The encaged lung: rapidly progressive idiopathic pleurisy

Abstract

A 56-year-old, non-smoker male with no exposure, presented with right chest pain and a huge loss in forced vital capacity due to right lung volume reduction with consensual pleural thickening on high-resolution computed tomography. All serological and microbiological tests were negative. The surgical lung biopsy showed fibrinous pleurisy while the search for neoplastic cells resulted negative. Because of symptoms worsening he started low dose steroids without benefits until he died 3 months later for cardiac ischemic attack. We reviewed the literature to identify possible etiologies and a rapidly progressive idiopathic pleurisy revealed to be the most probable diagnosis.

Figure 1:

Chest X-ray in antero-posterior (A) and lateral view (B) showing consistent reduction of the right lung with basal pleural effusion.

Figure 2:

High-resolution CT scan showing right pleural thickening (A). Coronal view clearly shows both right lung volume loss and intra-lobar pleural abnormalities (B).

Figure 3:

Histologic samples at different magnification of the video assisted pleural biopsy. (A and B) Show diffuse organized fibrosis with fibrinous exudates and little sporadic amount of inflammatory cells. (C and D) Show fibroblasts with collagen deposition.