Beware the malignant jellyfish

Small pleural effusions that cannot be assessed by thoracentesis prior to s urgery may represent a diagnostic challenge in the patient with a resectabl e, non-small cell cancer of the lung. Even if the effusion is drained preop eratively and analyzed, the cytology may be falsely negative. We have found that careful inspection of pleural effusions using a single small 2-cm inc ision and video-assisted thorascopy may reveal a gelatinous piece of clotli ke material that resembles a jellyfish. This cohesive particulate piece of material lies in the effusion. This material can be sent for frozen section (unlike cytologic exams in most hospitals), and an immediate answer can be obtained. Cytology results of the surrounding effusion that return 24 hour s later confirm the frozen section findings. If malignant, this avoids thor acotomy and pulmonary resection in a patient with unsuspected T4, stage III B lung cancer. It also avoids closing a patient with an unsuspected effusio n and having to wait 24 hours for the cytology results. We review our exper ience with this jellyfish-like material. (C) 2001 by The Society of Thoraci c Surgeons.