Benign pleural schwannoma presenting with a large, blood-stained pleural effusion

A previously fit and well 43-year-old man presented with 8 weeks of worsening breathlessness and a dry cough. He was an ex-smoker of 10 pack-years with no history of asbestos exposure, thoracic radiation or recent trauma. Chest radiograph and CT thorax are shown in figure 1. Pleural aspiration was undertaken and 1.5 L of blood-stained fluid was removed, with symptomatic improvement. The fluid was exudative, with lactose dehydrogenase (LDH) 437U/L (serum 374U/L) and protein 47g/L (serum 77g/L). Infection was excluded by negative microbiological culture and normal inflammatory markers. Cytology revealed numerous red blood cells, scattered lymphocytes and eosinophils, but no malignant cells. Figure 1 (A) Posterior–anterior chest radiograph showing moderate left-sided pleural effusion and an indistinct opacity at the left hilum with mediastinal shift to the right. (B) Coronal CT images showing a round, encapsulated extrapulmonary mass, with cystic areas within in, surrounded by a pleural effusion. (C) Coronal positron emission tomography-CT images demonstrating high SUV uptake within …