Pleural Fibrosis and Effusions

Pleural nodule: One particularly inflamed portion of pleura showed a small, intrapleural nodule (arrow) with central necrosis, but without a well-defined, palisaded margin.

Given this inflammation, it is not surprising that effusions are common. Further, multinucleated giant cells and necrotic debris can be found in cytologic preparations of the effusions.

This picture of a wet mount of pleural fluid from another patient with a chronic pleural effusion has been photographed with polarized light. What are these birefringent crystals? Answer

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Answer: What are these birefringent crystals?

The photograph shows rhomboid cholesterol crystals, which are characteristic of pseudochylous pleural effusions. Typically, the supernatant of the centrifuged fluid appears turbid. Pseudochylothorax is found in patients with chronic pleural inflammation with effusion, usually in those with rheumatoid arthritis or chronic tuberculosis, or in patients with another infectious or neoplastic effusion of long standing (see discussion).

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