Diagnosis of Pleural Lymphoma in a Kidney Transplant Patient by Medical Pleuroscopy with Cryoprobe Biopsies

Kidney transplant recipients are at increased risk of malignancy compared to age and gender matched populations. The development of a pleural effusion after transplantation requires further workup to determine if the etiology is malignant. We report a case of a patient with recurrent left-sided pleural effusion without a definitive diagnosis despite multiple thoracentesis. Positron emission tomography–computed tomography (PET-CT) was performed that showed nodular pleural lesions in the left hemithorax with low level fluorodeoxyglucose (FDG) uptake not amenable to CT guided biopsy. Pleuroscopy allowed for direct visualization of the nodules and a diagnosis of non-Hodgkin lymphoma was obtained with forceps and cryoprobe biopsy. Pleuroscopy is minimally invasive with high diagnostic yield and should be considered early in the setting of abnormal pleura and recurrent pleural effusions that is lymphocytic predominant despite negative cytology.