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Year : 2018  |  Volume : 7  |  Issue : 3  |  Page : 157-158

The diagnostic challenge of unfamiliar cases with black pleural effusion

Department of Cardiothoracic Surgery, Minia Cardiothoracic University Hospital, El-Minia 61519, Egypt

Date of Web Publication10-Sep-2018

Correspondence Address:
Dr. Yasser Ali Kamal
Department of Cardiothoracic Surgery, Minia Cardiothoracic University Hospital, El-Minia 61519
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/rcm.rcm_19_18

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How to cite this article:
Kamal YA, Hakeem MN. The diagnostic challenge of unfamiliar cases with black pleural effusion. Res Cardiovasc Med 2018;7:157-8

How to cite this URL:
Kamal YA, Hakeem MN. The diagnostic challenge of unfamiliar cases with black pleural effusion. Res Cardiovasc Med [serial online] 2018 [cited 2021 Mar 4];7:157-8. Available from: https://www.rcvmonline.com/text.asp?2018/7/3/157/240990

Dear Editor,

We have read with great interest the published review article by Palakuru et al. regarding black pleural effusion, in the journal issue from January to March 2018.[1] In this article, the authors described pathophysiology, diagnosis, treatment, and prognosis of the rare cases of black pleural effusion. The importance of this review arises from the need to provide physicians with a guide to suspect, diagnose, and treat the rare unfamiliar serious cases of pleural effusion. Black pleural effusion may hide different critical diseases with different strategies for diagnosis and treatment.

We would like to thank the authors for their great work to clarify the important clinical aspects of black pleural effusion. In addition, we would like to provide some critical points that could not reduce the significance of this review article; however, it may support its aim and conclusion. On searching PubMed only, the authors found nine case reports, three abstracts, and 1 review; however, the authors did not mention the search items and the date of their search. When we searched other medical search engines for keywords of (black pleural effusion) in all fields of the published articles, we found 16 case reports and 3 meeting abstracts, but the authors did not include in their article,[2],[3],[4] thus the authors should target other search engines to determine more published cases of black pleural effusion. We found three more cases of black pleural effusion published in the year 2016 and 2017.

The results of our search reflect that metastatic melanoma is the most common underlying cause of black pleural effusion, and most of the cases of black pleural effusion had nonspecific clinical findings at presentation. In addition, when the pancreaticopleural fistula is the underlying cause of black pleural effusion, there is an increase in the diagnostic challenge with a frequent delay in its discovery. In general, it is important to provide physicians with sufficient data regarding etiology and management of unfamiliar rare cases to avoid the subsequent complications of delayed diagnosis and treatment. High index of suspicion is crucial to determine the underlying causes of black pleural effusion. To avoid delayed or missed diagnosis, a stepwise diagnostic approach should be applied as for any type of pleural effusion which includes initially chest X-ray and thoracocentesis if appropriate. The pleural fluid should be examined for its appearance and biochemical characteristics. Computed tomography is the next step to determine the underlying causes of exudative pleural effusion, followed by pleural or lung biopsy if the diagnosis is not evident.

Cultures in cases with constitutional manifestations or empyema should be considered. Contrast-enhanced thoracoabdominal computed tomography is useful to determine cases with pancreaticopleural fistula. In addition, black pleural effusion should be differentiated from dark greenish bilious pleural effusion by elevated pleural fluid levels of indirect bilirubin levels and glycocholic acids in cases with bilious effusion.[5]

In conclusion, organized knowledge driven from literature about the management of rare diseases is important to establish the appropriate strategies for diagnosis and treatment of the underlying causes to prevent the subsequent complications.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Palakuru SS, Vijhani P, Cherian SV. Black pleural effusion. Res Cardiovasc Med 2018;7:1-4.  Back to cited text no. 1
  [Full text]  
Guo F, Wu J, Peng Y, Tu M, Xiao B, Dai C, et al. Black pleural effusion due to pancreatic pseudocyst: A case report. Medicine (Baltimore) 2017;96:e9043.  Back to cited text no. 2
Patel G, Saxena A, Khangarot S, Takhar RP, Patel D. Recurrence of malignant melanoma presenting as black-colored pyopneumothorax: A rare entity. Ann Saudi Med 2017;37:469-71.  Back to cited text no. 3
Mishe'el S, Ziv M, Bisharat N. Black urine and black pleural fluid: A distinctive presentation of metastatic melanoma. Eur J Case Rep Internal Med 2016;3:1-3.  Back to cited text no. 4
Saraya T, Light RW, Takizawa H, Goto H. Black pleural effusion. Am J Med 2013;126:641.e1-6.  Back to cited text no. 5


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