Figure 1: Computed tomography picture showing right-sided moderate to massive pleural effusion

Mentions: A 23-year-old woman homemaker from Southern part of India, was admitted to our hospital with history of shortness of breath, cough with mucoid expectoration and right-sided chest pain of 6-months duration. She was treated at outside hospital with oral and subsequent intravenous antibiotics with no symptomatic relief. She denied any history of hemoptysis, joint pain, rashes, fever, loss of weight or appetite. She denied any history of atopy, allergy, asthma, or pulmonary tuberculosis. Her past medical record showed that she was evaluated at outside place and was found to have right-sided pleural effusion. Pleural tapping was done which revealed fluid to be hemorrhagic and lymphocytic exudative in nature with normal ADA. Ultrasound abdomen was showing bilateral polycystic ovarian disease, bilateral pleural effusion and mild ascites. She was sent to our center for further evaluation and management. On examination she was found to be comfortable at rest with HR: 90/min, RR: 20/min and oxygen saturation on breathing room air was 98%. Respiratory system examination findings were consistent with mild to moderate pleural effusion. No abnormality was detected in any other system. The tuberculin test (100 T.U.) was negative. Her blood investigations were following: Hb 11.5 gm/dl, total white blood cell counts 7.2 ku/ml, neutrophil 73%, eosinophil 1.8%. Her liver function test, renal function test and serum electrolytes were with in normal limits. A chest radiograph showed right-sided moderate pleural effusion. 2D ECHO was normal. Contrast enhanced and HRCT of chest was ordered [Figure 1]. Medical thoracoscopy was done.