PMC8450262_01
A, B: Computed tomography (CT) Thorax with contrast media, day 1: Unilateral, pronounced left sided pleural effusion, mediastinal lymphadenopathy and shift to the right, space-occupying effect on the diaphragm, no signs of pulmonary embolism. C, D, E: Exploratory thoracoscopy, day 2: C: turbid empyema fluid, D: fibrotic visceral and parietal pleural thickening and adhesions, E: detachment of fibrotic septae by forceps. F: Chest X-ray, day 2: Following thoracoscopy residual left sided pleural effusion, dystelectasis lower zone, apical pneumothorax of 1.6 cm width (white arrow), chest drainage tube in place (red arrows), soft tissue emphysema (yellow arrows). G: CT Thorax, day 2: Following thoracoscopy, partial reexpansion left lung with residual, residual multiloculated effusion, partial atelectasis lower lobe, mild diaphragmatic protrusion, no signs of tumor growth. Chest drainage tube in place (red arrow). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
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Especially to rule out pleural carcinomatosis, as cause of the mediastinal shift, medical thoracoscopy was performed, which besides turbid empyema fluid, revealed widespread adhesions, parietal and visceral pleural thickening, multiple septae formation, which in part were mechanically dissolved by forceps (Fig. 1 C, D, E). The follow up chest X-ray (CXR) and CT thorax demonstrated an expanded lung and residual multiloculated pleural effusion on the left (Fig. 1 F, G).