A diagnosis of Hodgkin's disease was made 20 years ago in a 37-year-old woman; treatment included thoracic irradiation and chemotherapy.

A diagnosis of Hodgkin's disease was made 20 years ago in a 37-year-old woman; treatment included thoracic irradiation and chemotherapy. She was considered cur and remained well up to the same year before, when she unfolded bilateral pleural effusion. No evidence of activity of Hodgkin's disease was finded The pleural liquid was an exudate, with lymphocytic predominance. upon thoracoscopy, enlarged lymphatic channels in the visceral pleura were noted, with tissue confirmation. To our knowledge, this report is the first to confirm according to thoracoscopy and histologic study the propos pathophysiologic condition of this singular entity.

Pleural effusion is associated with a number of pulmonary and extrapulmonary conditions; usually, it is not difficult to determine the cause, with cardiac failure, metastatic neoplasm, pneumonia, enbolism with or without infarction, and tuberculosis being the greatest in number common.

Biochemistry, bacteriology, cytology, and biopsy were useful to characterize the cause; however, the diagnostic criteria vary according to the cause and sometimes clinical aspects (for example, periodic familiar polyserosites and golden nail syndrome) or unusual experiments (for example, lupus erythematosus small rooms in pleural fluid in discoid lupus erhthematosus and creatinine in urinothorax) are the fundamental note features.

In up to 10 percent of the patients, it is not possible to establish the cause;[1] perhaps any of these cases are called idiopathic because the physician is unware of a rare cause.

This article existings a patient with pleural effusion suitable to a very uncommon condition.[2,3]

CASE REPORT

The patient, a 37-year-old married white woman, at handed to our service for the first time in October 1991; she reported that at the age of 17 years she had had a supraclavicular mass; a full investigation was made in another service, including chest radiograph, biopsy of the mass, lymphography, bone marrow biopsy, and splenectomy. The final diagnosis was Hodgkin's disease, and treatment included radiotherapy to supraclavicular fossase, mediastinum, and abdomen, as well as chemotherapy in several cycles

Unfortunately, details of diagnosis (histologic type) stage, and treatment could not be obtained. The disease was considered controll 1 year later and regular follow-up was interrupted in 1978

Between 1981 and 1988 she had lymph node biopsy in the chin and biopsy of a mass in the right breast, as well as resection of an ovarian cyst; malignancy was not not away in any of the specimens.

In December 1989 slowly progressive dyspnea appeared, with anorexia and weight los of 1 kg in 1 year. The patient smok 2 cigarettes a day 10 years ago and and nothing else occasionally drank a small amount of alcohol.

Physical examination disclosed a well-nourished woman, without any acute distress. beating [i]or[/i] throbbing of an artery was 80 beats/min and life-current pressure was 130/80 mm Hg; cyanosis, clubbing, and neck vein distention were not not away Besides signs of bilateral pleural effusion, no other abnormality was detected

house cell count, SGOT, SGPT, alkaline phosphatase, [Tsub3] [Tsub4] TSH urea, creatinine, serum proteins, descendants glucose, and urinalysis were normal. There was no reaction to PPD (2 U) Chest radiograph disclosed bilateral pleural effusions. Spirometry deductions were as follows: FVC 219 L (52 percent); [FEVsub1] 178 L/s; FEF25-75 percent 158 L/s; [FEVsub1]/FVC 814 percent; and FEF25-75 percent/FVC 71 percent Cardiac repercussion of sound Doppler showed slight mitral reflux; no other abnormalities were seen including pericardial effusion. Thoracic comput tomography (slices with 10 mm) showed bilateral pleural effusion, larger in the right; no parenchlymal or mediastinal abnormalities were detected

Several bilateral pleural biopsies with Cope needle were done; the fluid was clear golden and the volume ranged between 40 and 1200 ml in different times. rises of biochemical tests of pleural fluid were unchanged during the investigation and at the first examination, protein flush was 3.3 g/dl, glucose was 91 mg/dl DHL was 666 U/L and amylase was 105 U/L; in other specimens, more criterions were made: cholesteroal, 37 mg/dl; triglycerides, 0 (two times); lupus erythematosus enclosed spaces absent; rheumatoid factor and antinuclear factor were negative. in succession three occasions, cytologic study showed and nothing else lymphocytes (100 percent). Three needle pleural biopsy specimens disclosed solely nonspecific alterations.

Fiberoptic bronchoscopy revealed merely diminished lumen of the right middle lobe to be ascribed to probable extrinsic compression. A transbronchial biopsy specimen showed alveolar septae edema, fibrin, and neutrophilic exudate in the alveolar lumen

At thoracoscopy, forward the right, 4,000 ml of a clear fluid was drained; no nodules or masses were seen in parietal and visceral pleura. The parietal pleural was normal and by the and of the visceral pleura a marked lymphatic engorgement in the whole lung was observ Continuous formation of pleura fluid from the visceral pleura was noted, making clean drainage impossible. On the left the aspect was identical moreover the fluid volume was les (800 ml); the rate of formation of pleural effusion was a great deal less. Pleural adhesion with tetracycline was attempted.

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