Intercostal arteriovenous fistula due to pleural biopsy

Diagnostic Yield of Closed Pleural Biopsy in Undiagnosed Exudative Pleural Effusions

Introduction: In our practice, etiological diagnosis of pleural effusion is sometimes difficult despite cytological, biochemical and microbiological tests. The aim of the present study was to make an etiological diagnosis by means of closed pleural biopsy in undiagnosed pleural effusions. Methods:The study group consisted of patients with exudative pleural effusion where etiology was not determined by means of conventional cytological, biochemical and microbiological investigations. Pleural tissue was obtained by Abrams pleural biopsy needle. Pleural biopsy was subjected to histopathology, Ziehl-Neelsen (Z-N) staining and mycobacterial culture. Results:Four hundred fifty eight patients with pleural effusion were screened over three years and 82 of them were found to have undiagnosed exudative effusion after investigations, as mentioned in the Method section. The age of the 82 subjects [56 (68.29%) men and 26 (31.71%) women] ranged from 15 to 65 years (mean 32.6). Histopathology showed epitheloid granuloma with caseation necrosis in 50 (60.9%) patients and non-specific chronic inflammation in 14 (17.1%) subjects. Ziehl-Neelsen stain was positive for acid fast bacilli (AFB) in 10 (12.2%) patients and culture of pleural tissue showed the presence of Mycobacterium tuberculosis in 18 (21.9%) patients. Conclusion:In the era of thoracoscopy, percutaneous closed needle pleural biopsy still holds a significant role in cases of undiagnosed exudative pleural effusions where thoracoscopy is not available, being also a cost effective approach for developing countries. It can achieve specific diagnosis among 86.6% of cases with undiagnosed exudative pleural effusions.

Role of common investigations in aetiological evaluation of exudative pleural effusions

BACKGROUND

Pleural effusion is a common problem encountered in daily practice. To Establish aetiology of exudative effusions is a diagnostic challenge to general practitioners and even to pulmonologists especially in resource poor government hospitals with lack of investigations like thoracoscopy. Some recent studies had shown that around 2% of patients remained undiagnosed even after these investigations.

AIMS AND OBJECTIVE

To evaluate the role of the commonly available investigations such as pleural fluid study, blind pleural biopsy, sputum examination, CT scan thorax, bronchoscopy in the aetiological evaluation of exudative effusions and to ascertain the proportion of cases which remain undiagnosed after all the above investigations.

MATERIAL AND METHODS

This was a prospective single-centred cross-sectional study carried out at the NRS Medical College, Kolkata, India from February 2008 to February 2013 which included 568 patients of exudative pleural effusions. We performed commonly available procedures like pleural fluid study, blind pleural biopsy, sputum examination, CT scan thorax, bronchoscopic procedures to the diagnosis.

RESULTS

Total number of patients studied were 568. Tuberculosis was the most common cause (54.57%) followed by malignancy (28.17%), empyema (10.56%), parapneumonic effusion (5.28%) and others. Carcinoma of the lung was the commonest cause of malignant effusions and bronchoscopic biopsy was given the highest yield of histological diagnosis (84.6%) followed by CT guided FNAC (77.6%) and pleural fluid cytology (55%). Highest yield to diagnose tubercular effusion was found in lymph node FNAC (81.5%) followed by pleural biopsy (62%). Sputum smear for AFB was positive in only 27.4% cases. Bleeding followed by pneumothorax were the most common complications. Complications are very less (1.3% and 0.9% respectively). 2 patients (0.34%) remained undiagnosed even after these all above said investigations.

CONCLUSION

Above mentioned commonly available investigations can ascertain diagnosis in most of the cases in the aetiological evaluation of exudative effusions and they are relatively safe procedures.

Intercostal artery pseudoaneurysm after computed tomography-guided percutaneous fine needle aspiration lung biopsy

Intercostal artery pseudoaneurysm is a rare but life-threatening complication. Herein we report an unusual case of an intercostal artery pseudoaneurysm caused by computed tomography-guided percutaneous fine needle aspiration lung biopsy and successfully treated with endovascular embolization. Radiologists performing percutaneous fine needle aspiration lung biopsies should be aware of this rare potential complication.

False aneurysm of an intercostal artery after thoracoscopic sympathectomy

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Acquired Intercostal Arteriovenous Fistulas: Transesophageal Doppler Echocardiographic Diagnosis

Acquired intercostal arteriovenous fistulas are recognized complications of traumatic injuries. In this article, transesophageal Doppler echocardiographic findings in a patient with posttraumatic acquired intercostal arteriovenous fistulas are presented. The findings have been confirmed by angiography. The demonstration of intercostal arteriovenous fistulas by transesophageal Doppler echocardiography has not been reported before. (ECHOCARDIOGRAPHY, Volume 13, November 1996)

Recurrent massive bleeding from an intercostal artery aneurysm through an empyema chest tube

Intercostal artery aneurysms can be of congenital, posttraumatic, or mycotic type. Intercostal arterial aneurysmal bleeding can be brisk enough to lead into shock or sudden death. Bleeding through chest tubes has been reported due to various causes; it is commonly due to injury to intercostal or pulmonary vessels and is occasionally due to leaking aortic aneurysms. We describe a patient who had development of repeated episodes of brisk bleeding through an empyema chest tube leading to shock episodes requiring resuscitations. After extensive search, the bleeding source was found to be an intercostal artery aneurysm. Transcatheter embolization of that intercostal artery with absorbable gelatin sponge (Gelfoam) was successful in obliterating the blood flow to the aneurysm and in preventing further bleeding.