Chest X-Ray Reveals Large Pleural Mass

A 70-year-old woman with no history of smoking or asbestos exposure presented with dyspnea on exertion, nonproductive cough, left-sided pleuritic chest pain, and fatigue. Chest radiography revealed a large left pleural effusion and a mass in the left lower lobe. Chest CT confirmed a pleural-based mass of 7.8 × 5.5 cm invading the anterior chest wall. A left-sided thoracentesis revealed a bloody, lymphocyte-predominant exudative pleural effusion, with a white blood cell count of 8,144/μL (26% lymphocytes, 2% neutrophils, 3% monocytes, and 69% other cell-line types). A cytologic examination of the pleural fluid and a biopsy of the pleural mass were performed, followed by aspiration and biopsy of the bone marrow.