Bronchogenic carcinoma presenting as pleural empyema

Summary An 84-year-old patient reporting increased coughing, dyspnea and whitish phlegm was admitted to hospital with a tentative diagnosis of pneumonia and metapneumonic pleural effusion. Biochemical and microbiological analyses of pleural fluid were compatible with empyema, but pleural fluid cytology showed non-small-cell bronchogenic carcinoma. A few days after admission, perforation of the small intestine with tumoral infiltration was detected. Urgent surgery was followed by postoperative death. This case appears to reinforce the arguments for including cytological examination as routine when pleural fluid is analysed.