RUPTURED POSTERIOR MEDIASTINAL SCHWANNOMA: AN UNCOMMON CAUSE OF MASSIVE PLEURAL EFFUSION

Schwannomas, benign tumors derived from Schwann cells constituting approximately 20% of mediastinal and 80% of posterior mediastinal tumors, often arising from intercostal nerves. Although typically asymptomatic, they can lead to complications such as pleural effusion, especially in their cystic forms. This report presents a unique case of a ruptured posterior mediastinal schwannoma manifesting as massive pleural effusion. A 55-year-old female presented with persistent back pain and sudden-onset breathlessness. Imaging revealed a "white-out" appearance of the right lung, indicating massive pleural effusion. Subsequent imaging with CT and MRI characterized a heterogeneously enhancing solid-cystic mass in the right posterior mediastinum, extending into the D3-D4 neural foramina, with associated pleural effusion. CT findings further demonstrated cystic areas communicating with the effusion. Histopathological examination confirmed the diagnosis, and surgical intervention was performed, resulting in a favorable outcome. This case underscores the importance of recognizing the complex presentations of posterior mediastinal schwannomas, highlighting the need for prompt diagnosis and surgical management, especially in cases presenting with unusual complications like massive pleural effusion.