Pleural effuse is a common medical problem with more than 50 recognized causes including disease local to the pleura or underlying lung, systemic conditions, organ dysfunction, and drugs. The majority of malignant PEf is caused by metastatic disease: Most commonly lung cancer in men and breast cancer in women. However, few germinal teratomas have been reported as the main cause of unilateral PEf.
A 17-year-old female patient was admitting to the emergency department. She has a chronic non-productive cough with six-week of evolution, non cyanotizing; progressive dyspnea to small or medium efforts, and intermittent chest pain in left-hemitorax witch increase at forced respiratory movements.; pulmonary fields with a decreased vesicular murmur, vocal vibrations; respiratory movements in left hemithorax. Chest radiographic image showed 95% left pleural effusion. Community-acquired pneumonia and massive pleural effusion are established as the initial diagnosis. After 24-h evolution was taken, a simple chest computerized tomography (CT) scan, that shows a left pleural effusion and a structure in the right pulmonary apex with heterogeneous densities, focal calcifications and a displacement of the mediastinal structures towards right hemitorax. Posteriorly, a biopsy guided by computerized tomography was performed; histologic diagnosis was established and, classified as a mature and benign teratoma. Subsequently, after 1-month; a complete resection of the tumor was performed successfully without complication.
Benign germinal teratoma is a frequent tumor in the mediastinum and rarely in adjacent organs. However, as in this case it is possible to find it as the cause of a unilateral pleural effusion. Clinical diagnosis should be suspected when there is no apparent clinical pathology to explain unilateral pleural effusion. Habitually a CT scan establishes the initial diagnosis and confirmed by biopsy and histopathological study to be later removed.