2013 Volume 35 Issue 2 Pages 215-219
Background. Intra-pulmonary and endobronchial metastases are the most frequently encountered types of metastases from renal cell carcinoma to the respiratory system, while pleural metastases are rare. We report a patient of renal cell carcinoma who presented with pleural metastases without any associated pulmonary or endobronchial metastases, and the diagnosis was made by thoracoscopy under general anesthesia. Case. A 75-year-old man visited our department with a chief complaint of malaise. A plain chest X-ray showed right pleural effusion and a chest CT scan revealed pleural tumors with effusion. One week later, the patient presented with dyspnea associated with increased pleural effusion. He was admitted to the hospital, and intercostal tube drainage was performed. Cytology of the pleural aspirate was non-diagnostic on two occasions; therefore, thoracoscopy was performed under general anesthesia, which revealed hemorrhagic pleural nodules. Histopathological examination revealed that the nodules were composed of metastatic clear cell nests, suggesting metastatic renal cell carcinoma. Conclusion. Thoracoscopy is useful and safe for the diagnosis of pleural effusion and pleural tumors, especially in cases in which pleural fluid cytology proves non-diagnostic.
