Introduction: Large pleural effusions can rarely lead to respiratory distress and mediastinal shift, indicating the presence of a tension hydrothorax, which requires immediate surgical intervention. Primary mediastinal B-cell lymphoma (PMBL) typically presents as a mass in the anterior mediastinum. Tension hydrothorax in PMBL has not been well documented in the published literature.
Case Report: A previously healthy 28-year-old female presented to the emergency department (ED) with tachycardia and increasing shortness of breath over three weeks. Imaging revealed a mediastinal mass and tension hydrothorax resulting in a severe mediastinal shift. Pathology of the mass was consistent with PMBL. The patient had a prolonged hospital course, which included severe neutropenia, pulmonary embolisms, prolonged partial thromboplastin time, and continuous drainage of the pleural fluid. The patient was discharged home and is being followed and treated by medical oncology.
Conclusion: While PMBL can present with pleural effusion, it does not typically accumulate to the degree seen in this patient and result in a tension hydrothorax. Due to the tension hydrothorax and mediastinal mass, the patient had significant risk for cardiopulmonary collapse and was evaluated urgently by surgery. A major consideration of the surgical team was prevention of re-expansion pulmonary edema while reducing enough fluid to stabilize the patient. Weighing the risks of the procedures and the instability of the patient, the surgeon elected to treat with emergent thoracoscopy and chest tube placement in the operating room (OR) instead of interventions in the ED as this was the safest option.
[abstract] =>Introduction: Large pleural effusions can rarely lead to respiratory distress and mediastinal shift, indicating the presence of a tension hydrothorax, which requires immediate surgical intervention. Primary mediastinal B-cell lymphoma (PMBL) typically presents as a mass in the anterior mediastinum. Tension hydrothorax in PMBL has not been well documented in the published literature.
Case Report: A previously healthy 28-year-old female presented to the emergency department (ED) with tachycardia and increasing shortness of breath over three weeks. Imaging revealed a mediastinal mass and tension hydrothorax resulting in a severe mediastinal shift. Pathology of the mass was consistent with PMBL. The patient had a prolonged hospital course, which included severe neutropenia, pulmonary embolisms, prolonged partial thromboplastin time, and continuous drainage of the pleural fluid. The patient was discharged home and is being followed and treated by medical oncology.
Conclusion: While PMBL can present with pleural effusion, it does not typically accumulate to the degree seen in this patient and result in a tension hydrothorax. Due to the tension hydrothorax and mediastinal mass, the patient had significant risk for cardiopulmonary collapse and was evaluated urgently by surgery. A major consideration of the surgical team was prevention of re-expansion pulmonary edema while reducing enough fluid to stabilize the patient. Weighing the risks of the procedures and the instability of the patient, the surgeon elected to treat with emergent thoracoscopy and chest tube placement in the operating room (OR) instead of interventions in the ED as this was the safest option.
[24] => [abstract_aim] => [25] => [abstract_methods] => [26] => [abstract_results] => [27] => [abstract_conclusion] => [28] => Chest tube,Hydrothorax,Mediastinal neoplasm (Source: MeSH-NLM) [article_keywords] => Chest tube,Hydrothorax,Mediastinal neoplasm (Source: MeSH-NLM) [29] => yes [full_text] => yes [30] => yes [reference] => yes [31] => yes [author_contribution] => yes [32] => We thank Dr. Carol Brenner and Diane Labbe (University of New England, College of Osteopathic Medicine Research) in providing us with the information, resources, and mentorship needed to write this manuscript and submit for publication. [acknowledgement] => We thank Dr. Carol Brenner and Diane Labbe (University of New England, College of Osteopathic Medicine Research) in providing us with the information, resources, and mentorship needed to write this manuscript and submit for publication. [33] => [funding_statement] => [34] => The corresponding author is the guarantor of submission. [data_availability_statement] => The corresponding author is the guarantor of submission. [35] => [ethics_approval] => [36] => Written informed consent was obtained from the patient for publication of this article. [concent_for_publication] => Written informed consent was obtained from the patient for publication of this article. [37] => [copyright_statement] => [38] => Cassidy Cunningham et al [copyright_statement_name] => Cassidy Cunningham et al [39] => Authors declare no conflict of interest. [competing_interests] => Authors declare no conflict of interest. [40] => [open_access_statement] => [41] => [article_video] => [42] => 100082Z12CC2021.pdf [article_pdf] => 100082Z12CC2021.pdf [43] => [article_epub] => [44] => [article_xml] => [45] => [article_image] => [46] => 4156 [page_views] => 4156 [47] => 1097 [abstract_views] => 1097 [48] => 108 [pdf_downloads] => 108 [49] => 0 [xml_downloads] => 0 [50] => 0 [epub_downloads] => 0 [51] => 2 [citation_downloads] => 2 [52] => 100082Z12CC2021.docx [article_citation_file] => 100082Z12CC2021.docx [53] => 100080Z12CC2020,100079Z12PV2020,100078Z12SK2020 [related_articles] => 100080Z12CC2020,100079Z12PV2020,100078Z12SK2020 [54] => 0 [citations] => 0 [55] => 0 [shares] => 0 [56] => [suggested_reading] => [57] => 2021-01-13 22:58:52 [date_added] => 2021-01-13 22:58:52 [58] => 2026-01-18 02:46:02 [date_modified] => 2026-01-18 02:46:02 [59] => 1 [status] => 1 [60] => [heading_archive] => )