James X. Liu, BS, Maria C. Shiau, MD, Daisuke Nonaka, MD CHEST

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An 80-Year-Old Man With Shortness of Breath and Large Right-Sided Pleural Effusion James X. Liu, BS, Maria C. Shiau, MD, Daisuke Nonaka, MD CHEST Volume 138, Issue 5, Pages 1247-1252 (November 2010) DOI: 10.1378/chest.09-2439 Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 1. Posteroanterior and lateral chest radiograph in an 80-year-old man with progressive dyspnea on exertion demonstrating a large right-sided pleural effusion. CHEST 2010 138, 1247-1252DOI: (10.1378/chest.09-2439) Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 2. Noncontrast axial CT image through the lower chest demonstrates a large right-sided pleural effusion and collapse of the right middle and lower lobes. There is a mild mediastinal shift to the left. Pleural surfaces are not significantly thickened at this level. Arrows denote an atelectatic lung. CHEST 2010 138, 1247-1252DOI: (10.1378/chest.09-2439) Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 3. Axial CT images of the thorax at the level of the aortic arch displayed in soft tissue and lung windows. Arrows denote areas of pleural thickening along the right major fissure and along the mediastinal pleura. Note volume loss of the right hemithorax. There is concavity of the posterior tracheal membrane secondary to expiratory phase of imaging. CHEST 2010 138, 1247-1252DOI: (10.1378/chest.09-2439) Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 4. Solid sheets of epithelioid cells characterized by abundant pink cytoplasms and round hyperchromatic nuclei (hematoxylin-eosin stain, original magnification ×100). CHEST 2010 138, 1247-1252DOI: (10.1378/chest.09-2439) Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 5. Tumor cells with nuclei displaced peripherally by globular cytoplasmic inclusions imparting a rhabdoid phenotype. Tumor cells indicated by arrows have intracytoplasmic lumens containing RBCs (hematoxylin-eosin stain, original magnification ×400.) CHEST 2010 138, 1247-1252DOI: (10.1378/chest.09-2439) Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 6. Tumor cells strongly positive for the vascular marker CD31 (CD31 immunostain, original magnification ×400). CHEST 2010 138, 1247-1252DOI: (10.1378/chest.09-2439) Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 7. Tumor cells showing weak cytokeratin expression (pan-cytokeratin stain, original magnification ×400). CHEST 2010 138, 1247-1252DOI: (10.1378/chest.09-2439) Copyright © 2010 The American College of Chest Physicians Terms and Conditions