Sutton Jacob, Grabie Yisroel, Rotblat David, El-Hage Halim
Northwell Health I Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA.
J Med Case Rep. 2025 Aug 15;19(1):407. doi: 10.1186/s13256-025-05427-4.
Gelatinous pleural effusions, a rare subtype of exudative effusions with elevated viscosity due to high hyaluronic acid levels, are often associated with malignancies, particularly malignant pleural mesothelioma and some metastatic cancers. Such effusions present unique challenges in both diagnosis and management due to their thickness, which complicates drainage using standard techniques. This case highlights the clinical significance of recognizing unusual pleural fluid characteristics and employing advanced drainage interventions, particularly in metastatic lung adenocarcinoma. Given their rarity, gelatinous pleural effusions are not widely reported, emphasizing the need for increased awareness of their diagnostic and therapeutic implications.
A 46-year-old African American female patient with lung adenocarcinoma was admitted with a re-accumulating pleural effusion that required further intervention. A Pleurex catheter was placed for continuous drainage, revealing a gelatinous, coagulated effusion that resisted standard drainage techniques. An initial 250 mL of fluid was removed, followed by an additional 1.2 L after intrapleural hyaluronidase was administered to break down the viscosity. Cytology confirmed the presence of malignant cells, positive for CK-7 and TTF-1, and negative for calretinin, Ber-EP4, and CK-20, supporting the diagnosis of primary lung adenocarcinoma. Despite successful fluid removal, imaging indicated a trapped lung, preventing full re-expansion of the pleural space. The patient's care was transitioned to home management with intermittent Pleurex catheter drainage and palliative care support, with plans for outpatient follow-up and ongoing monitoring.
This case underscores the complexities associated with managing gelatinous pleural effusions, particularly in the context of malignancy. The patient's palliative management, including the use of an indwelling pleural catheter, highlights the focus on symptom relief in advanced disease stages. Recognizing gelatinous pleural effusions as a potential diagnostic indicator, particularly in patients with malignancies, can facilitate timely interventions that may improve quality of life. Continued research and clinical awareness are essential to optimize diagnostic approaches and treatment options for these rare, challenging effusions.
胶冻样胸腔积液是渗出性胸腔积液的一种罕见亚型，由于透明质酸水平升高而具有较高的黏稠度，常与恶性肿瘤相关，尤其是恶性胸膜间皮瘤和一些转移性癌症。由于其黏稠度，这种胸腔积液在诊断和管理方面都带来了独特的挑战，这使得使用标准技术进行引流变得复杂。本病例突出了认识不寻常的胸腔积液特征并采用先进引流干预措施的临床意义，特别是在转移性肺腺癌中。鉴于其罕见性，胶冻样胸腔积液的报道并不广泛，这凸显了提高对其诊断和治疗意义认识的必要性。
一名46岁的非裔美国女性肺腺癌患者因胸腔积液再次积聚入院，需要进一步干预。放置了一根Pleurex导管进行持续引流，引流出来的是一种胶冻样、凝固的胸腔积液，常规引流技术对此无效。最初抽出了250毫升液体，在胸腔内注射透明质酸酶以降低黏稠度后，又抽出了1.2升液体。细胞学检查证实存在恶性细胞，CK-7和TTF-1呈阳性，钙视网膜蛋白、Ber-EP4和CK-20呈阴性，支持原发性肺腺癌的诊断。尽管成功抽出了液体，但影像学检查显示肺被包裹，胸腔无法完全复张。患者的护理转为居家管理，采用间歇性Pleurex导管引流并给予姑息治疗支持，计划进行门诊随访和持续监测。
本病例强调了处理胶冻样胸腔积液的复杂性，特别是在恶性肿瘤背景下。患者的姑息治疗，包括使用留置胸腔导管，突出了在疾病晚期对缓解症状的关注。将胶冻样胸腔积液视为一种潜在的诊断指标，特别是在恶性肿瘤患者中，可以促进及时干预，可能改善生活质量。持续的研究和临床认识对于优化这些罕见且具有挑战性的胸腔积液的诊断方法和治疗选择至关重要。
