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Jelly-like Pleural Effusions: An Uncommon Manifestation of Pseudomyxoma Peritonei
Derrames pleurales gelatinosos: una manifestación infrecuente del pseudomixoma peritoneal
a Department of Gastroenterology, Gaochun People's Hospital of Nanjing, Nanjing, China
b Department of Gastroenterology, Suzhou Ninth People's Hospital, Affiliated Wujiang Hospital of Nantong University, Suzhou, China
c Department of General Surgery, Nantong Hospital of Traditional Chinese Medicine, Nantong, China
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The X-ray on the left (a) was performed before corticosteroids therapy and the one on the right (b) about seven months after the beginning of that therapy; (c, d) coronal and axial views of thoracic computed tomography performed after six months of Itraconazole, showing giant aspergilloma in left lung; (e, f) necrotic material of fungus ball observed during surgery.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cláudia S. Sousa, Pedro Mendes, António Brazão" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Cláudia S." "apellidos" => "Sousa" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Mendes" ] 2 => array:2 [ "nombre" => "António" "apellidos" => "Brazão" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028962100017X?idApp=UINPBA00003Z" "url" => "/03002896/0000005700000009/v1_202109020750/S030028962100017X/v1_202109020750/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Jelly-like Pleural Effusions: An Uncommon Manifestation of Pseudomyxoma Peritonei" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "592" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Yimin Ma, Zhenguo Qiao, Haidong Chen" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Yimin" "apellidos" => "Ma" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0005" ] ] ] 1 => array:3 [ "nombre" => "Zhenguo" "apellidos" => "Qiao" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0005" ] ] ] 2 => array:4 [ "nombre" => "Haidong" "apellidos" => "Chen" "email" => array:1 [ 0 => "songqianlian@yeah.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Gastroenterology, Gaochun People's Hospital of Nanjing, Nanjing, China" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Gastroenterology, Suzhou Ninth People's Hospital, Affiliated Wujiang Hospital of Nantong University, Suzhou, China" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of General Surgery, Nantong Hospital of Traditional Chinese Medicine, Nantong, China" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Derrames pleurales gelatinosos: una manifestación infrecuente del pseudomixoma peritoneal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1570 "Ancho" => 1500 "Tamanyo" => 488514 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT scan showed massive pleural effusions on the right side with local atelectasis of the right lung (A). Abdominal CT scan revealed multiple low-density shadows of unequal size in the liver, and the edge of the lesions were slightly enhanced (B). An open thoracotomy revealed 1500<span class="elsevierStyleHsp" style=""></span>ml free mucus in the right pleural space (C), and multiple masses along the pleura, diaphragm and liver (D). Postoperative pathological showed low-grade mucinous neoplasm (E).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 65-year-old female was admitted to the hospital in October 2019, with a chief complaint of chest tightness for 2 months. The patient underwent a complete cytoreductive surgery (CRS) for pseudomyxoma peritonei (PMP) one year ago. Thoracic computed tomography (CT) showed massive pleural effusions on the right side with local atelectasis of the right lung (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Abdominal CT revealed multiple low-density shadows of unequal size in the liver, and the edge of the lesions were slightly enhanced (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Combined with previous medical history, she was diagnosed as pleural extension of PMP. After comprehensive assessment, she underwent thoracotomy. The operation revealed 1500<span class="elsevierStyleHsp" style=""></span>ml free mucus in the right pleural space (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C), and multiple masses along the pleura, diaphragm and liver (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). Postoperative pathological consisted with low-grade mucinous neoplasm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">PMP is a rare disease characterized by mucinous ascites from intra-abdominal neoplastic mucin secreting cells proliferating on the peritoneal surface. It usually originates from the appendix or ovary.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Metastases and extraperitoneal involvement are extremely rare.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> Here, we report a rare case of PMP metastasizing to the pleural and speculate that is the result of diaphragmatic injury caused by the previous operation. The mucus-producing cells migrate to the pleural space through the minor injury and result progressive accumulation of gelatinous material. In addition, the tumor deposits also accumulate at the liver surface close to the diaphragm which supported our speculation.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">These authors contributed equally to this work.</p>" "identificador" => "fn0005" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1570 "Ancho" => 1500 "Tamanyo" => 488514 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT scan showed massive pleural effusions on the right side with local atelectasis of the right lung (A). Abdominal CT scan revealed multiple low-density shadows of unequal size in the liver, and the edge of the lesions were slightly enhanced (B). An open thoracotomy revealed 1500<span class="elsevierStyleHsp" style=""></span>ml free mucus in the right pleural space (C), and multiple masses along the pleura, diaphragm and liver (D). Postoperative pathological showed low-grade mucinous neoplasm (E).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A jelly belly: an unusual cause of ascites" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Dolapsakis" 1 => "A. Panagopoulos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejim.2018.07.009" "Revista" => array:6 [ "tituloSerie" => "Eur J Intern Med" "fecha" => "2019" "volumen" => "61" "paginaInicial" => "e5" "paginaFinal" => "e6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30017558" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital pleuroperitoneal communication in a patient with pseudomyxoma peritonei" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.R. Pestieau" 1 => "R. Wolk" 2 => "P.H. Sugarbaker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/(sici)1096-9098(200003)73:3<174::aid-jso12>3.0.co;2-u" "Revista" => array:6 [ "tituloSerie" => "J Surg Oncol" "fecha" => "2000" "volumen" => "73" "paginaInicial" => "174" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10738273" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005700000009/v1_202109020750/S0300289621000193/v1_202109020750/en/main.assets" "Apartado" => array:4 [ "identificador" => "21422" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Clinical Images / Imágenes clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005700000009/v1_202109020750/S0300289621000193/v1_202109020750/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621000193?idApp=UINPBA00003Z" ]
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