Brown-colored malignant pleural fluid with high bilirubin levels: a case series
Brown-colored pleural effusion is rare and may result from high bilirubin levels such as bilothorax (often described as a pleural fluid-to-serum bilirubin ratio of > 1.0). We describe four patients with malignant pleural effusion that appeared macroscopically brown with a pleural fluid-to-serum b...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English English |
| Published: |
John Wiley & Sons Ltd
2024
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| Subjects: | |
| Online Access: | https://eprints.ums.edu.my/id/eprint/42162/1/ABSTRACT.pdf https://eprints.ums.edu.my/id/eprint/42162/2/FULL%20TEXT.pdf https://eprints.ums.edu.my/id/eprint/42162/ https://doi.org/10.1155/crpu/5807681 |
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| Summary: | Brown-colored pleural effusion is rare and may result from high bilirubin levels such as bilothorax (often described as a pleural fluid-to-serum bilirubin ratio of > 1.0). We describe four patients with malignant pleural effusion that appeared macroscopically brown with a pleural fluid-to-serum bilirubin ratio between 3.7 and 16.2. All had metastatic adenocarcinomas; three were from lung and one from gastric origin. None demonstrated clear pleurobiliary fistulas on investigations. Postulates for the development of brown effusion include heme oxygenase 1 overexpression in malignant cells situated in the pleura, intrapleural hemolysis, passive movement of bile through microscopic diaphragmatic pores, and drainage of biliary fluid into the pleural lymphatics. |
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