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[Clinical Picture] Black pleural effusion

A 56-year-old man undergoing treatment for a prostatic acinar adenocarcinoma was referred to us in May, 2014, for assessment of a massive right pleural effusion (figure). Although the effusion was large, he had only mild shortness of breath and was admitted originally for urinary incontinence. A pleural aspiration showed black pleural fluid (figure). This fluid was determined to be an exudate with very high concentrations of protein (85 g/L; serum protein 56 g/L), lactate dehydrogenase, and amylase.