Roadside serendipity: an accident can lead to a rare diagnosis

A 78-year-old smoker, with no history of asbestos exposure, but with a history of COPD and arterial hypertension, was admitted to our pulmonology unit for investigation of a refractory pleural effusion. The patient's medical journey dated back to a few months earlier when, following investigations prompted by a car accident, a chest radiograph revealed a mild pleural effusion, which was interpreted as related to trauma (figure 1). A few weeks after starting corticosteroid therapy prescribed by the emergency physician, the patient underwent a follow-up chest ultrasound at our centre. Chest ultrasound revealed an anechoic effusion, extending at least three intercostal spaces, without signs of visible loculations, organisation, pleural thickening or lung atelectasis.