Pau‑Yuan Changa, Bing‑Ru Chungb,c, Yen‑Chang Chend,e*
aDepartment of Radiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, bDivision of Thoracic Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, cDepartment of Surgery, School of Medicine, Tzu Chi University, Hualien, Taiwan, dDivision of Digital Pathology, Department of Anatomical Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, eDepartment of Pathology, School of Medicine, Tzu Chi University, Hualien, Taiwan
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
A 72‑year‑old woman with underlying disease of essential hypertension, type 2 diabetes mellitus, osteoporosis, and traumatic ruptured intervertebral disc of L4/5 status post microdiscectomy presented dyspnea, general weakness, and poor intake for 2 weeks and chest tightness for 2 days. She was brought to the emergency room by her family for help. The chest X‑ray revealed a large pleural effusion on the right side along with a collapse of the right middle lobe. Thoracocentesis was performed, and 1200 mL of fluid was drained. The cytology showed negative for malignancy. However, chest computed tomography (CT) revealed multiple nodules with varying sizes in the left and right lungs and thickening pleura with nodules and effusion, favoring cancer metastases [Figure 1]. Therefore, she received a biopsy of the right lung and decortication of the pleura.
