An unusual case of pleural nodularity

A 65‐year‐old man was referred to the respiratory unit for evaluation of a left lower‐zone opacity noted on a chest radiograph. On review, he appeared well and denied any respiratory symptoms. Physical examination was normal. A thoracic computed tomogram (CT) revealed widespread pleural nodularity with fissural and diaphragmatic involvement and prominent mediastinal lymph nodes. An image‐guided percutaneous pleural biopsy was arranged. Histological analysis confirmed adenocarcinoma, with initial immunostaining failing to identify the primary site. However, a staging CT scan demonstrated bony lesions and an irregular prostate. Serum PSA level was elevated, and subsequent PSA immunohistochemistry strongly positive; a diagnosis of metastatic prostate cancer was made. Prostate cancer has a well‐recognized pattern of metastatic disease (local lymph nodes and bone). Autopsy studies demonstrate that a significant number of patients have pleural involvement, contrasting with the rarity of clinically evident pleural disease during life.