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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Axial computed tomography &#40;CT&#41; image shows bilateral pleural effusion and parietal pleural thickening exhibiting the sandwich sign on the left side &#40;arrow&#41;&#46; &#40;B&#41; Immunohistochemistry showing lymphoid cell highlighted by BCL2 marker&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 74 year-old male patient was referred to the Pleural Service by the Haematology team with progressive breathlessness&#46; The patient had been diagnosed with follicular lymphoma two years earlier with excellent clinical response to chemotherapy&#46; A computed tomography &#40;CT&#41; scan with intravenous contrast showed bilateral pleural effusions in addition to the pleural sandwich sign &#8211; parietal pleural thickening with evidence of engulfment of the intercostal arteries into the pleural thickening &#40;when the enhancing intercostal vessels &#40;the filling&#41; are engulfed by intra and extra-pleural lymphoid infiltration &#40;the buns&#41; &#40;arrow&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The ultrasound appearance is shown in the supplementary video&#46; On thoracentesis the fluid was chylous with pleural fluid triglyceride level of 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and cholesterol of 70<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; An omental biopsy showed infiltration by large lymphoid cells that were highlighted by the markers CD79a and BCL6 on immunohistochemistry &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#44; panel B&#41; thus confirming recurrence of follicular lymphoma&#46; The patient was restarted on chemotherapy&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The sandwich sign was first coined to describe the CT appearance of bulky mesenteric adenopathy that engulf from both sides mesenteric vasculature and fat&#44; in lymphoma&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> The pleural sandwich sign is reported in pleural involvement in non-Hodgkin&#39;s lymphoma and represents engulfment of intercostal vessels within lymphoid tissue&#44; that spreads in the parietal pleural as well as the extrapleural space&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> This is demonstrable on the CT scans of the presented case&#46; Whether this is a truly pathognomonic sign for lymphomatous pleural disease is yet to be determined&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Author Contribution</span><p id="par0015" class="elsevierStylePara elsevierViewall">All authors were involved in the management of the patient&#46; MH collected the report images and drafted the manuscript&#46; All authors critically revised the manuscript and approved the final version&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Disclosure</span><p id="par0020" class="elsevierStylePara elsevierViewall">No conflict of interest&#46; Written consent provided by the patient subject of the case report&#46; The authors would like to thank Dr Rasika Singh who kindly provided the images of the pathology slides&#46;</p></span></span>"
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