A Gelatinous Pleural Effusion as a Diagnostic Clue

Our plain-English summary of A Gelatinous Pleural Effusion as a Diagnostic Clue, by D. Barroso, R. Rego (Curēus, 2023).

The study

• Authors: D. Barroso, R. Rego
• Journal: Curēus
• Published: 2023;15(3):e35942
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

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. This article was previously presented as a meeting abstract at the 28º Congresso Nacional de Medicina Interna in October 2022.

Copyright © 2023, Barroso et al.

In plain English

This article is a case report from the internal medicine department of a university hospital in Porto, Portugal. It described one patient, an 84-year-old man. He was a retired construction materials truck driver with a 25-year smoking history and chronic bronchitis. For a month he had fatigue, shortness of breath and chest pain. A chest X-ray showed a large collection of fluid around the right lung (a pleural effusion). Draining it removed 1500 mL of yellow, gelatinous fluid, which tests classed as an exudate. Tests for tuberculosis were negative. A thoracoscopy found a large mass in the pleura, and biopsies supported a diagnosis of epithelioid mesothelioma. He received palliative systemic treatment and died two years after diagnosis as the disease progressed. The article did not report whether he had been exposed to asbestos. The authors concluded that malignant pleural mesothelioma may present as a thick, gelatinous pleural effusion, which should immediately raise suspicion and serve as a diagnostic clue. As a single case, the report shows what happened to one patient, not how often this occurs.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: one 84-year-old man living in a rural area of Porto, Portugal, with a 25-year history of smoking and chronic bronchitis, seen at an emergency department
• Exposure: The article does not report asbestos exposure for this patient. It gives his occupation as retired construction materials truck driver and notes a 25-year smoking history.
• Main results:
  • Initial thoracocentesis in the patient removed 1500 mL of yellow, gelatinous fluid
  • Pleural fluid in the patient: protein 4.4 g/dL (serum 7.2 g/dL), lactate dehydrogenase 824 U/L (serum 195 U/L), pH 7.1; fluid glucose was 15 mg/dL (serum 84 mg/dL); adenosine deaminase was normal (18 U/L)
  • Pleural tuberculosis was excluded; thoracoscopy found a large pleural mass extending to the parietal and diaphragmatic pleura, very suggestive of malignancy
  • Biopsy findings supported a diagnosis of epithelioid mesothelioma
  • The patient received palliative systemic treatment and died two years after diagnosis as the disease progressed
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma may present as a viscous, gelatinous pleural effusion, which should immediately raise suspicion and serve as a diagnostic clue in the initial study of a pleural effusion.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Thoracentesis, Exudate, Mesothelioma, Prognosis, Pleural Mesothelioma.

Related studies

• Gelatinous Pleural Effusion: A Diagnostic Challenge for Pleural Mesothelioma in an 80-Year-Old Man — A.M. Ibnian, O.U. Khan, et al. (2023)
• Gelatinous pleural effusion in advanced lung adenocarcinoma: a case report — J. Sutton, Y. Grabie, et al. (2025)
• Parakeratotic-like cells in effusions - A clue to diagnosis of malignant mesothelioma — L. Gao, W. Reeves, et al. (2012)
• Gelatinous Pleural Fluid With Mesothelioma — M. Kaous, L. Bashoura, et al. (2021)
• Diagnostic problems in serous effusions — C.W. Bedrossian (1998)
• Diagnostic usefulness of EMA, IMP3, and GLUT-1 for the immunocytochemical distinction of malignant cells from reactive mesothelial cells in effusion cytology using cytospin preparations — K. Ikeda, G. Tate, et al. (2011)

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