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Garlapati S, Tambolkar S, Verma S, Pathak NV, Patil MG. Isolated Malignant Pleural Effusion in a Child: Unusual Presentation of Acute Leukemia. Cureus 2024; 16:e54232. [PMID: 38496208 PMCID: PMC10944318 DOI: 10.7759/cureus.54232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
Pleural effusion in the pediatric population is an abnormal pathology characterized by the accumulation of fluids between the parietal and visceral pleura. The etiology of this excessive fluid accumulation can be attributed to both infectious and non-infectious factors. Notably, Streptococcus pneumoniae stands out as the predominant infectious agent responsible for this condition. Non-infectious causative factors encompass hematolymphoid malignancies, congestive heart failure, hemothorax, hypoalbuminemia, and iatrogenic causes. Among the hematolymphoid malignancies, lymphoma emerges as the most prevalent malignancy associated with pleural effusion. It is followed by T-cell lymphoblastic leukemia, germ cell tumor, neurogenic tumor, chest wall and pulmonary malignancy, carcinoid tumor, pleuro-pulmonary blastoma, and Askin's tumor, among others. Malignant pleural effusion is predominantly linked to T-cell lymphoblastic malignancies. In the context of acute lymphoblastic leukemia (ALL), cases where T-cell presentation is accompanied by leukemic pleural effusion are commonly associated with either a mediastinal mass or significant lymphadenopathy. Here, we describe a case of a four-year-old male child who exhibited a brief history of febrile illness. Notably, this case was characterized by isolated pleural effusion, devoid of any mediastinal mass or lymphadenopathy. Pathological investigations of pleural fluid analysis revealed the presence of malignant cells, facilitating an expedited diagnosis.
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Affiliation(s)
- Srinija Garlapati
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Sampada Tambolkar
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Sarita Verma
- Pediatric Oncology, KEM Hospital Research Centre, Pune, IND
| | - Nakul V Pathak
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Manojkumar G Patil
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
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2
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Zaki HA, Albaroudi B, Shaban EE, Shaban A, Elgassim M, Almarri ND, Basharat K, Azad AM. Advancement in pleura effusion diagnosis: a systematic review and meta-analysis of point-of-care ultrasound versus radiographic thoracic imaging. Ultrasound J 2024; 16:3. [PMID: 38261109 PMCID: PMC10805747 DOI: 10.1186/s13089-023-00356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Pleural effusion is a fluid buildup in the pleural space that mostly result from congestive heart failure, bacterial pneumonia, malignancy, and pulmonary embolism. The diagnosis of this condition can be challenging as it presents symptoms that may overlap with other conditions; therefore, imaging diagnostic tools such as chest x-ray/radiograph (CXR), point-of-care ultrasound (POCUS), and computed tomography (CT) have been employed to make an accurate diagnosis. Although POCUS has high diagnostic accuracy, it is yet to be considered a first-line diagnostic tool as most physicians use radiography. Therefore, the current meta-analysis was designed to compare POCUS to chest radiography. METHODS n extended search for studies related to our topic was done on five electronic databases, including PubMed, Medline, Embase, Scopus, and Google Scholar. A quality assessment using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) was performed on all eligible articles obtained from the databases. Moreover, the diagnostic accuracy of POCUS and CXR was performed using STATA 16 software. RESULTS Our search yielded 1642 articles, of which only 18 were eligible for inclusion and analysis. The pooled analysis showed that POCUS had a higher diagnostic accuracy compared to CXR (94.54% (95% CI 91.74-97.34) vs. 67.68% (95% CI 58.29-77.08) and 97.88% (95% CI 95.77-99.99) vs. 85.30% (95% CI 80.06-90.54) sensitivity and specificity, respectively). A subgroup analysis based on the position of patients during examinations showed that POCUS carried out in supine and upright positions had higher specificity than other POCUS positions (99%). In comparison, lateral decubitus CXR had higher sensitivity (96%) and specificity (99%) than the other CXR positions. Further subgroup analyses demonstrated that CXR had higher specificity in studies that included more than 100 patients (92.74% (95% CI 85.41-100). Moreover, CXR tends to have a higher diagnostic accuracy when other CXR positions are used as reference tests (93.38% (95% CI 86.30-100) and 98.51% (95% CI 94.65-100) sensitivity and specificity, respectively). CONCLUSION POCUS as an imaging modality has higher diagnostic accuracy than CXR in detecting pleural effusion. Moreover, the accuracy is still high even when performed by physicians with less POCUS training. Therefore, we suggest it is considered a first-line imaging tool for diagnosing pleural effusion at the patients' bedside.
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Affiliation(s)
- Hany A Zaki
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Bilal Albaroudi
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Eman E Shaban
- Department of Cardiology, Al Jufairi Diagnosis and Treatment, MOH, Doha, Qatar
| | - Ahmed Shaban
- Department of Internal Medicine, Mansoura General Hospital, Mansoura, Egypt
| | - Mohamed Elgassim
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nood Dhafi Almarri
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Kaleem Basharat
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Aftab Mohammad Azad
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
- Hamad Medical Corporation, Collège of Medicine QU and Weil Cornell Medical College, Doha, Qatar
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Lin J, Grosu HB. Managing Medical Thoracoscopy Pain With Opioid-sparing Approaches. J Bronchology Interv Pulmonol 2023; 30:318-320. [PMID: 37784237 DOI: 10.1097/lbr.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
- Julie Lin
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
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Rabbi MF, Ahmed MN, Patowary MSA, Huq SR, Razzaque SMA, Arafat HM, Nahar T, Iktidar MA. Pleural fluid adenosine deaminase to serum C-reactive protein ratio for diagnosing tuberculous pleural effusion. BMC Pulm Med 2023; 23:349. [PMID: 37715196 PMCID: PMC10504718 DOI: 10.1186/s12890-023-02644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) may occasionally show similar cytological and biochemical picture including ADA. In such cases, differentiating TPE and MPE is challenging and needs histopathology of pleural tissue which may involve invasive procedures. The present study aims to evaluate the diagnostic accuracy of pleural fluid ADA to serum CRP (ADA/CRP) ratio to discriminate between tuberculous and malignant pleural effusion. In addition, we investigated whether the ratio ADA/CRP adds diagnostic value to ADA. METHODS This cross-sectional study was conducted in the National Institute of Diseases of the Chest and Hospital (NIDCH), Mohakhali, Dhaka, from July 2021 to February 2022 on diagnosed patients of TPE and malignant pleural effusion MPE. A receiver operating characteristic curve (ROC) was constructed for identifying TPE. The added value of the ADA/CRP ratio to ADA was evaluated using the net reclassification improvement (NRI) and integrated discrimination improvement (IDI). A value of p < 0.05 was considered statistically significant for all tests. RESULTS Fifty-nine patients were enrolled in this study, of which 31 had TPE, and 28 had MPE. Pleural fluid ADA to serum CRP ratio and pleural fluid ADA level was significantly higher in patients with TPE, but there was no significant difference in serum CRP levels between patients with TPE and MPE. At cut off value of > 1.25, pleural fluid ADA to serum CRP ratio had a sensitivity of 93.8%, specificity of 85.2%, and positive and negative predictive values were 88.2% and 92% respectively, in the diagnosis of TPE and area under ROC curve (AUC) was 0.94. The NRI and IDI analyses revealed added diagnostic value of ADA/CRP to ADA. CONCLUSION This study shows that the ADA/CRP ratio improves the diagnostic usefulness of ADA for TPE.
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Affiliation(s)
- Mohammad Fazle Rabbi
- National Institute of Diseases of the Chest and Hospital, Dhaka, 1212, Bangladesh
| | - Mushfiq Newaz Ahmed
- National Institute of Diseases of the Chest and Hospital, Dhaka, 1212, Bangladesh
| | | | | | - S M Abdur Razzaque
- National Institute of Diseases of the Chest and Hospital, Dhaka, 1212, Bangladesh
| | - Hossain Md Arafat
- National Institute of Cancer Research and Hospital, Dhaka, 1212, Bangladesh
| | - Tasnuva Nahar
- Mugda Medical College Hospital, Dhaka, 1214, Bangladesh
| | - Mohammad Azmain Iktidar
- Directorate General of Health Services, Dhaka, Bangladesh.
- School of Research, Chattogram, Bangladesh.
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Kapoor H, Gulati V, Gulati A, Donuru A, Parekh M. Comprehensive Imaging Review of Pleural Fistulas from Diagnosis to Management. Radiographics 2022; 42:1940-1955. [PMID: 36269669 DOI: 10.1148/rg.220083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pleural fistula is an abnormal communication between the pleural cavity and an adjacent structure. The interplay of anatomic and physiologic factors including proximity to various intrathoracic structures, deep pleural recesses, and negative pleural pressures makes the pleura an easy victim of fistulization. Iatrogenic creation followed by necrotizing infections and malignancies are the most common causes. While the overall incidence and size of postsurgical pleural fistulas are decreasing with increased adoption of vascularized flaps for high-risk resections, the smaller fistulas that develop in the setting of post-radiation therapy changes, with necrotizing infections in immunosuppressed patients, and with use of newer antiangiogenic chemotherapies can be challenging to visualize directly. Imaging signs in clinical practice are often subtle and indirect. Multimodality imaging and biochemical pleural fluid analysis can offer important adjunctive information when a diagnosis is only suggested with the first imaging study. Certain pleural fistulas are inconsequential, some spontaneously close with or without diversion of flow or use of positive-pressure ventilation, while others carry a higher risk of complications or recurrence. Estimated fistula size, factors that impair healing, and the possibility of diversion are important considerations when deciding between endoscopic or surgical closure. The authors have tailored this article for a general imager or clinical practitioner and review 10 types of pleural fistulas, ranging from routine to rare, with regard to their etiology, pathophysiology, clinical cues, imaging features, nuances of pleural fluid analysis, and management options available today. ©RSNA, 2022.
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Affiliation(s)
- Harit Kapoor
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
| | - Vaibhav Gulati
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
| | - Aishwarya Gulati
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
| | - Achala Donuru
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
| | - Maansi Parekh
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
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Hu K, Chopra A, Kurman J, Huggins JT. Management of complex pleural disease in the critically ill patient. J Thorac Dis 2021; 13:5205-5222. [PMID: 34527360 PMCID: PMC8411157 DOI: 10.21037/jtd-2021-31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/21/2021] [Indexed: 11/08/2022]
Abstract
Disorders of the pleural space are quite common in the critically ill patient. They are generally associated with the underlying illness. It is sometimes difficult to assess for pleural space disorders in the ICU given the instability of some patients. Although the portable chest X-ray remains the primary modality of diagnosis for pleural disorders in the ICU. It can be nonspecific and may miss subtle findings. Ultrasound has become a useful tool to the bedside clinician to aid in diagnosis and management of pleural disease. The majority of pleural space disorders resolve as the patient’s illness improves. There remain a few pleural processes that need specific therapies. While uncomplicated parapneumonic effusions do not have their own treatments. Those that progress to become a complex infected pleural space can have its individual complexity in therapy. Chest tube drainage remains the cornerstone in therapy. The use of intrapleural fibrinolytics has decreased the need for surgical referral. A large hemothorax or pneumothorax in patients admitted to the ICU represent medical emergencies and require emergent action. In this review we focus on the management of commonly encountered complex pleural space disorders in critically ill patients such as complicated pleural space infections, hemothoraces and pneumothoraces.
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Affiliation(s)
- Kurt Hu
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amit Chopra
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Jonathan Kurman
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Terrill Huggins
- Division of Pulmonary, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
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7
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Wong E, Jeganathan V, Wreghitt S, Davis G, Wimaleswaran H, Howard ME. Worsening respiratory failure in an adult hydrocephalic patient with a ventriculo-pleural shunt. Respirol Case Rep 2020; 8:e00660. [PMID: 33005422 PMCID: PMC7519950 DOI: 10.1002/rcr2.660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022] Open
Abstract
Ventriculo-pleural (VPL) shunt insertion is performed in hydrocephalic patients when alternative sites of cerebrospinal fluid (CSF) diversion are contraindicated. These include patients with peritoneal complications from ventriculo-peritoneal shunts. Despite its utility, VPL shunts are uncommon. Hydrothoraces should be considered as a potential cause of dyspnoea in the setting of a VPL shunt. We present a case of worsening respiratory failure in the setting of a massive CSF hydrothorax in a hydrocephalic patient with a VPL shunt to highlight this potential complication of pleural CSF diversion, and present a potential management strategy in patients with premorbid underlying lung pathology. In this case, the hydrothorax was drained and the shunt was converted to ventriculo-atrial (VA) shunt.
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Affiliation(s)
- Edmond Wong
- Department of Respiratory and Sleep MedicineAustin HealthHeidelbergVICAustralia
| | - Vishnu Jeganathan
- Department of Respiratory and Sleep MedicineAustin HealthHeidelbergVICAustralia
- Institute for Breathing and SleepHeidelbergVICAustralia
| | - Samuel Wreghitt
- Department of NeurosurgeryAustin HealthHeidelbergVICAustralia
| | - Gavin Davis
- Department of NeurosurgeryAustin HealthHeidelbergVICAustralia
| | - Hari Wimaleswaran
- Department of Respiratory and Sleep MedicineAustin HealthHeidelbergVICAustralia
- Institute for Breathing and SleepHeidelbergVICAustralia
- Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVICAustralia
| | - Mark E Howard
- Department of Respiratory and Sleep MedicineAustin HealthHeidelbergVICAustralia
- Institute for Breathing and SleepHeidelbergVICAustralia
- Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVICAustralia
- Turner Institute for Brain and Mental HealthMonash UniversityClaytonVICAustralia
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8
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Kierstead P, Lanks C. A 26-Year-Old Man With a Pleural Effusion and Headache. Chest 2019; 154:e113-e117. [PMID: 30290952 DOI: 10.1016/j.chest.2018.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/06/2018] [Indexed: 10/28/2022] Open
Abstract
CASE PRESENTATION A 26-year-old man presented to the ED with dizziness and gait imbalance. He noted dizziness for 3 months, but symptoms progressed more rapidly over the last 3 weeks when he began experiencing nausea, vomiting, and "wobbly legs." These symptoms would worsen with physical exertion, especially when lifting heavy objects. On review of systems, he also reported subjective fevers and chills. He had no appreciable dyspnea, cough, chest pain, or increased sputum production. The patient recalled a history of "brain surgery" approximately 4 years prior to his presentation, but no further details could be provided at the time.
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Affiliation(s)
- Peter Kierstead
- Division of Pulmonary and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, CA.
| | - Charles Lanks
- Division of Pulmonary and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, CA
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9
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Hopkins D, Pattman S, Jones R, Aujayeb A. A left-sided cerebrospinal fluid hydrothorax and a right ventricular-peritoneal shunt: a unique clinical case study. BMJ Case Rep 2019; 12:12/9/e230236. [PMID: 31540921 DOI: 10.1136/bcr-2019-230236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] Open
Abstract
We describe the case of a 84-year-old woman with a right ventricular-peritoneal shunt and a left-sided pleural effusion, the analysis of which was positive for cerebrospinal fluid. We consider the potential causative mechanisms. Our patient was managed conservatively due to her frailty, the effusion being asymptomatic and her preference not to pursue further invasive diagnostic testing. This case report is unique due to the contralateral nature of the effusion to the shunt, which has not been described before in the literature.
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Affiliation(s)
- David Hopkins
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Stewart Pattman
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Rhian Jones
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Avinash Aujayeb
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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10
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Bhatnagar R, Janssen J, Maskell N. The International Collaborative Effusion (ICE) database: an ERS Clinical Research Collaboration. Eur Respir J 2019; 53:53/5/1900591. [PMID: 31048373 DOI: 10.1183/13993003.00591-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 04/07/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Julius Janssen
- Pulmonology Dept, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
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Guo F, Wu J, Peng Y, Tu M, Xiao B, Dai C, Jiang K, Gao W, Li Q, Wei J, Chen J, Xi C, Lu Z, Miao Y. Black pleural effusion due to pancreatic pseudocyst: A case report. Medicine (Baltimore) 2017; 96:e9043. [PMID: 29390299 PMCID: PMC5815711 DOI: 10.1097/md.0000000000009043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Black pleural effusion (BPE) is an extremely uncommon type of pleural fluid, which can be due to infection, primary or metastatic malignancy, and hemorrhage. As reported in previous studies, BPE is also observed in some patients with pancreatic pseudocyst. PATIENT CONCERNS We herein reported a case of a 14-year-old female patient who was admitted to our center with a history of cough for 1 and a half months and right chest pain for 1 month. Before this, she was consecutively hospitalized in 3 different hospitals due to the same symptoms. However, the previous treatments were ineffective due to the lack of a definitive diagnosis. Laboratory examination of the pleural effusion showed BPE with a high amylase concentration. Chest x-ray and computed tomography (CT) showed massive pleural effusion, more prominent in the right chest. CT and MRCP of the abdomen showed a cystic lesion located in the tail of the pancreas, which entered the chest cavity via an esophageal hiatal hernia. DIAGNOSES:: pancreatic pseudocyst. INTERVENTIONS After confirming that the tumor was a pancreatic pseudocyst by intraoperative biopsy, internal drainage to the jejunum was performed. OUTCOMES The postoperative recovery was rapid and without complications, and the final discharge diagnosis was idiopathic pancreatic pseudocyst (without history of pancreatitis or pancreatic injuries) with BPE of the right chest. LESSONS This case demonstrates that massive BPE could present as a rare complication of pancreatic pseudocyst, and surgery is a potential treatment for such patients.
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Affiliation(s)
- Feng Guo
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Junli Wu
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Yunpeng Peng
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Min Tu
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Bin Xiao
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Cuncai Dai
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Kuirong Jiang
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Wentao Gao
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Qiang Li
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Jishu Wei
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Jianmin Chen
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Chunhua Xi
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Zipeng Lu
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Yi Miao
- Pancreas Center, First Affiliated Hospital
- Pancreas Institute, Nanjing Medical University, Nanjing, P.R. China
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Austin A, Jogani SN, Brasher PB, Argula RG, Huggins JT, Chopra A. The Urinothorax: A Comprehensive Review With Case Series. Am J Med Sci 2017; 354:44-53. [PMID: 28755732 DOI: 10.1016/j.amjms.2017.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/17/2017] [Accepted: 03/29/2017] [Indexed: 01/08/2023]
Abstract
Urinothorax is an uncommon thoracic complication of genitourinary (GU) tract disease, which is most frequently caused by obstructive uropathy, but may also occur as a result of iatrogenic or traumatic GU injury. It is underrecognized because of a perceived notion as to the rarity of the diagnosis and the absence of established diagnostic criteria. Urinothorax is typically described as a paucicellular, transudative pleural effusion with a pleural fluid/serum creatinine ratio >1.0. It is the only transudate associated with pleural fluid acidosis (pH < 7.40). When the pleural fluid analysis demonstrates features of a transudate, pH <7.40 and a pleural fluid/serum creatinine ratio >1.0, a confident clinical diagnosis of urinothorax can be established. A technetium 99m renal scan can be considered a confirmatory test in patients who lack the typical pleural fluid analysis features or fail to demonstrate evidence of obstructive uropathy that can be identified via conventional radiographic modalities. Management of a urinothorax requires a multidisciplinary approach with an emphasis on the correction of the underlying GU tract pathology, and once corrected, this often leads to a rapid resolution of the pleural effusion.
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Affiliation(s)
- Adam Austin
- Department of Medicine, Albany Medical College, Albany, New York.
| | - Sidharth Navin Jogani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, Albany, New York
| | - Paul Bradley Brasher
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Rahul Gupta Argula
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - John Terrill Huggins
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Amit Chopra
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, Albany, New York
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Adeoye PO, Johnson WR, Desalu OO, Ofoegbu CP, Fawibe AE, Salami AK, Fadeyi A, Akin-Dosumu AA, Rasheedat IM. Etiology, clinical characteristics, and management of pleural effusion in Ilorin, Nigeria. Niger Med J 2017; 58:76-80. [PMID: 29269986 PMCID: PMC5726178 DOI: 10.4103/0300-1652.219349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Pleural effusion (PE) is a primary manifestation or secondary complication of many disorders. This study reviews the pattern and management of PE in a Nigerian hospital. Materials and Methods: The medical records of 213 patients with clinical diagnosis of PE over a period of 3 years were reviewed. Results: PE accounted for 0.5% of the total hospital admissions. The most common cause of PE was tuberculosis (TB) (32.9%), followed by malignancy (29.1%) and pneumonia (15.0%). The male to female ratio was 1.3:1. TB was the leading cause of effusion in males, while it was malignancy in females. Pneumonia accounted for 61.9% of PE in preschool age and 66.7% in school age. Breathlessness (50.0%), cough (39.4%), and chest pain (24.9%) were the common presentations. Most (90.1%) of them were exudative effusion and with half in the right lung. Chest radiography (91.6%), pleural fluid for Ziehl–Neelsen stain (74.7%), cytology (59.2%), and tissue biopsy (57.8%) were the common diagnostic investigations. The majority (92.0%) had closed thoracostomy tube drainage, while 9.9% had chemical pleurodesis. The intra-hospital mortality was 10 (4.7%). Conclusion: TB, malignancy, and pneumonia are the leading causes of PE. A multidisciplinary approach is needed for optimal management.
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Affiliation(s)
| | - Wahab Rotimi Johnson
- Department of Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | | | | | - Abayomi Fadeyi
- Department of Medical Microbiology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Ibraheem M Rasheedat
- Department of Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Recurrent Right Pleural Effusion after Double Lung Transplant. Ann Am Thorac Soc 2016; 12:1572-4. [PMID: 26448352 DOI: 10.1513/annalsats.201503-167le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Garcia-Simon R, Hergueta Herrera J, Cañizares Oliver S, Roldan Rivas F, Fabre González E. Urinothorax: An unusual complication of an oncologic gynecological surgery. Taiwan J Obstet Gynecol 2016; 54:336-8. [PMID: 26166356 DOI: 10.1016/j.tjog.2014.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2014] [Indexed: 11/24/2022] Open
Affiliation(s)
- Raquel Garcia-Simon
- Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, Zaragoza, Spain; Instituto Aragonés de la Salud, Zaragoza, Spain.
| | - Jesus Hergueta Herrera
- Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, Zaragoza, Spain; Instituto Aragonés de la Salud, Zaragoza, Spain
| | - Silvia Cañizares Oliver
- Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, Zaragoza, Spain; Instituto Aragonés de la Salud, Zaragoza, Spain
| | - Fernando Roldan Rivas
- Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, Zaragoza, Spain; Instituto Aragonés de la Salud, Zaragoza, Spain
| | - Ernesto Fabre González
- Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, Zaragoza, Spain; Instituto Aragonés de la Salud, Zaragoza, Spain; Obstetrics and Gynaecology Department, University of Zaragoza, Zaragoza, Spain
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Li H, Huang L, Tang H, Zhong N, He J. Pleural fluid carcinoembryonic antigen as a biomarker for the discrimination of tumor-related pleural effusion. CLINICAL RESPIRATORY JOURNAL 2016; 11:881-886. [PMID: 26662658 DOI: 10.1111/crj.12431] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 11/20/2015] [Accepted: 12/04/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Huiling Li
- Department of Respiratory; Hainan Branch of PLA Hospital; Sanya 572000 Hainan Province China
- Department of Cardiothoracic Surgery; Guangzhou Institute of Respiratory Disease, State Key Laboratary of Respiratory Disease, The First Hospital Affiliated to Guangzhou Medical University; Guangzhou 510120 Guangdong Province China
| | - Liyan Huang
- Department of Cardiothoracic Surgery; Guangzhou Institute of Respiratory Disease, State Key Laboratary of Respiratory Disease, The First Hospital Affiliated to Guangzhou Medical University; Guangzhou 510120 Guangdong Province China
| | - Hailing Tang
- Department of Cardiothoracic Surgery; Guangzhou Institute of Respiratory Disease, State Key Laboratary of Respiratory Disease, The First Hospital Affiliated to Guangzhou Medical University; Guangzhou 510120 Guangdong Province China
| | - Nanshan Zhong
- Department of Cardiothoracic Surgery; Guangzhou Institute of Respiratory Disease, State Key Laboratary of Respiratory Disease, The First Hospital Affiliated to Guangzhou Medical University; Guangzhou 510120 Guangdong Province China
| | - Jianhang He
- Department of Cardiothoracic Surgery; Guangzhou Institute of Respiratory Disease, State Key Laboratary of Respiratory Disease, The First Hospital Affiliated to Guangzhou Medical University; Guangzhou 510120 Guangdong Province China
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Yao F, Wang J, Yao J, Hang F, Cao S, Qian J, Xu L. Early Chest Tube Removal After Thoracoscopic Esophagectomy with High Output. J Laparoendosc Adv Surg Tech A 2016; 26:17-22. [PMID: 26618398 DOI: 10.1089/lap.2015.0454] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Fei Yao
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian Wang
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ju Yao
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fangrong Hang
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shiqi Cao
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Junling Qian
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Xu
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Adamidi T, Soulitzis N, Neofytou E, Zannetos S, Georgiou A, Benidis K, Papadopoulos A, Siafakas NM, Schiza SE. Expression of YKL-40 and MIP-1a proteins in exudates and transudates: biomarkers for differential diagnosis of pleural effusions? A pilot study. BMC Pulm Med 2015; 15:150. [PMID: 26620310 PMCID: PMC4665844 DOI: 10.1186/s12890-015-0144-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/18/2015] [Indexed: 11/13/2022] Open
Abstract
Background YKL-40 is an extracellular matrix glycoprotein with a significant role in tissue inflammation and remodeling. MIP-1a has chemotactic and pro-inflammatory properties, and is induced by YKL-40 in several lung disorders. The aim of this study was to determine the levels of YKL-40 and MIP-1a in blood serum and pleural fluids of various pulmonary diseases, and to evaluate their potential role as differential diagnosis biomarkers. Methods We recruited 60 patients (age: 62.5 ± 20.6 years) with pleural effusions: 49 exudates and 11 transudates (T). Exudates were further classified based on the underlying disease: ten with tuberculosis (TB), 13 with lung cancer (LCa), 15 with metastatic cancer (MCa) of non-lung origin and 11 with parapneumonic (PN) effusions. YKL-40 and MIP-1a levels were measured by ELISA. Results Pleural YKL-40 levels (ng/ml) were similar among all patient groups (TB: 399 ± 36, LCa: 401 ± 112, MCa: 416 ± 34, PN: 401 ± 50, T: 399 ± 42, p = 0.92). On the contrary, YKL-40 was significantly lower in the serum of TB patients (TB: 58 ± 22, LCa: 212 ± 106, MCa: 254 ± 140, PN: 265 ± 140, T: 229 ± 123, p < 0.001). Pleural MIP-1a protein levels (ng/ml) were statistically lower only in patients with LCa (TB: 25.0 ± 20.2, LCa: 7.3 ± 6.0, MCa: 16.1 ± 14.9, PN: 25.4 ± 27.9, T: 18.5 ± 7.9, p = 0.012), a finding also observed in serum MIP-1a levels (TB: 17.1 ± 7.6, LCa: 9.4 ± 7.0, MCa: 28.7 ± 28.7, PN: 33.3 ± 24.0, T: 22.9 ± 8.7, p = 0.003). Conclusions Our data suggest that both YKL-40 and MIP-1a, particularly in serum, could prove useful for the differentiation of pleural effusions in clinical practice, especially of TB or LCa origin. However, large-scale studies are needed to validate these findings.
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Affiliation(s)
- Tonia Adamidi
- Department of Thoracic Medicine, Nicosia General Hospital, Nicosia, Cyprus
| | - Nikolaos Soulitzis
- Laboratory of Molecular and Cellular Pneumology, Medical School, University of Crete, Heraklion, Crete, Greece.
| | - Eirini Neofytou
- Laboratory of Molecular and Cellular Pneumology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Savvas Zannetos
- Department of HealthCare Management, Open University of Cyprus, Nicosia, Cyprus
| | - Andreas Georgiou
- Department of Thoracic Medicine, Nicosia General Hospital, Nicosia, Cyprus
| | - Kleomenis Benidis
- Department of Thoracic Medicine, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Nikolaos M Siafakas
- Laboratory of Molecular and Cellular Pneumology, Medical School, University of Crete, Heraklion, Crete, Greece.,Department of Thoracic Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Sophia E Schiza
- Laboratory of Molecular and Cellular Pneumology, Medical School, University of Crete, Heraklion, Crete, Greece.,Department of Thoracic Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
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Dixon G, de Fonseka D, Maskell N. Pleural controversies: image guided biopsy vs. thoracoscopy for undiagnosed pleural effusions? J Thorac Dis 2015; 7:1041-51. [PMID: 26150917 DOI: 10.3978/j.issn.2072-1439.2015.01.36] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 01/15/2015] [Indexed: 12/14/2022]
Abstract
Undiagnosed pleural effusions present an increasing diagnostic burden upon healthcare providers internationally. The investigation of pleural effusions often requires the acquisition of tissue for histological analysis and diagnosis. Historically there were two options for tissue biopsy: a 'gold standard' surgical biopsy or a "blind" closed pleural biopsy. Over the last decade however, image-guided Tru-cut biopsies and local anaesthetic thoracoscopic (local anaesthetic thoracoscopy) biopsies have become more widespread. Image-guided techniques acquire samples under ultrasound (US) or computed tomography (CT) guidance whereas LAT involves the direct visualisation and biopsy of the pleura with pleuroscopy. Both techniques have been shown to be superior to 'blind' closed pleural biopsy for the diagnosis of pleural or metastatic malignancy. However, closed biopsy remains a viable method of investigation in areas of high incidence of tuberculosis (TB). Beyond this, each investigative technique has its own advantages and disadvantages. Image-guided biopsy is less invasive, usually carried out as an outpatient procedure, and enables tissue biopsy in frail patients and those with pleural thickening but no pleural fluid. Local anaesthetic thoracoscopy (LAT) provides diagnostic and therapeutic capabilities in one procedure. Large volume thoracentesis, multiple pleural biopsies and talc poudrage can be carried out in a single procedure. The overall diagnostic yield is similar for both techniques, although there are no large-scale direct comparisons. Both techniques share low complication rates.
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Affiliation(s)
- Giles Dixon
- 1 North Bristol NHS Trust, Bristol, UK ; 2 Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Duneesha de Fonseka
- 1 North Bristol NHS Trust, Bristol, UK ; 2 Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Nick Maskell
- 1 North Bristol NHS Trust, Bristol, UK ; 2 Academic Respiratory Unit, University of Bristol, Bristol, UK
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20
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[Contribution of pleural fluid analysis to the diagnosis of pleural effusion]. Med Clin (Barc) 2014; 145:171-7. [PMID: 25433793 DOI: 10.1016/j.medcli.2014.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 07/24/2014] [Accepted: 08/29/2014] [Indexed: 11/24/2022]
Abstract
Analysis of pleural fluid can have, on its own, a high diagnostic value. In addition to thoracocentesis, a diagnostic hypothesis based on medical history, physical examination, blood analysis and imaging tests, the diagnostic effectiveness will significantly increase in order to establish a definite or high probable diagnosis in a substantial number of patients. Differentiating transudates from exudates by the classical Light's criteria helps knowing the pathogenic mechanism resulting in pleural effusion, and it is also useful for differential diagnosis purposes. An increased N-terminal pro-brain natriuretic peptide, both in the fluid and in blood, in a due clinical context, is highly suggestive of heart failure. The presence of an increased inflammatory marker, such as C-reactive protein, together with the presence of over 50% of neutrophils is highly suggestive of parapneumonic pleural effusion. If, in these cases, the pH is<7.20, then the likelihood of complicated pleural effusion is high. There remains to be demonstrated the usefulness of other markers to differentiate complicated from uncomplicated effusions. An adenosine deaminase > 45 U/L and>50% lymphocytes is suggestive of tuberculosis. If a malignant effusion is suspected but the cytological result is negative, increased concentrations of some markers in the pleural fluid can yield high specificity values. Increased levels of mesothelin and fibruline-3 are suggestive of mesothelioma. Immunohistochemical studies can be useful to differentiate reactive mesothelial cells, mesothelioma and metastatic adenocarcinoma. An inadequate use of the information provided by the analysis of pleural fluid would results in a high rate of undiagnosed effusions, which is unacceptable in current clinical practice.
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21
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Khalbuss WE, Hooda S, Auger M. Cytomorphology of Boerhaave's syndrome: A critical value in cytology. Cytojournal 2013; 10:8. [PMID: 23858318 PMCID: PMC3709518 DOI: 10.4103/1742-6413.111811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 04/09/2013] [Indexed: 11/08/2022] Open
Abstract
Spontaneous esophageal perforation into the pleural cavity (Boerhaave's syndrome) is a rare life-threatening condition, which requires early diagnosis and urgent management. The diagnosis of such critical condition in many cases is delayed because of atypical clinical presentation, resulting in increased morbidity and mortality. Cytological examination of pleural fluid can provide early, fast and accurate diagnosis of such critical condition and help in better and early management of this disease. We describe a case of an 81-year-old female with esophageal perforation who presented with a left sided pleural effusion. The correct diagnosis was established in this case by observing gastrointestinal-like fluid characteristics of the thoracic drainage upon cytological and chemical analyses and the rupture was confirmed by esophagography. The cytological examination of pleural fluid revealed benign reactive squamous cells, fungal organisms, bacterial colonies, and vegetable material consistent with a ruptured esophagus. Cytological examination of pleural fluid is a rapid and accurate technique that can help in establishing the diagnosis of this challenging entity and guide initiation proper management of this unusual entity.
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Affiliation(s)
- Walid E Khalbuss
- Departments of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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22
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Demirhan O, Kasapoglu T, Ece F, Toker A. The use of Jackson-Pratt silicone flat drains as prolonged pleural catheters for the management of pleural effusions. J Thorac Dis 2013; 5:265-9. [PMID: 23825757 DOI: 10.3978/j.issn.2072-1439.2013.06.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/14/2013] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Imbalance between secretion and absorbtion of pleural fluid results in pleural effusion. Emergence of pleural effusion ipsilateral or contralateral to the side drained previously is named recurrent effusion. There is currently no standart approach for the management of recurrent pleural effusions. MATERIALS AND METHODS Eighteen patients, treated between 2011 and 2012 for recurrent pleural effusions due to various etiologies, not considered for surgical or other treatments, and underwent placement of prolonged pleural catheters (Jackson-Pratt drain) were included in this study. Twenty two prolonged pleural catheters were inserted in 18 patients. There were 10 females and 8 males, with mean age 59 (35-77). In 20 patients the catheters were inserted by an anterior approach, and by a posterior approach in one patient. Daily drainage above 1,500 mL was not permitted in order to avoid pulmonary edema. Catheters were removed in patients who had lung expansion and drainage under 50 mL/day. RESULTS The most common etiology for pleural effusions was extrathoracic malignancy in 9 patients, primary bronchial carcinoma in 5 patients, and benign pleural effusion in 4 patients. Four patients underwent bilateral prolonged pleural catheter insertion. The catheters were retained for a mean period of 19 (10-40) days. Pleural effusion recurred two months after removal of the catheter in one patient with primary bronchial cancer (5%). Only one patient developed a complication (empyema) while under drainage (5%). Two patients died while the catheter was in place. CONCLUSIONS Decreased length of stay and lower costs have enabled prolonged are the major advantages of pleural catheter applications in appropriate patients compared to other treatment methods. We believe that the Jackson Pratt silicone flat drains provide effective pleurodesis along with easy application, and suggest their use as an alternative to pleurodesis in especially malignant pleural effusions and not benign pleural effusions.
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Affiliation(s)
- Ozkan Demirhan
- Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty, Turkey
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Saraya T, Light RW, Takizawa H, Goto H. Black pleural effusion. Am J Med 2013; 126:641.e1-6. [PMID: 23591042 DOI: 10.1016/j.amjmed.2012.11.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/06/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Black pleural effusions are extremely rare and have been reported in patients with infection, malignancy, and hemorrhage. However, no review articles appear to have focused on this rare clinical presentation. PURPOSE To classify and characterize diseases causing "black pleural effusion" based on the pathophysiological mechanisms involved. METHODS We searched the medical literature to find reports of "black pleural effusion" using the PubMed database. RESULTS We identified 8 cases and classified the underlying diseases into the following 4 entities based on pathophysiological conditions: 1) infection (Aspergillus niger and Rhizopus oryzae); 2) malignant melanoma, in which cells contain melanin pigment; 3) hemorrhage and hemolysis associated with non-small cell lung cancer or rupture of a pancreatic pseudocyst; and 4) other causes (charcoal-containing empyema). Discrimination between biliopleural fistula and pancreatico-pleural fistula, which also mimicking in color, was easily achieved by focusing on pleural amylase levels, elevation of pleural indirect bilirubin, presence of pleural glycoholic acid, and the predominant site of pleural effusion. CONCLUSION Black pleural effusions can be divided into 4 major categories based on the underlying pathophysiological conditions.
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Affiliation(s)
- Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan.
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24
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Sahn SA, Huggins JT, San Jose E, Alvarez-Dobano JM, Valdes L. The Art of Pleural Fluid Analysis. ACTA ACUST UNITED AC 2013. [DOI: 10.1097/cpm.0b013e318285ba37] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
OBJECTIVE The purpose of this article is to depict the anatomic pathways along which transphrenic spread of diseases and entities can disseminate. CONCLUSION The abdomen and thorax form a continuum on which the diaphragm is an important but incomplete barrier to disease migration.
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Abstract
Virtually, every pulmonary disease and most non-pulmonary diseases may be associated with a pleural effusion. The presence of a pleural effusion allows the clinician to 'diagnose' or narrow the differential diagnosis and aetiology of the fluid collection. However, pleural fluid analysis (PFA) in isolation rarely provides a definitive diagnosis. This review discusses the rationale for evaluating patients with a pleural effusion. If the clinician obtains a detailed history, performs a comprehensive physical examination, reviews pertinent blood tests, and evaluates the chest imaging findings prior to thoracentesis, there should be a high likelihood of establishing a firm clinical diagnosis based on the appropriate PFA. This manuscript reviews the clinical presentation, chest imaging findings, duration and natural course of specific pleural effusions to help narrow the range of pre-thoracentesis diagnoses. A diagnosis of transudative effusion confirms an imbalance in hydrostatic and oncotic pressures, normal pleura and a limited differential diagnosis, which is typically apparent from the clinical presentation. Exudates are the result of infections, malignancies, inflammation, impaired lymphatic drainage or the effects of drugs, and pose a greater diagnostic challenge. The differential diagnosis for a pleural exudate can be narrowed if LDH levels exceed 1000 IU/L, the proportion of lymphocytes is ≥80%, pleural fluid pH is <7.30 or there is pleural eosinophilia of >10%.
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Affiliation(s)
- Steven A Sahn
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Koide T, Saraya T, Nakajima A, Kurai D, Ishii H, Goto H. A 54-Year-Old Man With an Uncommon Cause of Left Pleural Effusion. Chest 2012; 141:560-563. [DOI: 10.1378/chest.11-1493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Lyman D. Spontaneous esophageal perforation in a patient with mixed connective tissue disease. Open Rheumatol J 2012; 5:138-43. [PMID: 22279514 PMCID: PMC3263470 DOI: 10.2174/1874312901105010138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/28/2011] [Accepted: 10/31/2011] [Indexed: 11/22/2022] Open
Abstract
Spontaneous esophageal perforation is a rare and life-threatening disorder. Failure to diagnosis within the first 24-48 hours of presentation portends a poor prognosis. A patient with mixed connective tissue disease (MCTD) on low-dose prednisone and methotrexate presented moribund with chest and shoulder pain, a left hydropneumothorax, progressive respiratory failure and shock. Initial management focussed on presumed community acquired pneumonia (CAP) in a patient on immunosuppressants. Bilateral yeast empyemas were treated and attributed to immunosuppression. On day 26, the patient developed mediastinitis, and the diagnosis of esophageal perforation was first considered. A review of the literature suggests that the diagnosis and management of spontaneous esophageal perforation could have been more timely and the outcome less catastrophic.
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Affiliation(s)
- David Lyman
- Cherry Street Health Services, 100 Cherry Street SE, Grand Rapids, Michigan, 49053, USA
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Shamji MF, Sundaresan S, Da Silva V, Seely J, Shamji FM. Subarachnoid-pleural fistula: applied anatomy of the thoracic spinal nerve root. ISRN SURGERY 2011; 2011:168959. [PMID: 22084743 PMCID: PMC3196872 DOI: 10.5402/2011/168959] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 07/03/2011] [Indexed: 11/23/2022]
Abstract
Subarachnoid-pleural fistula (SPF) is a rare complication of chest or spine operations for neoplastic disease. Concomitant dural and parietal pleural defects permit flow of cerebrospinal fluid into the pleural cavity or intrapleural air into the subarachnoid space. Dural injury recognized intraoperatively permits immediate repair, but unnoticed damage may cause postoperative pleural effusion, intracranial hypotension, meningitis, or pneumocephalus. We review two cases of SPF following surgical intervention for chest wall metastatic disease to motivate a detailed review of the anatomy of neural, osseous, and ligamentous structures at the intervertebral foramen. We further provide recommendations for avoidance and detection of such complication.
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Affiliation(s)
- Mohammed F Shamji
- Division of Neurosurgery, The Ottawa Hospital, Ottawa, ON, Canada K1Y 4E9
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Küpeli E, Yilmaz C, Akçay S. Pleural effusion following ventriculopleural shunt: Case reports and review of the literature. Ann Thorac Med 2011; 5:166-70. [PMID: 20835312 PMCID: PMC2930656 DOI: 10.4103/1817-1737.65048] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 12/18/2009] [Accepted: 03/10/2010] [Indexed: 12/04/2022] Open
Abstract
Ventriculo-pleural shunt (VPLS) is an acceptable alternative in the management of hydrocephalus. Imbalance between the production and absorption of cerebrospinal fluid an lead to formation of pleural effusion in patient with VPLS and on occasion produce symptoms. Pleural effusion could be a transudate or a non-specific exudate. We report our experience with this modality in relation to formation of pleural effusion and review the literature to make recommendation for its management. Information related to patients’ demographics, smoking history, prior pulmonary and occupational history, indication, duration and complications of the VPLS and their management was gathered to substantiate current recommendation with our experience.
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Affiliation(s)
- Elif Küpeli
- Department of Chest Diseases, Baskent University School of Medicine, Ankara, Turkey.
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Pakula AM, Phillips W, Skinner RA. A case of a traumatic chyle leak following an acute thoracic spine injury: successful resolution with strict dietary manipulation. World J Emerg Surg 2011; 6:10. [PMID: 21443785 PMCID: PMC3072950 DOI: 10.1186/1749-7922-6-10] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 03/28/2011] [Indexed: 11/29/2022] Open
Abstract
Background Chylothorax is a rare form of pleural effusion that can be associated with both traumatic and non-traumatic causes. Thoracic duct ligation is often the treatment of choice in postsurgical patients; however the optimal treatment of this disease process after traumatic injury remains unclear [1]. We present a rare case of a thoracic duct injury secondary to a blunt thoracic spine fracture and subluxation which was successfully treated non-operatively. Case Presentation A 51 year old male presented as a tier one trauma code due to an automobile versus bicycle collision. His examination and radiographic work-up revealed fractures and a subluxation at the third and fourth thoracic spine levels resulting in paraplegia. He also sustained bilateral hemothoraces secondary to multiple rib fractures. Drainage of the left hemothorax led to the diagnosis of a traumatic chylothorax. The thoracic spine fractures were addressed with surgical stabilization and the chylothorax was successfully treated with drainage and dietary manipulation. Conclusions This unusual and complex blunt thoracic duct injury required a multidisciplinary approach. Although the spine injury required surgical fixation, successful resolution of the chyle leak was achieved without surgical intervention.
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Affiliation(s)
- Andrea M Pakula
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kern Medical Center, Bakersfield, California
| | - Wendy Phillips
- Department of Nutrition and Dietary Services, Kern Medical Center, Bakersfield, California
| | - Ruby A Skinner
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kern Medical Center, Bakersfield, California
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Commandeur D, Danguy des Deserts M, Giacardi C, Nguyen BV, Drouillard I. [Accidental urothorax diagnosis]. ACTA ACUST UNITED AC 2010; 29:312-3. [PMID: 20227235 DOI: 10.1016/j.annfar.2010.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abdominal chyloma: CT findings and percutaneous drainage. Cardiovasc Intervent Radiol 2009; 32:601-2. [PMID: 19137370 DOI: 10.1007/s00270-008-9496-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 12/07/2008] [Accepted: 12/08/2008] [Indexed: 10/21/2022]
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Jeanty C, Ismail L, Turner CD. Incidental Findings During Routine Antepartum Obstetrical Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2008. [DOI: 10.1177/8756479308325465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The standard for performing an antepartum obstetrical sonogram primarily involves the examination of the fetus; however, both the American Institute of Ultrasound in Medicine (AIUM) and American College of Radiology (ACR) guidelines suggest the evaluation of maternal structures as well. The authors present 35 incidental findings that were discovered on routine antepartum obstetrical sonography. These include abdominal wall, gastrointestinal, reproductive, urinary, and vascular anomalies in the maternal structures. A review of the literature demonstrates that many of these findings have clinical significance, which highlights the wisdom of the AIUM and ACR guidelines, and it also stresses the importance of seeking and reporting them.
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Affiliation(s)
- Cerine Jeanty
- Wayne State University, School of Medicine, Detroit, Michigan
| | - Lana Ismail
- Wayne State University, School of Medicine, Detroit, Michigan
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Abstract
Pleural fluid analysis in isolation may have clinical value. To have the greatest diagnostic impact, the clinician must formulate a prethoracentesis diagnosis based on the clinical presentation, blood tests, and radiographic imaging. With this approach, a definitive or confident clinical diagnosis can be expected in up to 95% of patients. The information in this report should allow the clinician to achieve this goal.
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