Pleural effusion accumulating in the epidural space: Recurrent cord compression in a patient with progressive lung adenocarcinoma

Pleural effusions are common in patients with advanced carcioma, particularly of the lung and breast. While the spinal column ies adjacent to the pleura, to our knowledge there is no reported ase of a pleural effusion causing cord compression. The epidural pace is normally isolated from the pleural space by the parietal leura, spinal column, ribs, and associated soft tissue. Here we describe a patient with lung carcinoma and a prior horacic laminectomy for epidural metastasis who presented with ecurrent cord compression. She was found to have a large epidural uid collection in the region of the prior laminectomy, as well as large pleural effusion which had developed simultaneously. The pidural collection was thin in consistency and under high pressure, onsistent with pleural fluid. The pleural effusion became smaller fter drainage of the epidural collection, suggesting the presence f a pleural–epidural fistula.