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Christopher DJ, Gupta R, Thangakunam B, Daniel J, Jindal SK, Kant S, Chhajed PN, Gupta KB, Dhooria S, Chaudhri S, Chaudhry D, Patel D, Mehta R, Chawla RK, Srinivasan A, Kumar A, Bal SK, James P, Roger SJ, Nair AA, Katiyar SK, Agarwal R, Dhar R, Aggarwal AN, Samaria JK, Behera D, Madan K, Singh RB, Luhadia SK, Sarangdhar N, Souza GD, Nene A, Paul A, Varghese V, Rajagopal TV, Arun M, Nair S, Roy AD, Williams BE, Christopher SA, Subodh DV, Sinha N, Isaac B, Oliver AA, Priya N, Deva J, Chandy ST, Kurien RB. Pleural effusion guidelines from ICS and NCCP Section 1: Basic principles, laboratory tests and pleural procedures. Lung India 2024; 41:230-248. [PMID: 38704658 PMCID: PMC11093145 DOI: 10.4103/lungindia.lungindia_33_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 05/06/2024] Open
Abstract
Pleural effusion is a common problem in our country, and most of these patients need invasive tests as they can't be evaluated by blood tests alone. The simplest of them is diagnostic pleural aspiration, and diagnostic techniques such as medical thoracoscopy are being performed more frequently than ever before. However, most physicians in India treat pleural effusion empirically, leading to delays in diagnosis, misdiagnosis and complications from wrong treatments. This situation must change, and the adoption of evidence-based protocols is urgently needed. Furthermore, the spectrum of pleural disease in India is different from that in the West, and yet Western guidelines and algorithms are used by Indian physicians. Therefore, India-specific consensus guidelines are needed. To fulfil this need, the Indian Chest Society and the National College of Chest Physicians; the premier societies for pulmonary physicians came together to create this National guideline. This document aims to provide evidence based recommendations on basic principles, initial assessment, diagnostic modalities and management of pleural effusions.
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Affiliation(s)
| | - Richa Gupta
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Jefferson Daniel
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Surya Kant
- Department of Respiratory Medicine, King George’s Medical University, Lucknow, UP, India
| | - Prashant N. Chhajed
- Centre for Chest and Respiratory Diseases, Nanavati Max Super Specialty Hospital, Mumbai, Maharashtra, India
| | - K B Gupta
- Department of Respiratory Medicine, Eras Medical College, Lucknow, Uttar Pradesh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudhir Chaudhri
- Department of Respiratory Medicine, Rama Medical College, Kanpur, Uttar Pradesh, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences Rohtak, Haryana, India
| | - Dharmesh Patel
- City Clinic and Bhailal Amin General Hospital, Vadodara, Gujarat, India
| | - Ravindra Mehta
- VAAYU Chest and Sleep Services and VAAYU Pulmonary Wellness and Rehabilitation Center, Bengaluru, Karnataka, India
| | - Rakesh K. Chawla
- Department of Respiratory Medicine Critical Care and Sleep Disorders, Jaipur Golden Hospital and Saroj Super Specialty Hospital, Delhi, India
| | - Arjun Srinivasan
- Centre for Advanced Pulmonary Interventions, Royal Care Hospital, Coimbatore, Tamil Nadu, India
| | - Arvind Kumar
- Institute of Chest Surgery, Chest Onco Surgery and Lung Transplantation and Medanta Robotic Institute, Medanta-the Medicity, Gurugram, Haranya, India
| | - Shakti K. Bal
- Department of Pulmonary Medicine, AIIMS Bhubaneswar, Odisha, India
| | - Prince James
- Interventional Pulmonology and Respiratory Medicine, Naruvi Hospital, Vellore, Tamil Nadu, India
| | - S Jebin Roger
- Department of Respiratory Medicine, Apollo Hospital, Chennai, Tamil Nadu, India
| | | | - S K Katiyar
- Department of Tuberculosis and Respiratory Diseases, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Dhar
- Department of Pulmonology, C K Birla Hospitals, Kolkata, West Bengal, India
| | - Ashutosh N. Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - J K Samaria
- Department of Chest Diseases, IMS, B.H.U., Varanasi, Uttar Pradesh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Raj B Singh
- Department of Respiratory Medicine, Apollo Hospital, Chennai, Tamil Nadu, India
| | - S K Luhadia
- Department of Respiratory Medicine, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | | | - George D’ Souza
- Department of Pulmonary Medicine, St. John’s Medical College, Bangalore, Karnataka, India
| | - Amita Nene
- Department of Respiratory Medicine, Bombay Hospital India, Mumbai, Maharashtra, India
| | - Akhil Paul
- Department of Pulmonary Medicine, MOSC Medical Mission Hospital, Thrissur, Kerala, India
| | - Vimi Varghese
- Department of Heart and Lung Transplant, Yashoda Hospitals, Hyderabad, Telangana, India
| | - T V Rajagopal
- SKS Hospital and Post Graduate Medical Institute, Salem, Tamil Nadu, India
| | - M Arun
- Department of Respiratory Medicine, Meenakshi Hospital, Thanjavur, Tamil Nadu, India
| | - Shraddha Nair
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - A Dhivya Roy
- Kanyakumari Medical Mission, CSI Mission Hospital, Neyyoor, Tamil Nadu, India
| | - Benjamin E. Williams
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shona A. Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dhanawade V. Subodh
- Division of Critical Care Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nishant Sinha
- Department of Pulmonary Medicine, Continental Hospitals, Financial District, Hyderabad, Telangana, India
| | - Barney Isaac
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - A Ashwin Oliver
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - N Priya
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Sujith T. Chandy
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Richu Bob Kurien
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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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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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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Arrigo C, Aloisio E, Rovegno L, Dolci A, Panteghini M. The laboratory investigation of pleural fluids: An update based on the available evidence. Ann Clin Biochem 2023:45632231157547. [PMID: 36860132 DOI: 10.1177/00045632231157547] [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: 03/03/2023]
Abstract
Selecting appropriate laboratory tests based on available evidence is central to improve clinical effectiveness and impacting on patient outcome. Although long studied, there is no mutual agreement upon pleural fluid (PF) management in the laboratory context. Given the experienced confusion about the real contribution of laboratory investigations to guide clinical interpretation, in this update, we tried to identify useful tests for the PF analysis, aiming to unravel critical points and to define a common line in requesting modalities and practical management. We performed a careful literature review and a deepened study on available guidelines to finalize an evidence-based test selection, intended for clinicians' use to streamline PF management. The following tests depicted the basic PF profile routinely needed: (1) abbreviated Light's criteria (PF/serum total protein ratio and PF/serum lactate dehydrogenase ratio) and (2) cell count with differential analysis of haematological cells. This profile fulfils the primary goal to determine the PF nature and discriminate between exudative and transudative effusions. In specific circumstances, clinicians may consider additional tests as follows: the albumin serum to PF gradient, which reduces exudate misclassification rate by Light's criteria in patients with cardiac failure assuming diuretics; PF triglycerides, in differentiating chylothorax from pseudochylothorax; PF glucose, for identification of parapneumonic effusions and other causes of effusion, such as rheumatoid arthritis and malignancy; PF pH, in suspected infectious pleuritis and to give indications for pleural drainage; and PF adenosine deaminase, for a rapid detection of tuberculous effusion.
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Affiliation(s)
- Claudia Arrigo
- Clinical Pathology Unit, 472674ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elena Aloisio
- Clinical Pathology Unit, 472674ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Leila Rovegno
- Clinical Pathology Unit, 472674ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alberto Dolci
- Clinical Pathology Unit, 472674ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, 472674ASST Fatebenefratelli-Sacco, Milan, Italy
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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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Lee J, Kim YK, Park JE, Lee YH, Choi SH, Seo H, Yoo SS, Lee SY, Cha SI, Park JY, Kim CH. Automated and manual microscopic analyses for leukocyte differential counts in exudative pleural effusions: Real-world disagreement and clinical application. Medicine (Baltimore) 2022; 101:e30611. [PMID: 36123947 PMCID: PMC9478221 DOI: 10.1097/md.0000000000030611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Differential leukocyte counts of pleural fluid are routinely recommended for the early diagnosis and management of exudative pleural effusions. Rapid automated cellular analysis agrees strongly with standard manual microscopic counts and has become a reality in many clinical laboratories. However, discordant results sometimes observed between automated and manual analyses raise concern about using automated analysis to aid prompt differential diagnosis. This study aimed to evaluate the real-world disagreement between automated and manual leukocyte analyses in exudative pleural effusions and to investigate whether the discordant results occur in specific cellular ranges or randomly. We conducted a retrospective study of patients who were diagnosed with parapneumonic pleural effusions (PPE), tuberculous pleural effusions (TPE), and malignant pleural effusions (MPE) between September 2018 and December 2020. Differential and predominant leukocyte counts were performed using an automated XN-350 analyzer with a two-part differential count consisting of polymorphonuclear (PMN) and mononuclear (MN) leukocytes and a manual method with Wright-stained cytospin slides. We compared the two methods on cases of 109 PPEs, 50 TPEs, and 116 MPEs. Although the overall correlation between the two methods for differential leukocyte counts was excellent, there were etiologic variations; MPEs showed a lower correlation compared to PPEs and TPEs. Automated-PMN predominance almost corresponded to manual cytospin-neutrophilic predominance. In contrast, ~10% of the automated-MN predominance did not correspond with the cytospin-lymphocytic predominance. These discrepancies occurred most in the automated-MN% range of 51% to 60%, followed by 61% to 70%. The PMN% range ≥50% and <30% on the automated analysis reliably corresponds to the neutrophilic and lymphocytic predominance, respectively. However, the MN% range of 51% to 70% may not coincide with lymphocytic predominance on manual cytospin analysis. This range leaves the potential cause of exudative pleural effusions open.
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Affiliation(s)
- Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yu Kyung Kim
- Department of Clinical Pathology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ji Eun Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yong Hoon Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Sun Ha Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyewon Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seung Soo Yoo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Shin Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jae Yong Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Chang Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
- *Correspondence: Chang Ho Kim, Department of Internal Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, South Korea (e-mail: )
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Kim CH, Lee J. Mycoplasma pneumoniae Pleural Effusion in Adults. J Clin Med 2022; 11:jcm11051281. [PMID: 35268372 PMCID: PMC8911427 DOI: 10.3390/jcm11051281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022] Open
Abstract
Parapneumonic effusions often complicate Mycoplasma pneumoniae (MP) pneumonia, contrary to the notion that they are a rare feature of MP infection. Increased research and evidence on MP parapneumonic effusions (MPPE) can help elucidate its clinical significance as one of the variable manifestations of MP infection. This article aims to summarize the existing literature about the clinical characteristics of MPPE in adults and discuss its diagnostic implications from the perspective of pleural fluid analysis. Approximately 20–25% of adult patients with MP pneumonia develop MPPE, and its frequency in children and adults seems to be similar. Although the pathogenesis of MPPE remains to be elucidated, MP-induced cell-mediated immune mechanisms might be partially associated with the development of MPPE. MPPE usually shows mononuclear leukocyte predominance with elevated adenosine deaminase (ADA) activity, similar to tuberculous pleural effusion (TPE). The degree of increase in pleural fluid ADA levels and serum inflammatory biomarkers may help differentiate between MPPE and TPE. During the acute phase, a single positive IgM and positive polymerase chain reaction results allow for a precise and reliable MP infection diagnosis. The mainstay of treatment is the selection of adequate anti-mycoplasma antibiotics with or without corticosteroid, based on the local epidemiologic data on macrolide resistance.
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Affiliation(s)
| | - Jaehee Lee
- Correspondence: ; Tel.: +82-53-200-5536; Fax: +82-53-426-2046
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Choi G, Tang Z, Guan W. Microfluidic high-throughput single-cell mechanotyping: Devices and
applications. NANOTECHNOLOGY AND PRECISION ENGINEERING 2021. [DOI: 10.1063/10.0006042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Gihoon Choi
- Department of Electrical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802,
USA
| | - Zifan Tang
- Department of Electrical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802,
USA
| | - Weihua Guan
- Department of Electrical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802,
USA
- Department of Biomedical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802,
USA
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Godfrey M, Puchalski J. Pleural Effusions in the Critically Ill and "At-Bleeding-Risk" Population. Clin Chest Med 2021; 42:677-686. [PMID: 34774174 DOI: 10.1016/j.ccm.2021.08.012] [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: 10/19/2022]
Abstract
Thoracentesis is a common bedside procedure, which has a low risk of complications when performed with thoracic ultrasound and by experienced operators. In critically ill or mechanically ventilated patients, or in patients with bleeding risks due to medications or other coagulopathies, the complication rate remains low. Drainage of pleural effusion in the intensive care unit has diagnostic and therapeutic utility, and perceived bleeding risks should be one part of an individualized and comprehensive risk-benefit analysis.
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Affiliation(s)
- Mark Godfrey
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, 15 York Street, LCI 100, New Haven, CT 06510, USA
| | - Jonathan Puchalski
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, 15 York Street, LCI 100, New Haven, CT 06510, USA.
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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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11
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Zhang J, Chen Y, He G, Jiang X, Chen P, Ouyang J. Differential diagnosis of tuberculous and malignant pleural effusions: comparison of the Th1/Th2 cytokine panel, tumor marker panel and chemistry panel. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:265-270. [PMID: 32108543 DOI: 10.1080/00365513.2020.1728784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jiang Zhang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yili Chen
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guodong He
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Xiaobing Jiang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peisong Chen
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Juan Ouyang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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12
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Milevoj Kopcinovic L, Culej J, Jokic A, Bozovic M, Kocijan I. Laboratory testing of extravascular body fluids: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Part I - Serous fluids. Biochem Med (Zagreb) 2019; 30:010502. [PMID: 31839720 PMCID: PMC6904973 DOI: 10.11613/bm.2020.010502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 05/20/2019] [Indexed: 12/16/2022] Open
Abstract
Extravascular body fluids (EBF) analysis can provide useful information in the differential diagnosis of conditions that caused their accumulation. Their unique nature and particular requirements accompanying EBF analysis need to be recognized in order to minimize possible negative implications on patient safety. This recommendation was prepared by the members of the Working group for extravascular body fluid samples (WG EBFS). It is designed to address the total testing process and clinical significance of tests used in EBF analysis. The recommendation begins with a chapter addressing validation of methods used in EBF analysis, and continues with specific recommendations for serous fluids analysis. It is organized in sections referring to the preanalytical, analytical and postanalytical phase with specific recommendations presented in boxes. Its main goal is to assist in the attainment of national harmonization of serous fluid analysis and ultimately improve patient safety and healthcare outcomes. This recommendation is intended to all laboratory professionals performing EBF analysis and healthcare professionals involved in EBF collection and processing. Cytological and microbiological evaluations of EBF are beyond the scope of this document.
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Affiliation(s)
- Lara Milevoj Kopcinovic
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Jelena Culej
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Anja Jokic
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Department of Medical Biochemistry, Haematology and Coagulation with Cytology, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
| | - Marija Bozovic
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Irena Kocijan
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Medical Biochemistry Laboratory, General hospital Varaždin, Varaždin, Croatia
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13
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Ferreiro L, Toubes ME, San José ME, Suárez-Antelo J, Golpe A, Valdés L. Advances in pleural effusion diagnostics. Expert Rev Respir Med 2019; 14:51-66. [PMID: 31640432 DOI: 10.1080/17476348.2020.1684266] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Pleural effusion is a common clinical problem. Yet, in a significant proportion of patients (~20%), the cause of pleural effusion remains unknown. Understanding the diagnostic value of pleural fluid tests is crucial for the development of accurate diagnostic models.Areas covered: This paper provides an overview of latest advances in the diagnosis of pleural effusion based on the best evidence available.Expert opinion: For pleural fluid tests to have a good diagnostic value, it is necessary that data obtained from clinical history, physical examination, and radiological studies are correctly interpreted. Thoracentesis and pleural biopsy should always be performed under image guidance to improve its diagnostic sensitivity and prevent complications. Nucleic acid amplification tests, pleural tissue cultures, and collection of pleural fluid in blood culture bottles improve the diagnostic yield of pleural fluid cultures. Although undiagnosed pleural effusions generally have a favorable prognosis, follow-up is recommended to prevent the development of a malignant pleural effusion.
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Affiliation(s)
- Lucía Ferreiro
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Interdisciplinary Group of Research in Pulmonology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - María E Toubes
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - María E San José
- Interdisciplinary Group of Research in Pulmonology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Department of Clinical Analysis, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Golpe
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Interdisciplinary Group of Research in Pulmonology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Interdisciplinary Group of Research in Pulmonology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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14
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Cho J, Kim YS, Kim YH, Lee JY, Bae IC, Lee SG, Kim JH. Comparison of analytical performance of i-Smart 300 and pHOx ultra for the accurate determination of pleural fluid pH. Pract Lab Med 2019; 14:e00117. [PMID: 30815526 PMCID: PMC6378778 DOI: 10.1016/j.plabm.2019.e00117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/09/2019] [Accepted: 01/25/2019] [Indexed: 11/30/2022] Open
Abstract
Background Pleural fluid pH is an essential test for diagnosing complicated parapneumonic effusion. We evaluated the performance of two blood gas analyzers in measuring pleural fluid pH. Methods The i-STAT G3+ (Abbott) was used as a reference analyzer to evaluate the pH values obtained from other methods: the i-Smart 300 (i-SENS), the pHOx Ultra (Nova Biomedical), using a clot catcher to filter off microclot, and pH indicator paper. Within-device precision was performed using quality control materials. We compared pleural fluid pH (n = 86) by the above methods and analyzed the concordance rate at the level of the medical decision point, pH 7.2. Results The within-device coefficient of variations of pH were below 0.1% for all blood gas analyzers tested. The slopes of the regression equations for the i-Smart 300, pHOx Ultra, and pH indicator paper against the reference analyzer were 0.850 (95% confidence interval, CI, 0.800–0.896), 0.714 (95% CI, 0.671–0.766), and 1.105 (95% CI, 0.781–1.581), respectively. The kappa values for the i-Smart 300, pHOx Ultra, and pH indicator paper against the reference analyzer were 0.883 (95% CI, 0.656–1.110), 0.739 (95% CI, 0.393–1.084), and 0.464 (95% CI, 0.102–0.826), respectively. Conclusions The i-Smart 300 and pHOx Ultra demonstrated good analytical performance and diagnostic accuracy when determining pleural fluid pH compared with that by the i-STAT G3+, whereas the pH indicator paper showed unsatisfactory results. Pleural fluid pH should be determined by a blood gas analyzer using anaerobically collected blood in a heparinized syringe. Both i-Smart 300 and pHOx Ultra blood gas analyzers showed acceptable performance for the determination of pleural fluid pH. Use of a Clot Catcher prevented instrument errors when testing pleural fluid pH on both blood gas analyzers.
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Affiliation(s)
- Jooyoung Cho
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Young Sam Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Hwan Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Yeon Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Cheol Bae
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Guk Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ho Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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15
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Migrated T lymphocytes into malignant pleural effusions: an indicator of good prognosis in lung adenocarcinoma patients. Sci Rep 2019; 9:2996. [PMID: 30816121 PMCID: PMC6395746 DOI: 10.1038/s41598-018-35840-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/09/2018] [Indexed: 01/16/2023] Open
Abstract
The presence of leukocyte subpopulations in malignant pleural effusions (MPEs) can have a different impact on tumor cell proliferation and vascular leakiness, their analysis can help to understand the metastatic microenvironment. We analyzed the relationship between the leukocyte subpopulation counts per ml of pleural fluid and the tumor cell count, molecular phenotype of lung adenocarcinoma (LAC), time from cancer diagnosis and previous oncologic therapy. We also evaluated the leukocyte composition of MPEs as a biomarker of prognosis. We determined CD4+ T, CD8+ T and CD20+ B cells, monocytes and neutrophils per ml in pleural effusions of 22 LAC and 10 heart failure (HF) patients by flow cytometry. Tumor cells were identified by morphology and CD326 expression. IFNγ, IL-10 and IL-17, and chemokines were determined by ELISAs and migratory response to pleural fluids by transwell assays. MPEs from LAC patients had more CD8+ T lymphocytes and a tendency to more CD4+ T and CD20+ B lymphocytes than HF-related fluids. However, no correlation was found between lymphocytes and tumor cells. In those MPEs which were detected >1 month from LAC diagnosis, there was a negative correlation between pleural tumor cells and CD8+ T lymphocytes. CXCL10 was responsible for the attraction of CD20+ B, CD4+ T and CD8+ T lymphocytes in malignant fluids. Concentrations of IL-17 were higher in MPEs than in HF-related effusions. Survival after MPE diagnosis correlated positively with CD4+ T and CD8+ T lymphocytes, but negatively with neutrophils and IL-17 levels. In conclusion, lymphocyte enrichment in MPEs from LAC patients is mostly due to local migration and increases patient survival.
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16
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Casalini AG, Mori PA, Majori M, Anghinolfi M, Silini EM, Gnetti L, Motta F, Larini S, Montecchini S, Pisi R, Calderaro A. Pleural tuberculosis: medical thoracoscopy greatly increases the diagnostic accuracy. ERJ Open Res 2018; 4:00046-2017. [PMID: 29318136 PMCID: PMC5754561 DOI: 10.1183/23120541.00046-2017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/19/2017] [Indexed: 12/28/2022] Open
Abstract
Our objective was to evaluate the efficacy of a standardised work-up in the diagnosis of pleural tuberculosis (TB) that included fibreoptic bronchoscopy and medical thoracoscopy. A consecutive series of 52 pleural TB patients observed during the period 2001–2015 was evaluated retrospectively. 20 females, mean (range) age 39.7 (18–74) years, and 32 males, mean (range) age 45.75 (21–83) years, were included (28 non-EU citizens (53.8%)). The diagnosis of TB infections was established by identification (using stains, culture or molecular tests) of Mycobacterium tuberculosis in the pleura, sputum and/or bronchial specimens, or by evidence of caseous granulomas on pleural biopsies. Patients with and without lung lesions were considered separately. The diagnostic yield of the microbiological tests on pleural fluid was 17.3% (nine out of 52 patients). Among the 18 patients with lung lesions, bronchial samples (washing, lavage or biopsy) were positive in 50% of cases (nine patients). Cultures of pleural biopsies were positive in 63% of cases (29 out of 46 patients); pleural histology was relevant in all patients. Without pleural biopsy, a diagnosis would have been reached in 15 out of 52 patients (28.6%) and in four of them only following culture at 30–40 days. An integrated diagnostic work-up that includes all the diagnostic methods of interventional pulmonology is required for a diagnosis of pleural TB. In the majority of patients, a diagnosis can be reached only with pleural biopsy. Diagnosis of tuberculous pleural effusion can be a challenge; medical thoracoscopy greatly increases accuracyhttp://ow.ly/EnY430gubm9
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Affiliation(s)
| | - Pier Anselmo Mori
- Unit of Pulmonology and Thoracic Endoscopy, University Hospital of Parma, Parma, Italy
| | - Maria Majori
- Unit of Pulmonology and Thoracic Endoscopy, University Hospital of Parma, Parma, Italy
| | - Miriam Anghinolfi
- Unit of Pulmonology and Thoracic Endoscopy, University Hospital of Parma, Parma, Italy
| | | | - Letizia Gnetti
- Unit of Surgical Pathology, University Hospital of Parma, Parma, Italy
| | - Federica Motta
- Dept of Clinical and Experimental Medicine, Unit of Microbiology and Virology, University of Parma, Parma, Italy
| | - Sandra Larini
- Dept of Clinical and Experimental Medicine, Unit of Microbiology and Virology, University of Parma, Parma, Italy
| | - Sara Montecchini
- Dept of Clinical and Experimental Medicine, Unit of Microbiology and Virology, University of Parma, Parma, Italy
| | - Roberta Pisi
- Respiratory Disease and Lung Function Unit, Dept of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Adriana Calderaro
- Dept of Clinical and Experimental Medicine, Unit of Microbiology and Virology, University of Parma, Parma, Italy
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17
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An undiagnosed pleural effusion with surprising consequences. Respir Med Case Rep 2017; 22:53-56. [PMID: 28702335 PMCID: PMC5487223 DOI: 10.1016/j.rmcr.2017.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/16/2017] [Accepted: 05/25/2017] [Indexed: 12/29/2022] Open
Abstract
We present the case of a 43-year-old Italian woman with a left undiagnosed pleural effusion, which in subsequent months presented a clinically unexpected evolution with the appearance at first of a right wrist tenosynovitis and subsequently a bilateral lung involvement caused by M. Tuberculosis. With this case report, we would like to underline the importance of making a correct diagnosis of any pleural effusion as soon as possible by at least a thoracocentesis. If untreated, tuberculosis may easily disseminate to other organs. Some considerations and suggestions for antibiotic treatment of pleural effusion will also be given, since many antibiotics have some anti-tuberculosis effect and may delay the diagnosis of this infectious disease.
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18
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Ferreiro L, Pereiro T, San José E, Toubes M, Suárez-Antelo J, Álvarez Dobaño J, González Barcala F, Rodríguez Núñez N, Lama A, Valdés L. Comportamiento de las células nucleadas en los distintos tipos de derrame pleural. Rev Clin Esp 2017; 217:136-143. [DOI: 10.1016/j.rce.2016.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/16/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
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19
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Ferreiro L, Pereiro T, San José E, Toubes M, Suárez-Antelo J, Álvarez Dobaño J, González Barcala F, Rodríguez Núñez N, Lama A, Valdés L. Behavior of nucleated cells in various types of pleural effusion. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2016.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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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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21
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Patil M, Dhillon SS, Attwood K, Saoud M, Alraiyes AH, Harris K. Management of Benign Pleural Effusions Using Indwelling Pleural Catheters: A Systematic Review and Meta-analysis. Chest 2016; 151:626-635. [PMID: 27845052 DOI: 10.1016/j.chest.2016.10.052] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/15/2016] [Accepted: 10/27/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The indwelling pleural catheter (IPC), which was initially introduced for the management of recurrent malignant effusions, could be a valuable management option for recurrent benign pleural effusion (BPE), replacing chemical pleurodesis. The purpose of this study is to analyze the efficacy and safety of IPC use in the management of refractory nonmalignant effusions. METHODS We conducted a systematic review and meta-analysis on the published literature. Retrospective cohort studies, case series, and reports that used IPCs for the management of pleural effusion were included in the study. RESULTS Thirteen studies were included in the analysis, with a total of 325 patients. Congestive heart failure (49.8%) was the most common cause of BPE requiring IPC placement. The estimated average rate of spontaneous pleurodesis was 51.3% (95% CI, 37.1%-65.6%). The estimated average rate of all complications was 17.2% (95% CI, 9.8%-24.5%) for the entire group. The estimated average rate of major complications included the following: empyema, 2.3% (95% CI, 0.0%-4.7%); loculation, 2.0% (95% CI, 0.0%-4.7%); dislodgement, 1.3% (95% CI, 0.0%-3.7%); leakage, 1.3% (95% CI, 0.0%-3.5%); and pneumothorax, 1.2% (95% CI, 0.0%-4.1%). The estimated average rate of minor complications included the following: skin infection, 2.7% (95% CI, 0.6%-4.9%); blockage and drainage failure, 1.1% (95% CI, 0.0%-3.5%); subcutaneous emphysema, 1.1% (95% CI, 0.0%-4.0%); and other, 2.5% (95% CI, 0.0%-5.2%). One death was directly related to IPC use. CONCLUSIONS IPCs are an effective and viable option in the management of patients with refractory BPE. The quality of evidence to support IPC use for BPE remains low, and high-quality studies such as randomized controlled trials are needed.
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Affiliation(s)
- Monali Patil
- Department of Pulmonary, Critical Care and Sleep Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY
| | - Samjot Singh Dhillon
- Department of Pulmonary, Critical Care and Sleep Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY; Department of Medicine, Pulmonary Medicine, and Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, NY
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY
| | - Marwan Saoud
- Department of Internal Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY
| | - Abdul Hamid Alraiyes
- Department of Pulmonary, Critical Care and Sleep Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY; Department of Medicine, Pulmonary Medicine, and Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, NY
| | - Kassem Harris
- Department of Pulmonary, Critical Care and Sleep Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY; Department of Medicine, Pulmonary Medicine, and Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, NY.
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22
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Ferreiro L, Sánchez-Sánchez R, Valdés L, Kummerfeldt CE, Huggins JT. Concordant and Discordant Exudates and Their Effect on the Accuracy of Light's Criteria to Diagnose Exudative Pleural Effusions. Am J Med Sci 2016; 352:549-556. [PMID: 27916209 DOI: 10.1016/j.amjms.2016.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 07/23/2016] [Accepted: 08/18/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION To describe the incidence of discordant exudate (DE) effusions, their underlying etiologies and their effect on the accuracy of the Light's criteria to diagnose exudate effusions. METHODS A retrospective review of pleural fluid analysis (PFA) from a cohort of patients with pleural effusion (PE) who underwent thoracentesis. PEs were defined as exudative based on the Light's criteria. The effusions were further classified in concordant or DE. RESULTS From 847 PE samples, 611 (72.1%) were diagnosed as an exudate and 236 (27.9%) as a transudate. In 10.3% of cases (n = 87), there was discordancy between the final pleural fluid diagnosis and the PFA defined by Light's criteria. 281 (33.2%) of the 632 effusions classified as an exudate by Light's criteria were DE (52 transudates and 229 exudates). 182 (65%) of the 281 DE were found to be protein discordant (37 transudates and 145 exudates), and 99 (35.2%) were lactate dehydrogenase discordant (15 transudates and 84 exudates). The positive predictive value and positive likelihood ratio of Light's criteria for the diagnosis of an exudate effusion decreased from 99.4% and 67.4%, respectively, when the exudates were concordant to 81.5% and 1.7, respectively, if they were discordant. CONCLUSIONS In a significant percentage of patients, there is discordancy between the results of the PFA and the final clinical diagnosis. DE decreased the accuracy of Light's criteria to identify exudate PE, increasing the risk of misclassifying a transudate as an exudate. Concordant exudates almost universally established the presence of an exudative PE.
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Affiliation(s)
- Lucía Ferreiro
- Division of Pulmonary, University Hospital Complex of Santiago de Compostela, Interdisciplinary Research Group of Pulmonary, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Rolando Sánchez-Sánchez
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Luis Valdés
- Division of Pulmonary, University Hospital Complex of Santiago de Compostela, Interdisciplinary Research Group of Pulmonary, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Carlos E Kummerfeldt
- Division of Pulmonary and Critical Care, T J Samson Community Hospital, Glasgow, Kentucky
| | - John T Huggins
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina.
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Pleural biopsies in undiagnosed pleural effusions; Abrams vs image-guided vs thoracoscopic biopsies. Curr Opin Pulm Med 2016; 22:392-8. [DOI: 10.1097/mcp.0000000000000258] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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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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Estimation of Pleural Fluid Volumes on Chest Radiography Using Computed Tomography Volumetric Analysis. J Thorac Imaging 2015; 30:336-9. [DOI: 10.1097/rti.0000000000000147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Abstract
Traditionally, cell analysis has focused on using molecular biomarkers for basic research, cell preparation, and clinical diagnostics; however, new microtechnologies are enabling evaluation of the mechanical properties of cells at throughputs that make them amenable to widespread use. We review the current understanding of how the mechanical characteristics of cells relate to underlying molecular and architectural changes, describe how these changes evolve with cell-state and disease processes, and propose promising biomedical applications that will be facilitated by the increased throughput of mechanical testing: from diagnosing cancer and monitoring immune states to preparing cells for regenerative medicine. We provide background about techniques that laid the groundwork for the quantitative understanding of cell mechanics and discuss current efforts to develop robust techniques for rapid analysis that aim to implement mechanophenotyping as a routine tool in biomedicine. Looking forward, we describe additional milestones that will facilitate broad adoption, as well as new directions not only in mechanically assessing cells but also in perturbing them to passively engineer cell state.
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Affiliation(s)
- Eric M Darling
- Center for Biomedical Engineering.,Department of Molecular Pharmacology, Physiology, and Biotechnology.,Department of Orthopaedics, and.,School of Engineering, Brown University, Providence, Rhode Island 02912;
| | - Dino Di Carlo
- Department of Bioengineering.,California NanoSystems Institute, and.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California 90095;
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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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Reed RM, Eberlein M, Netzer G, Pickering E, Shanholtz C, Verceles AC, McCurdy MT. Diagnostic value of pleural fluid obtained from a chest tube collection system. Lung 2014; 193:141-6. [PMID: 25394673 DOI: 10.1007/s00408-014-9666-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/03/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pleural fluid is typically drawn directly from the pleural space for diagnostic studies, but occasionally analyses are desired when a chest tube is already in place and a traditional approach is not feasible. The diagnostic value of analyzing fluid samples obtained from the pleural fluid collection system after chest tube insertion is unknown. METHODS We performed a prospective observational study of patients in whom chest tube placement was planned for clinical indications. Diagnostic studies were performed on fluid obtained from the pleural space at the time of tube insertion and then repeated 2, 6, and 24 h later on samples obtained from the fluid collection system. RESULTS Fifty-five percent of the 23 effusions studied met light's criteria for exudate at baseline. Lactate dehydrogenase (LDH) varied considerably over time from baseline measures with only 25 % of measures at 24 h falling within 25 % of baseline levels. The sensitivity for exudate by LDH remained 100 % with poor specificity ranging 50-69 % with repeat measures. Total protein exhibited less variability with 85 % of measures at 24 h falling within 25 % of baseline measure. Sensitivity and specificity at 24 h were 88 and 82 %, respectively. Repeat measures of cholesterol, albumin, and triglycerides generally correlated well (Spearman's rho > 0.90) with baseline values. Measures of glucose and cell counts varied considerably from baseline. CONCLUSIONS Analysis of pleural fluid from a chest tube collection system is feasible and can provide useful diagnostic information. Practitioners should consider the test characteristics of each measure when interpreting samples obtained.
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Affiliation(s)
- Robert M Reed
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 South Paca Street, 2nd Floor, Baltimore, MD, 21201, USA,
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29
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Valdés L, San-José E, Ferreiro L, Golpe A, González-Barcala FJ, Toubes ME, Rodríguez-Álvarez MX, Álvarez-Dobaño JM, Rodríguez-Núñez N, Rábade C, Gude F. Predicting malignant and tuberculous pleural effusions through demographics and pleural fluid analysis of patients. CLINICAL RESPIRATORY JOURNAL 2014; 9:203-13. [DOI: 10.1111/crj.12125] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 12/20/2013] [Accepted: 02/17/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Luis Valdés
- Servicio de Neumología; Complejo Hospitalario Clínico-Universitario de Santiago; Grupo Interdisciplinar de Investigación en Neumología; Instituto de Investigaciones Sanitarias de Santiago (IDIS); Santiago de Compostela Spain
| | - Esther San-José
- Servicio de AnálisisClínicos; Complejo Hospitalario Clínico-Universitario de Santiago; Grupo Interdisciplinar de Investigación en Neumología; Instituto de Investigaciones Sanitarias de Santiago (IDIS); Santiago de Compostela Spain
| | - Lucía Ferreiro
- Servicio de Neumología; Complejo Hospitalario Clínico-Universitario de Santiago; Santiago de Compostela Spain
| | - Antonio Golpe
- Servicio de Neumología; Complejo Hospitalario Clínico-Universitario de Santiago; Grupo Interdisciplinar de Investigación en Neumología; Instituto de Investigaciones Sanitarias de Santiago (IDIS); Santiago de Compostela Spain
| | - Francisco-Javier González-Barcala
- Servicio de Neumología; Complejo Hospitalario Clínico-Universitario de Santiago; Grupo Interdisciplinar de Investigación en Neumología; Instituto de Investigaciones Sanitarias de Santiago (IDIS); Santiago de Compostela Spain
| | - María E. Toubes
- Servicio de Neumología; Complejo Hospitalario Clínico-Universitario de Santiago; Santiago de Compostela Spain
| | - María X. Rodríguez-Álvarez
- Unidad de Epidemiología Clínica; Complejo Hospitalario Clínico-Universitario de Santiago; Santiago de Compostela Spain
| | - José M. Álvarez-Dobaño
- Servicio de Neumología; Complejo Hospitalario Clínico-Universitario de Santiago; Grupo Interdisciplinar de Investigación en Neumología; Instituto de Investigaciones Sanitarias de Santiago (IDIS); Santiago de Compostela Spain
| | - Nuria Rodríguez-Núñez
- Servicio de Neumología; Complejo Hospitalario Clínico-Universitario de Santiago; Santiago de Compostela Spain
| | - Carlos Rábade
- Servicio de Neumología; Complejo Hospitalario Clínico-Universitario de Santiago; Santiago de Compostela Spain
| | - Francisco Gude
- Unidad de Epidemiologia Clínica; Complejo Hospitalario Clínico-Universitario de Santiago; Grupo Epidemiologia de Enfermedades Frecuentes; Instituto de Investigaciones, Sanitarias de Santiago (IDIS); Santiago de Compostela Spain
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Bautista A, Heine M, van Berkel V, Kelly-Frasher L, Remmel K, Akca O. Right-Sided Pleural Effusion in a Critically Ill Stroke Patient. J Investig Med High Impact Case Rep 2014; 2:2324709614523258. [PMID: 26425594 PMCID: PMC4528863 DOI: 10.1177/2324709614523258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pleural fluid collections are common in those critically ill. We report the case of a left middle cerebral artery stroke patient who developed respiratory distress and required intubation and mechanical ventilation. Although the patient's clinical status and oxygenation improved, there was persistence of right-sided opacity in the chest radiograph. Further workup proved a right-sided pleural effusion, which was drained and managed. Following extubation, a swallow study was ordered, which led to a fluoroscopic examination that demonstrated esophageal perforation. Thoracic surgery was consulted and did a primary repair of perforation and noted non-small cell carcinoma on the perforated site.
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Affiliation(s)
| | | | | | | | | | - Ozan Akca
- University of Louisville, Louisville, KY, USA
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31
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Tse HTK, Gossett DR, Moon YS, Masaeli M, Sohsman M, Ying Y, Mislick K, Adams RP, Rao J, Di Carlo D. Quantitative Diagnosis of Malignant Pleural Effusions by Single-Cell Mechanophenotyping. Sci Transl Med 2013; 5:212ra163. [DOI: 10.1126/scitranslmed.3006559] [Citation(s) in RCA: 196] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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32
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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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33
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Hydrodynamic stretching of single cells for large population mechanical phenotyping. Proc Natl Acad Sci U S A 2012; 109:7630-5. [PMID: 22547795 DOI: 10.1073/pnas.1200107109] [Citation(s) in RCA: 483] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cell state is often assayed through measurement of biochemical and biophysical markers. Although biochemical markers have been widely used, intrinsic biophysical markers, such as the ability to mechanically deform under a load, are advantageous in that they do not require costly labeling or sample preparation. However, current techniques that assay cell mechanical properties have had limited adoption in clinical and cell biology research applications. Here, we demonstrate an automated microfluidic technology capable of probing single-cell deformability at approximately 2,000 cells/s. The method uses inertial focusing to uniformly deliver cells to a stretching extensional flow where cells are deformed at high strain rates, imaged with a high-speed camera, and computationally analyzed to extract quantitative parameters. This approach allows us to analyze cells at throughputs orders of magnitude faster than previously reported biophysical flow cytometers and single-cell mechanics tools, while creating easily observable larger strains and limiting user time commitment and bias through automation. Using this approach we rapidly assay the deformability of native populations of leukocytes and malignant cells in pleural effusions and accurately predict disease state in patients with cancer and immune activation with a sensitivity of 91% and a specificity of 86%. As a tool for biological research, we show the deformability we measure is an early biomarker for pluripotent stem cell differentiation and is likely linked to nuclear structural changes. Microfluidic deformability cytometry brings the statistical accuracy of traditional flow cytometric techniques to label-free biophysical biomarkers, enabling applications in clinical diagnostics, stem cell characterization, and single-cell biophysics.
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Abstract
The pathogenic fungus Cryptococcus neoformans exhibits a striking propensity to cause central nervous system (CNS) disease in people with HIV/AIDS. Given that cryptococcal infections are generally initiated by pulmonary colonization, dissemination requires that the fungus withstand phagocytic killing, cross the alveolar-capillary interface in the lung, survive in the circulatory system and breach the blood-brain barrier. We know little about the molecular mechanisms underlying dissemination, but there is a rapidly growing list of mutants that fail to cause CNS disease. These mutants reveal a remarkable diversity of functions and therefore illustrate the complexity of the cryptococcal-host interaction. The challenge now is to extend the analysis of these mutants to acquire a detailed understanding of each step in dissemination.
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Abstract
Emergency department presentations of pleural-based diseases are common, with severity ranging from mild to life threatening. The acute assessment, diagnosis, and treatment of pleural disease are critical as urgent invasive maneuvers such as thoracocentesis and thoracostomy may be indicated. The emergency physician must have a systematic approach to these conditions that allows for rapid recognition, diagnosis, and definitive management. This article focuses on nontraumatic pleural disease, including diagnostic and treatment considerations of pleural effusion, empyema, primary spontaneous pneumothorax, secondary spontaneous pneumothorax, pediatric pneumothorax, spontaneous hemothorax, and spontaneous tension pneumothorax.
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Affiliation(s)
- Erin Weldon
- Department of Emergency Medicine, University of Manitoba, T258E Old Basic Science Building, 770 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W3, Canada.
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36
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Rafii R, Leslie K, Heo J, Chan A. A 71-year-old woman with an unusual cause for pleural effusions. Chest 2011; 139:1237-1241. [PMID: 21540222 DOI: 10.1378/chest.10-1375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Rokhsara Rafii
- Division of Pulmonary, Critical Care, and Sleep Medicine, Sacramento, CA; VA Northern California Health System, Mather, CA.
| | - Kevin Leslie
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Joline Heo
- Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Andrew Chan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Sacramento, CA; VA Northern California Health System, Mather, CA
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37
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Verdoorn BP, McDonald FS. 62-year-old woman with fever, dyspnea, pleuritic chest pain, and weight loss. Mayo Clin Proc 2011; 86:152-5. [PMID: 21282488 PMCID: PMC3031440 DOI: 10.4065/mcp.2010.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Brandon P Verdoorn
- Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Janda S, Swiston J. Diagnostic accuracy of pleural fluid NT-pro-BNP for pleural effusions of cardiac origin: a systematic review and meta-analysis. BMC Pulm Med 2010; 10:58. [PMID: 21092122 PMCID: PMC2994800 DOI: 10.1186/1471-2466-10-58] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 11/20/2010] [Indexed: 02/21/2023] Open
Abstract
Background Several studies have been published in the literature on the diagnostic accuracy of NT-pro-BNP for pleural effusions from heart failure in the last decade. The purpose of our study was to perform a systematic review and meta-analysis on the diagnostic accuracy of pleural fluid NT-pro-BNP for pleural effusions of cardiac origin. Methods MEDLINE, EMBASE, PapersFirst, and the Cochrane collaboration and the Cochrane Register of controlled trials were searched. All searches were inclusive as of March 2010. Studies were only included if the absolute number of true-positive, false-negative, true-negative, and false-positive observations were available, and the "reference standards" were described clearly. Two investigators independently reviewed articles and extracted data. Quality was assessed with the Quality Assessment for Diagnostic Accuracy Studies (QUADAS). The bivariate model for diagnostic meta-analysis was used to obtain a pooled sensitivity and a pooled specificity. Results Ten studies (total number of patients 1120) were included in the meta-analysis. The average pleural fluid NT-pro-BNP level in effusions of cardiac origin was 6140 pg/mL. The pooled sensitivity and specificity of all studies combined was 94% (95% CI: 90-97) and 94% (95% CI: 89-97) respectively. The pooled positive likelihood ratio was 15.2 (95% CI: 8.1-28.7) and the pooled negative likelihood ratio was 0.06 (95% CI: 0.03-0.11). The area under the ROC curve was 0.98 (95% CI: 0.96-0.99) and the diagnostic odds ratio was 246 (95% CI: 81-745). Conclusions Pleural fluid NT-pro-BNP is a very useful biomarker with high diagnostic accuracy for distinguishing pleural effusions of cardiac origin.
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Affiliation(s)
- Surinder Janda
- Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
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Dulohery MM, McDonald FS. 68-year-old man with chronic cough and weight loss. Mayo Clin Proc 2010; 85:e36-9. [PMID: 20511475 PMCID: PMC2878262 DOI: 10.4065/mcp.2009.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Megan M Dulohery
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Affiliation(s)
- Mark A. Crandall
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Sharon L. Mulvagh
- Adviser to resident and Consultant in Cardiovascular Diseases, Mayo Clinic, Rochester, MN
- Individual reprints of this article are not available. Address correspondence to Sharon L. Mulvagh, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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