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Anthracotic pigment in pleural fluid: a case report
Liron Pantanowitz1, Michael Warren, Robert A Goulart
1Division of Cytopathology, Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, 759 Chestnut Street, Springfield, Massachusetts 01199, USA. lpantanowitz@hotmail.com
Acta Cytologica
|June 19, 2009
Summary
Carbon-laden macrophages in pleural fluid are not exclusive to crack cocaine users. This finding can occur in various effusions and may indicate a subclinical pneumothorax, highlighting its clinical significance.
Area of Science:
- Pulmonology
- Cytopathology
- Toxicology
Background:
- Anthracotic pigment (carbon) in pleural fluid cytology is rare, previously linked only to crack cocaine smoking.
- This study investigates cases of carbon-laden macrophages in pleural fluid unrelated to crack abuse.
Observation:
- Two patients, one HIV-negative with a transudative effusion and one HIV-positive with an exudative effusion, presented with anthracotic pigment in pleural fluid.
- Dense black pigment was observed within macrophages in both ThinPrep slides and cell block material.
- The pigment was iron-negative and located within KP-1 positive, TFF-1 negative macrophages.
Findings:
- Carbon-laden macrophages can be present in both exudative and transudative pleural effusions.
- The presence of anthracotic pigment in pleural fluid does not exclusively correlate with crack cocaine abuse.
Implications:
- Identification of carbon-laden macrophages in pleural fluid has clinical significance.
- This finding may suggest an underlying subclinical pneumothorax.
- The study expands the differential diagnosis for anthracotic pigment in pleural effusions beyond crack cocaine use.
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