‘Malignant’ pleural effusion with abdominal gossypiboma

Following a 15-day history of cough with associated breathlessness, a 50-year-old woman presented with bilateral pleural effusions and a pericardial effusion. Her medical history included removal of an appendiceal cyst and a hysteromyoma resection 12 years previously. There was no cardiac or respiratory history. Physical examination revealed decreased breath sounds bilaterally with distant heart sounds heard. Pleural fluid demonstrated high levels of CA125 (2909.70 U/mL; reference range, 3.6–68.6 U/mL), cytokeratin fragment (CYFRA) (724.00 ng/mL; range, 0–3.3 ng/mL), squamous cell carcinoma antigen (SCC) (37.47 ng/mL; range, 0–1.5 ng/mL) and neuron specific enolase (NSE) (31.94 ng/mL; range, 0–16.3 ng/mL). Serum samples demonstrated high levels of CA125 (227.60 U/mL; range, 3.6–68.6 U/mL), CYFRA (6.79 ng/mL; …