: 10.4103/lungindia.lungindia_253_17

A diagnostic pleural fluid aspiration confirmed the black color of the effusion [Figure 1]b. Pleural fluid analysis revealed degenerated cells; Glucose was 2 mg/dl and protein 4 g/dl. A careful review of the CT films showed loculated collections with fat densities along with free fluid in the pleural cavity [Figure 2]a and [Figure 2]b.{Figure 2} Due to the presence of fat densities inside the cystic multiloculated mass, a diagnosis of mediastinal cystic teratoma was considered and the mistake of putting in a chest tube was avoided and the patient was referred to a cardiothoracic surgeon for exploratory thoracotomy. Acareful evaluation of CT revealed some fat densities in the multiloculated mass associated with the effusion enabling us to make a tentative diagnosis of a mature cystic teratoma before referring her for an urgent thoracotomy.