Pleural effusion is a common presentation of several pathologies, and the determination of its cause is facilitated by macroscopic, biochemical, microbiological, and cellular analysis. A systematic approach to analyzing the fluid allows for a reduction in clinical diagnoses. Only a select number of diagnoses can be established definitively by thoracentesis, including effusions because of malignancy.
We report the case of an 84-year-old male with a right large-volume pleural effusion with an initial diagnostic thoracocentesis demonstrating an exudate with a gelatinous appearance and exudate characteristics. The physical characteristics of the pleural effusion quickly raised the suspicion of mesothelioma, a rare tumor associated with a poor prognosis.
In most diseases related to pleural effusion, fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Malignant pleural mesothelioma may present as a viscous pleural effusion with gelatinous characteristics, which may immediately raise suspicion and contribute as a diagnostic clue in the initial study of a pleural effusion….
Excess fluid accumulation in the pleural space can be caused by both malignant and benign conditions. Usually, pleural effusions are classified into transudates and exudates. An exudate occurs when there is an increased vascular permeability, and more investigations are usually required to identify the cause and guide specific therapy. The patient’s medical history will help determine the working differential diagnosis and should include data such as the patient’s medications, risk factors, and symptoms that could point to respiratory infections, malignant diseases, autoimmune diseases, heart, liver, and renal conditions, as well as other conditions. Having a complete occupational history and asking detailed questions concerning asbestos exposure is crucial: even a small amount of asbestos exposure can result in mesothelioma, which develops decades later.
When making a clinical choice to determine an appropriate treatment for pleural effusion management, the composition of pleural fluid may be crucial. The fluid analysis provides significant diagnostic information for most pleural effusion-related disorders, and in some circumstances, the diagnosis can be made only based on the fluid analysis. Several complementary examinations that can help with the identification of common and uncommon pleural effusions are explained, along with the numerous noteworthy features of pleural fluid.
When first considering this pathology, further studies and diagnostic procedures can be carried out for an early diagnosis.
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