Pleural Effusion Caused by Trapped Lung

Jay T. Heidecker, MD, Marc A. Judson, MD

South Med J. 2003;96(5)

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Abstract

We report a case of pleural effusion from trapped lung secondary to sarcoidosis. The patient presented with dyspnea, right pleural effusion, left and right upper-lobe infiltrate and a widened mediastinum. The pleural effusion and dyspnea failed to respond to a course of oral corticosteroids but was relieved by decortication with stripping of inflammatory fibrous bands encasing the visceral pleural. Histologic examination of the lung, visceral and parietal pleura, and the fibrous adhesions all revealed noncaseating granulomas.

Introduction

Sarcoidosis is an idiopathic systemic granulomatous disease. It can affect any organ of the body, but most commonly affects the lungs. Pleural effusion is rare in sarcoidosis, with an incidence of approximately 2%.^[1] Mechanisms of pleural effusion in sarcoidosis include direct pleural involvement, thoracic duct obstruction, and lobar atelectasis.^[1,2] To our knowledge, only one previous case has ever been reported in the medical literature of pleural effusion in sarcoidosis secondary to trapped lung.^[3] We present a case of pleural effusion from trapped lung secondary to sarcoidosis. Our case is unique because the effusion did not respond to corticosteroids but required thoracotomy.

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