Disorders of the Pleura |

A Recurrent Large Pleural Effusion Due to a Contrast Enhancing Mediastinal Mass FREE TO VIEW

Michael Sanley, MD; Rajiv Sonti, MD; Trevor Upham, MD; Charles Read, MD
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MedStar Georgetown University Hospital, Washington, DC

Chest. 2015;148(4_MeetingAbstracts):453A. doi:10.1378/chest.2278500
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SESSION TITLE: Plueral Cases

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Monday, October 26, 2015 at 11:00 AM - 12:00 PM

INTRODUCTION: Mediastinal hemangiomas are rare tumors, accounting for 0.5% of mediastinal masses or less. We report a case of an anterior mediastinal hemangioma which presented with a large pleural effusion.

CASE PRESENTATION: A 56 yo male presented with exertional dyspnea. A chest xray showed a large left pleural effusion and mediastinal fullness. A CT of the chest was then performed which showed a left anterior mediastinal mass with intravenous contrast uptake. A thoracentesis of 1.8L of yellow fluid was performed, which revealed a lymphocytic predominant exudate. Cytology was negative. He required repeat thoracenteses for symptom control with similar lab and pathology results. He was ultimately referred for VATS with resection of the mediastinal mass and pleural biopsy. Pathology of the mass revealed a well circumscribed hemangioma consisting of small capillary-sized vessels and smooth muscle without evidence of maligancy. Pleural biopsy revealed chronic inflammation. An indwelling pleural catheter was inserted intra-operatively for continued drainage of his effusion.

DISCUSSION: Mediastinal hemangiomas are a rare, benign tumor, most often located in the the anterior mediastinum. Typical radiographic presentation consists of a round smooth mass with discontinuous nodular contrast enhancement. Our case is interesting in that it presented with a recurrent exudative effusion. To our knowledge, there are only two other case reports of a thymic hemangioma and cystic hemangioma that presented with uncomplicated recurrent effusion and bilateral bloody effusions, respectively. To date, laboratory studies and pleural biopsy in our patient has not revealed an alternative cause of his exudative effusion besides his hemangioma.

CONCLUSIONS: Mediastinal hemangiomas are rare tumors and often require surgical resection for diagnosis. While benign, they can cause significant complications, such as a recurrent pleural effusion in this case.

Reference #1: Cohen AJ, et al. Mediastinal Hemangiomas. Ann Thorac Surg 1987;43:656-659.

Reference #2: Papagiannopoulos, K, et al. Thymic hemangioma presenting with recurrent pleural effusion. Ann Thorac Surg 2000;70:297-9.

Reference #3: Kubokura H, et al. Mediastinal cystic hemangioma presenting as bilateral bloody pleural effusion: a case report. J Nippon Med Sch 2012;79:381-384.

DISCLOSURE: The following authors have nothing to disclose: Michael Sanley, Rajiv Sonti, Trevor Upham, Charles Read

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