77-year-old female, non smoker, no known exposure who comes in with dyspnea, weight loss, left sided pleural effusion and pleural disease on chest CT. She underwent rigid pleuroscopy, fluid drainage, pleural biopsy and tunneled pleural catheter placement - Pathology: Stage IV Adenocarcinoma

Image courtesy of MOUNIR FERTIKH

Malignant Trapped Lung - Metastatic Adenocarcinoma

Image courtesy of Kho Sze Shyang

Multiple large nodules and superficial dilated vessels over parietal pleura HPE: metastatic adenocarcinoma

Image courtesy of Lee Kai Quan

Pleural lipomatosis as a cause of pleural effusion -- Lipomas are benign tumors most commonly found in the subcutaneous tissue; however rarely, they may involve parietal pleura. Pleural lipomas are slow-growing tumors with no malignant potential but can diagnostic dilemmas to the clinicians. Pleural lipomas are benign soft-tissue neoplasms that originate from the submesothelial layers of parietal pleura and extend into the subpleural, pleural, or extrapleural space. They are soft, encapsulated fatty tumors with slow growth. The patient presented with pleural effusion of unknown etiology and semi rigid thoracoscopy revealed smooth, lobulated, multiple smooth yellowish nodules studded on the parietal pleura at multiple sites .Histopathology of biopsy sample was reported as adipose tissue comprising adipocytes and no evidence of atypia or malignancy, a finding which is characteristic of pleural lipomas.

Image courtesy of Saurabh Karmakar

Right-sided diaphragmatic pores in a patient with catamenial pneumothorax.

Image courtesy of Liu Estradioto and Rodrigo Bettega de Araújo

Thoracoscopic vision of central venous catheter wrongly positioned intrapleuraly.

Image courtesy of Cesar Ribeiro Zuccoli and Rodrigo Bettega de Araújo

Thoracoscopic image of parietal pleura showing potato like nodules- metastatic adenocarcinoma

Image courtesy of Dr. Sharad Joshi

Case Metastatic Malignant Melanoma. Male Patient 45 years old , with history of malignant Melanoma of the skin , removed surgically and received chemotherapy. 2 years later , he had right sided pleural effusion , exaudate , on thoracoscopic examination we found multiple parietal pleural based dark black nodules of different sizes , biopsy revealed Malignant Metastatic Melanoma

Image courtesy of Ayman A Hamid Farghaly, MD

Multiple large whitish nodules over visceral and parietal pleura HPE: metastatic adenocarcinoma

Image courtesy of Lee Kai Quan, MD

Thoracoscopy images of left pleural cavity with parietal pleura studded with large irregular nodules with yellowish tip - histopathology shown clear cell renal cell carcinoma - Fuhrman grade III.

Case description:
A 66 years old male patient with history of left nephrectomy 2 years back due to renal cell carcinoma, presented with left sided pleural effusion - and was found to have isolated left pleural metastasis of clear cell renal cell carcinoma.

Image courtesy of Dr. Jaykumar Mehta

Pleuroscopic images demonstrate bloody pleural effusion and multiple small round red nodules on the diaphragm (A) and parietal pleura (B). Multiple small holes (*) are also discovered on the diaphragm (C). The histopathology of the nodules shows proliferative endometrial-typed glands surrounding by endometrial stroma which is covered with mesothelial cells (D). Thus, the diagnosis of pleural endometriosis is made by flex-rigid pleuroscopy.

Image courtesy of Viboon Boonsarngsuk, MD & Tharintorn Chansoon, MD

65yrs male patient with left sided encysted pleural effusion under gone thoracoscopy biopsy showing multiple grape like vascular nodules on parietal pleura. Biopsy revealed Squamous Cell carcinoma.

Image courtesy of DR SOMNATH BHATTACHARYA

Genitourinary (renal cell carcinoma)

Image courtesy of Fabien Maldonado, MD

Sarcoidosis

Image courtesy of Fabien Maldonado, MD

Sarcomatoid mesothelioma

Image courtesy of Fabien Maldonado, MD

Epithelioid mesothelioma

Image courtesy of Fabien Maldonado, MD

GI malignancies (colon cancer)

Image courtesy of Fabien Maldonado, MD

Lung cancer/adenocarcinoma

Image courtesy of Fabien Maldonado, MD

Lung squamous cell cancer

Image courtesy of Fabien Maldonado, MD