A hormonal effusion?

To cite: Sharp C, Meller M, Moody A, et al. Thorax 2013;68:697–698. A 51-year-old woman presented to the chest clinic with history of progressive dyspnoea and dry cough for 8 weeks. Her past medical history was remarkable for sleeve gastrectomy 3 months ago, which resulted in loss of three stones. She also reported migraines for which she had an implanted occipital nerve stimulator and had undergone hysterectomy with bilateral salpingo-oophorectomy 18 months ago. Other history included hypothyroidism, hypertension and depression. Her medications were Hormone Replacement Therapy (HRT), Nifedipine, Losartan, Levothyroxine, Lansoprazole, Simvastatin and Fluoxetine. She had smoked for 3 years in her 20s, no more than 3–5 cigarettes per day and had no noteworthy occupational exposure. She had a family history of maternal myelodysplasia and paternal cerebral malignancy. Examination revealed right-sided thoracic dullness and reduced breath sounds. Blood results were unremarkable. A chest radiograph was performed confirming a right-sided effusion (figure 1); therapeutic aspiration demonstrated a chylous effusion. The pleural fluid showed haemosiderin-laden macrophages on cytological examination and there was no microbiological growth. The effusion recurred within 2 weeks and intercostal drainage was performed. A contrast-enhanced CT of her thorax was performed with retrospective high resolution reconstructions to investigate the cause of the effusion (figure 2).