Chew Wui Mei, Goh Ken Junyang, Thorne Jessica, ElSheikh Alguili, Rahman Najib M
Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, 529889, Singapore.
Respir Med Case Rep. 2025 Jul 24;57:102273. doi: 10.1016/j.rmcr.2025.102273. eCollection 2025.
Seromas are rare complications of ultrasound-guided pleural biopsies, and have not been described to be seeded with tract metastases before. We describe a case where a post-pleural biopsy seroma appeared to be resolving, but developed into a chest wall metastasis over a period of five months. This was an 84-year-old lady undergoing investigation for a malignant pleural effusion, and underwent a left pleural aspiration and ultrasound-guided pleural biopsies in the same sitting. The seroma presented as a painful swelling immediately after pleural biopsy, and was initially conservatively managed due to patient preference. Drainage of the effusion was performed two months after the procedure, and alleviated the patient's breathlessness but did not alter the resolution of the seroma. Serial ultrasound images illustrate the gradual changes in morphology from a hypoechoic collection to an echogenic, organized lesion with lobulated margins. In this case, despite the shrinking size of the original lesion, the patient's persistent pain and atypical ultrasound features of a solid lesion were suspicious for malignant transformation. Chest wall biopsy confirmed metastatic seeding five months after initial intervention. This case highlights the need for heightened surveillance for the development of tract seeding in patients with malignant effusion and seroma after pleural intervention. Delay in chest drainage may have contributed to the poor outcome.
血清肿是超声引导下胸膜活检的罕见并发症，此前尚无其发生穿刺道转移的报道。我们报告一例胸膜活检后血清肿起初似乎在消退，但在五个月内发展为胸壁转移瘤的病例。这是一位84岁的女性，因恶性胸腔积液接受检查，在同一次就诊时进行了左侧胸腔穿刺抽液和超声引导下胸膜活检。胸膜活检后血清肿立即表现为疼痛性肿胀，最初因患者意愿采取保守治疗。术后两个月进行了胸腔积液引流，缓解了患者的呼吸困难，但未改变血清肿的消退情况。系列超声图像显示了其形态从低回声液性暗区逐渐转变为有分叶边缘的高回声、有组织的病变的过程。在本病例中，尽管原病变大小缩小，但患者持续疼痛以及实性病变的非典型超声特征提示有恶变可能。胸壁活检证实初次干预五个月后发生了穿刺道转移。该病例强调，对于胸腔积液和胸膜干预后血清肿患者，需要加强对穿刺道转移发生情况的监测。胸腔引流延迟可能导致了不良结局。
