Correct!
5. All of the above

Although a lymphocyte predominant pleural effusion often suggests tuberculosis or malignancy, the differential diagnosis is quite large (Table 1) (1).  

Table 1. Differential diagnosis of lymphocyte predominant pleural effusions.

• Acute lung rejection
• Chronic rheumatoid pleurisy
• Chylothorax
• Lymphoma
• Post-coronary artery bypass graft surgery (2–12 months)
• Sarcoidosis
• Tuberculous effusion
• Uremic pleural effusion
• Yellow nail syndrome

In this patient, the pleural fluid cytology was negative for malignancy and the cause of the pleural effusion was unclear. A bronchoscopy was performed, and an endobronchial lesion was encountered (Figure 3).

Figure 3. Right upper lobe endobronchial mass seen on bronchoscopy.

Biopsies were performed of the lesion (Figure 4).

Figure 4. Panel A: Generous endobronchial biopsy fragments of tissue showing the surface epithelium (arrows) and a submucosal neoplastic proliferation (asterisks). H&E, 20X. Panel B: Neoplasm in the submucosal space with mucopolysaccharide rich matrix typical of cartilage. H&E, 100X.

Are metastases from the endobronchial lesion the cause of the pleural effusion? (Click on the correct answer to proceed to the fifth and final panel)

1. No
2. Yes

Home/Pulmonary