• Federico Mei, Martina Bonifazi, Stefano Menzo, Alessandro Di Marco Berardino, Michele Sediari, Luca Paolini, Antonina Re, Francesca Gonnelli, Claudia Duranti, Martina Grilli, Giacomo Spurio Vennarucci, Maria Agnese Latini, Lina Zuccatosta, and Stefano Gasparini.
• Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy. Electronic address: fedusmei@gmail.com.
• Chest. 2020 Oct 1; 158 (4): e143-e146.

AbstractCoronavirus disease 2019 (COVID-19) is a pandemic infection due to the spread of a novel coronavirus (severe acute respiratory syndrome coronavirus 2), resulting in a wide range of clinical features, from asymptomatic carriers to ARDS. The gold standard for diagnosis is nucleic acid detection by real-time reverse transcriptase-polymerase chain reaction in nasopharyngeal swabs. However, due to limitations in this technique's sensitivity, thoracic imaging plays a crucial, complementary role in diagnostic evaluation and also allows for detection of atypical findings and potential alternative targets for sampling (eg, pleural effusion). Although less common, pleural involvement has been described in a minority of patients. This report describes the first case of reverse transcriptase-polymerase chain reaction detection of severe acute respiratory syndrome coronavirus 2 in pleural fluid obtained by means of ultrasound-guided thoracentesis, and its main characteristics are detailed. Pleural effusion is not a common finding in COVID-19 infection, but a prompt recognition of this potential localization may be useful to optimize diagnostic evaluation as well as the management of these patients.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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