The autopsy findings are reported in an 84-year-old woman who presented with a six-year history of right and left heart failure. A right-sided sterile transsudate persisted for 5 years despite medical treatment and repeated thoracenteses. Three years before death, a rounded density appeared in the right lung field, followed by a second 2 years later. At autopsy the pleural effusion was found to be related to fibrothorax, and the rounded densities consisted of two foci of atelectasis.