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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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2
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Lavercombe M. Recommendations from The Medical Education Editor. Respirology 2023; 28:6-8. [PMID: 36446593 DOI: 10.1111/resp.14428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Mark Lavercombe
- Department of Respiratory & Sleep Disorders Medicine, Western Health, Melbourne, Victoria, Australia.,Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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3
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Désage AL, Mismetti V, Jacob M, Pointel S, Perquis MP, Morfin M, Guezara S, Langrand A, Galor C, Trouillon T, Diaz A, Karpathiou G, Froudarakis M. Place du pneumologue interventionnel dans la gestion des pleurésies métastatiques. Rev Mal Respir 2022; 39:778-790. [DOI: 10.1016/j.rmr.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/14/2022] [Indexed: 11/09/2022]
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4
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Mismetti V, Froudarakis ME. Medical management of pleural infection: Why not saline intrapleural lavage? THE CLINICAL RESPIRATORY JOURNAL 2022; 16:693-695. [PMID: 36173249 PMCID: PMC9629991 DOI: 10.1111/crj.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/18/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Valentine Mismetti
- Department of Pulmonology and Thoracic Oncology, North HospitalUniversity Hospital of Saint‐EtienneSaint‐Priest‐en‐JarezFrance
| | - Marios E. Froudarakis
- Department of Pulmonology and Thoracic Oncology, North HospitalUniversity Hospital of Saint‐EtienneSaint‐Priest‐en‐JarezFrance
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5
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Park BC, Mallemat H. Special Procedures for Pulmonary Disease in the Emergency Department. Emerg Med Clin North Am 2022; 40:583-602. [PMID: 35953218 DOI: 10.1016/j.emc.2022.05.009] [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: 11/29/2022]
Abstract
In the emergency department, there are infrequent but essential procedures related to pulmonary diseases that emergency physicians must be able to perform. These include thoracentesis, chest tube thoracostomy, tracheostomy manipulation, and fiberoptic intubation.
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Affiliation(s)
- Brian C Park
- Critical Care Medicine Program, Cooper Medical School of Rowan University, Cooper University Hospital, 1 Cooper Plaza, Dorrance 4th Floor, Suite D427, Camden, NJ 08103, USA.
| | - Haney Mallemat
- Emergency Medicine/Critical Care Medicine Program, Cooper Medical School of Rowan University, Cooper University Hospital, 1 Cooper Plaza, Dorrance 4th Floor, Suite D427, Camden, NJ 08103, USA. https://twitter.com/CritCareNow
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Sharma G, Saxena S, Seenivasagam R, Tarafdar S, Ilahi I. A Rare Case of Primary Pleural Neurofibroma. Cureus 2021; 13:e17062. [PMID: 34522540 PMCID: PMC8428201 DOI: 10.7759/cureus.17062] [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] [Accepted: 08/10/2021] [Indexed: 11/05/2022] Open
Abstract
Metastatic deposits are the most common cause of pleural masses, solitary or multiple. Primary pleural neoplasms are rare entities that are occasionally encountered. Of these, the tumors of neurogenic origin are exceedingly rare with only a few cases reported in the literature. We describe a case of an isolated neurofibroma involving the pleura in a 23-year-old male patient, who underwent CT and MRI scans of the thorax as part of the initial investigations. The final diagnosis was clinched by a CT-guided biopsy of the lesion.
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Affiliation(s)
- Garima Sharma
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Sudhir Saxena
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Rajkumar Seenivasagam
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Swarnava Tarafdar
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Ipsit Ilahi
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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7
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Gu R, Jiang L, Duan T, Chen C, Wu S, Mu D. A Case of Pulmonary Embolism with Sarcomatoid Malignant Pleural Mesothelioma with Long-Term Pleural Effusion. Onco Targets Ther 2021; 14:4231-4237. [PMID: 34295165 PMCID: PMC8291962 DOI: 10.2147/ott.s315869] [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] [Received: 04/20/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is a highly aggressive tumor that originates from pleural mesothelial cells. In recent years, with the development of asbestos-related industries and the increase in air pollution, its incidence has been increased. The incidence of pulmonary embolism combined with sarcomatoid MPM is very low and the prognosis is extremely poor. We here report a case of a patient with long term of pleural effusion and finally diagnosed as pulmonary embolism with sarcomatoid MPM. Case A 75-year-old male with a 30-year history of asbestos exposure was admitted to our hospital due to chest pain and difficulty in breathing after exercise. Radiologic examination revealed pleural effusion, computed tomography pulmonary angiography (CTPA) suggests pulmonary embolism, and we consider pleural effusion caused by pulmonary embolism. After anticoagulant therapy for pulmonary embolism and pleural puncture to reduce pleural effusion, the patient's symptoms improved. However, after that, the patient was still admitted to the hospital several times because of recurrent chest pain and dyspnea symptoms, and radiologic examination always showed unexplained pleural effusion. Finally, pathological and immunohistochemical examinations of the pleural biopsy specimens were performed, and the diagnosis was confirmed as sarcomatoid MPM. Conclusion In summary, sarcomatoid MPM with pulmonary embolism is relatively rare, and the prognosis is poor. Clinicians need to be alert to its occurrence. When the first diagnosis is confirmed and the effect of targeted treatment is still not good, the possibility of other diseases should be considered. In clinical practice, pleural biopsy guided by PET-CT is a good choice for patients with sarcomatoid MPM who cannot tolerate open pleural biopsies or thoracoscopy. And patients should undergo pleural morphology and immunohistochemistry as soon as possible, which are helpful for timely diagnosis.
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Affiliation(s)
- Rumeng Gu
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China.,Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, People's Republic of China
| | - Luxi Jiang
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Ting Duan
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Chun Chen
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Shengchang Wu
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Deguang Mu
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
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Froudarakis ME, Anevlavis S, Marquette CH, Astoul P. Medical Thoracoscopy Implementation after a European Respiratory Society Course Held from 2003 to 2016: A Survey. Respiration 2021; 100:523-529. [PMID: 33849020 DOI: 10.1159/000514317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Medical thoracoscopy (MT) is an important procedure in the management of patients with pleural diseases. OBJECTIVES We designed a survey to explore whether the participants of our courses implement MT at their hospital after attending the course as no real-life data exist. METHODS We distributed by e-mail a questionnaire to the participants of the courses. The questionnaire included general information about the participants, the precourse experience on MT, the postcourse implementation of the technique, and the reasons for failure. RESULTS Responses were obtained from 104 of 324 (32.3%) identified emails. Responders were males (76%), seniors (59.7%), respiratory physicians (91.3%), working in a public/university hospital (78.8%), and mostly beginners (65.3%) from 41 countries. Following the course, 58.6% of responders either created or modified a MT program in their workplace. The reasons for not performing MT before the course were as follows: patients' referral to a thoracic surgeon, not enough training, lack of funding, department understaffed, and refusal by the hospital/department. Overall, these reasons were significantly decreased (p = 0.002) after the course. CONCLUSIONS Real-life data of our survey suggest that more than half of the responders have implemented the technique or modified their practice according to the skills they got from the course.
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Affiliation(s)
- Marios E Froudarakis
- Department of Respiratory Medicine Medical School Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pneumonology-Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Stavros Anevlavis
- Department of Respiratory Medicine Medical School Democritus University of Thrace, Alexandroupolis, Greece
| | - Charles-Hugo Marquette
- Université Côte d'Azur, CHU de Nice, FHU OncoAge, Department of Pulmonary Medicine, Nice, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital NORD Aix-Marseille University, Marseille, France
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9
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Heraganahally SS, Silva SAMS, Howarth TP, Kangaharan N, Majoni SW. Comparison of clinical manifestation among Australian Indigenous and non- Indigenous patients presenting with pleural effusion. Intern Med J 2021; 52:1232-1241. [PMID: 33817935 DOI: 10.1111/imj.15310] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is sparse evidence in the literature in relation to the nature and causes of pleural effusion among Australian Indigenous population. METHODS In this retrospective study, Indigenous and non-Indigenous adults diagnosed to have pleural effusion over a two-year study period were included for comparative analysis. RESULTS Of the 314 patients, 205 (65%) were non-Indigenous and 52% were males. In comparison to non-Indigenous, the Indigenous patients were younger (50 years (IQR 39,60) vs 63 years (IQR 52,72), p<0.001), females (61% vs 41%, p=0.001), have higher prevalence of renal and cardiovascular disease and tend to have exudative effusion (93% vs 76%, p=0.032). Infections was judged to be the most common cause for effusion in both groups, more so among the Indigenous cohort. Effusion secondary to renal disease was higher (13% vs 1%, p<0.001) among Indigenous Australians, in contrast malignant effusions were higher (13% vs 4%, p=0.004) among non-Indigenous. Length of hospital stay was longer for Indigenous patients (p=0.001), and a greater proportion received renal dialysis (13% vs 1%, p<0.001). Intensive care unit (ICU) admissions rates were higher with infective etiology of pleural effusion (82% vs. 53% Indigenous & 44% vs. 39% non-Indigenous respectively). Re-presentations to hospital were higher among Indigenous patients (46% vs 33%, p=0.046) and were associated with renal and cardiac disease and malignancy in non-Indigenous. CONCLUSION There are significant differences in the way pleural effusion manifests among Australian Indigenous patients. Understanding these differences may facilitate approaches to the management and to implement strategies to reduce morbidity and mortality in this population. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Subash Shanthakumar Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Tiwi, Darwin, Northern Territory, Australia
| | - Sampathawaduge Anton Mario Shemil Silva
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia
| | - Timothy Paul Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Tiwi, Darwin, Northern Territory, Australia.,College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Nadarajah Kangaharan
- Department of General Medicine, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia.,NT Cardiac service, Darwin Private Hospital, Tiwi, Darwin, Northern Territory, Australia
| | - Sandawana William Majoni
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia.,Department of Nephrology, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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10
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Dewan N, Zuluaga D, Osorio L, Krienke ME, Bakker C, Kirsch J. Ultrasound in Dengue: A Scoping Review. Am J Trop Med Hyg 2021; 104:826-835. [PMID: 33534759 PMCID: PMC7941833 DOI: 10.4269/ajtmh.20-0103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 12/14/2020] [Indexed: 01/21/2023] Open
Abstract
To improve dengue triage and treatment decisions, the WHO recommends classifying the disease as dengue with or without warning signs or severe dengue. Vascular leakage is a key component of the pathophysiology of severe dengue and is detectable by ultrasound. The objective of this scoping review is to describe the primary literature on the use of ultrasound in dengue, summarize the findings, and identify knowledge gaps. Our database search retrieved 1,489 records which were reduced to 177 studies following eligibility screening. Descriptive analyses were conducted. Results showed most studies are from South Asia (n = 92, 52%) and assessed hospitalized dengue patients (130, 82%). Radiologists were the most reported ultrasonographers (14, 8%), and conventional ultrasound (39, 68%) was preferred over portable (9, 16%). The most common ultrasound findings in dengue were ascites (107, 60%), pleural effusion (102, 58%), and gallbladder wall thickening (97, 55%). However, the lack of a standard protocol to perform the ultrasound examination in dengue patients hinders conclusions about the frequency of ultrasound findings in dengue. Given the progress of current ultrasound technology, a focused point-of-care ultrasound protocol for early detection of vascular leakage in dengue is needed to generate the evidence required for its implementation in routine care.
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Affiliation(s)
- Neelesh Dewan
- University of Miami Miller School of Medicine, Miami, Florida
- Epidemiology and Population Health Research Group (GESP), School of Public Health, Universidad del Valle, Cali, Colombia
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Daniela Zuluaga
- Epidemiology and Population Health Research Group (GESP), School of Public Health, Universidad del Valle, Cali, Colombia
| | - Lyda Osorio
- Epidemiology and Population Health Research Group (GESP), School of Public Health, Universidad del Valle, Cali, Colombia
| | | | - Caitlin Bakker
- University of Minnesota, Health Sciences Libraries, Minneapolis, Minnesota
| | - Jonathan Kirsch
- Section of Hospital Medicine, Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Karpathiou G, Anevlavis S, Tiffet O, Casteillo F, Mobarki M, Mismetti V, Ntolios P, Koulelidis A, Trouillon T, Zadel N, Hathroubi S, Peoc'h M, Froudarakis ME. Clinical long-term outcome of non-specific pleuritis (NSP) after surgical or medical thoracoscopy. J Thorac Dis 2020; 12:2096-2104. [PMID: 32642113 PMCID: PMC7330408 DOI: 10.21037/jtd-19-3496] [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] [Indexed: 01/14/2023]
Abstract
Background Thoracoscopy, either “medical” or “surgical”, is the gold standard to reveal the cause of pleural effusion by taking large biopsies. However, in some cases, the histology of pleural biopsies is inconclusive for a specific cause, describing a variable process of inflammation, encompassing for non-specific pleuritis (NSP). Questions are raised whether the surgical (or video-assisted thoracoscopic surgery, VATS) is doing better than the medical thoracoscopy (MT or pleuroscopy), but no direct comparison between the two techniques exist in the current bibliography. The aim of our retrospective study was to compare these two techniques to find whether there is any difference in the false negative cases of NSP. Methods We included in our study 295 patients with NSP, 179 patients who underwent VATS comparing to 116 patients who underwent MT for pleural effusion of initially undetermined cause, having a follow-up of at least one year. Analysis of patients’ files, history, clinical examinations, further tests, and follow-up were recorded. Results The mean age of our patients was 58.5±19.1 and M/F gender was 216/79; no difference was observed between the two groups. The mean follow-up period was 47.3±20.7 months. After VATS, only one patient (0.55%) was finally diagnosed with pleural malignancy (false negative) while after MT 2 patients (1.7%). Negative predictive value for pleura-related malignancy for VATS was 0.994 and for MT 0.982. Conclusions In patients with histological diagnosis of NSP both VATS and MT showed similar and excellent results of false negative cases and negative predictive value in excluding malignant pleural disease.
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Affiliation(s)
- Georgia Karpathiou
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Stavros Anevlavis
- Department of Pneumonology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Olivier Tiffet
- Department of Thoracic Surgery, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Francois Casteillo
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Mousa Mobarki
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Valentine Mismetti
- Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Paschalis Ntolios
- Department of Pneumonology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Andreas Koulelidis
- Department of Pneumonology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Tiffany Trouillon
- Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Nicolas Zadel
- Department of Thoracic Surgery, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Sirine Hathroubi
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Michel Peoc'h
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Marios E Froudarakis
- Department of Pneumonology, University Hospital of Alexandroupolis, Alexandroupolis, Greece.,Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
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12
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Qaqish TR, Cox S, Carr R, Katlic M. Treatment of Pleural Effusions with Nonintubated Video-Assisted Thoracoscopic Surgery. Thorac Surg Clin 2019; 30:25-32. [PMID: 31761281 DOI: 10.1016/j.thorsurg.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Video-assisted thoracic surgery has considerably improved the care of the thoracic surgical patient. Patients are able to leave the hospital sooner and experience less pain with equal oncologic outcomes when compared with open surgery. Nonintubated thoracic surgery has more recently been applied in the management of both benign and malignant pleural effusions. This article provides the general thoracic surgeon a detailed description on how to manage pleural effusions using video-assisted thoracoscopic surgery in a nonintubated patient. Surgical techniques and pearls are also presented.
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Affiliation(s)
- Thamer Robert Qaqish
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA
| | - Solange Cox
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA
| | - Rebecca Carr
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA
| | - Mark Katlic
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA.
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A Case of Isolated Primary Pleural Neurofibroma in a 39-Year-Old Woman. Case Rep Pulmonol 2019; 2019:6458302. [PMID: 31871813 PMCID: PMC6906869 DOI: 10.1155/2019/6458302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/27/2019] [Indexed: 11/18/2022] Open
Abstract
Primary benign neurogenic neoplasms of the pleura are exceedingly rare. Neurofibromas rarely involve the pleura. A review of the literarture reveals only a single reported case of isolated pleural neurofibroma. Herein the authors describe another case of isolated primary pleural neurofibroma. A 39-year-old nonsmoker woman presented to the emergency room with complaints of progressively worsening chest pain of one month duration. A computed tomography of the chest revealed a crescent shaped, pleural based mass suspicious for a neurogenic tumor such as an intercostal schwannoma. A PET-CT skull base to midthigh failed to reveal any other masses or abnormalities. A surgical excision of the mass was performed due to the patient's intractable pain. The resected specimen consisted of an ovoid fragment of soft tissue with pale yellow, smooth and glistening cut surface. Microscopic examination revealed the tumor to be composed of spindle cells with wavy nuclei arranged haphazardly in loose collagenous and pale myxoid stroma with rare interspersed mast cells. The spindle cells were diffusely positive for S100 protein and SOX-10, and focally positive for neurofilament. In the absence of any other masses in the patient and no pertinent history, a diagnosis of primary pleural neurofibroma was made. This case emphasizes the need to consider neurofibroma in any spindle cell neoplasm of the pleura irrespective of age or singularity.
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14
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Hybrid panel of biomarkers can be useful in the diagnosis of pleural and peritoneal effusions. Clin Chim Acta 2019; 497:48-53. [PMID: 31310745 DOI: 10.1016/j.cca.2019.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 06/11/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND In clinical practice, pleural and peritoneal effusions are usual diagnosis. We evaluated the performance of a hybrid panel of biomarkers in the diagnosis of the main diseases affecting pleura and/or peritoneum. METHODS Samples of pleural/ peritoneal fluid from 120 patients were evaluated for: CEA (carcinoembryonic antigen), VEGF-A (vascular endothelial growth factor A), PD-L1/B7-H1 (programmed death-ligand 1), NGAL (neutrophil gelatinase-associated lipocalin), TREM-1 (triggering receptor expressed in myeloid cells type-1) and IFNγ (gamma-interferon) by Luminex®; CALP (Calprotectin) by ELISA, and ADA (adenosine deaminase) by enzymatic deamination. RESULTS For malignant effusion (ME) diagnosis, CEA and NGAL presented superior performance than VEGF-A, PD-L1 and CALP. A CEA-NGAL association showed good sensitivity (86.6%) and accuracy (79.2%). For non-tuberculous infectious effusion (NTBIE), NGAL presented the best performance with sensitivity (75.0%), specificity (62.0%) and accuracy (65.0%) higher than TREM-1 and CALP; however, when associated, although with good sensitivity, there was important decrease in specificity. For tuberculous pleural effusion (TPE), IFNy-ADA presented excellent sensitivity (100%), specificity (87.6%), NPV (100%) and accuracies (~90%). CONCLUSIONS CEA, NGAL, ADA and IFNy were useful in discriminating ME and TPE. However, for NTBIE diagnosis, the hybrid panel did not demonstrate advantages over the classic parameters.
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15
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Mandal KC, Mandal G, Halder P, Mitra D, Debnath B, Bhattacharya M. Empyema Thoracis in Children: A 5-Year Experience in a Tertiary Care Institute. J Indian Assoc Pediatr Surg 2019; 24:197-202. [PMID: 31258270 PMCID: PMC6568155 DOI: 10.4103/jiaps.jiaps_112_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: Empyema thoracis (ET) in children is a disease of significant morbidity and mortality. In the event of failure to resolute following intercostal chest tube drainage (ICD), thoracotomy decortication (TDC) remains the treatment of choice. We have reviewed the outcome of management of 96 cases of ET with the intent to establish the scope of ICD as primary form of the management. Materials and Methods: This is a retrospective study of 96 patients of ET who were managed in pediatric surgery department over a period of 5 years (April 2013 – March 2018). Ninety-six patients at a single center met inclusion criteria for having ET and underwent ICD. We excluded the cases where video-assisted thoracoscopic surgery was provided as primary treatment. The patients were categorized into complicated and uncomplicated groups. Those with pyopneumothorax, encysted empyema, multiloculated empyema, and bilateral ET were assigned as complicated group. There were two treatment groups: (I) those responded with ICD alone (II) those with ICD followed by TDC. Results: All 96 cases received ICD as primary management. There were 54 uncomplicated cases and 42 complicated cases. Out of 42 complicated cases, 26 patients recovered with ICD alone and 16 patients needed TDC. A total of 80 (83.33%) patients (54 uncomplicated ± 26 complicated) recovered with ICD alone. Significant complications were encountered in follow-up of patients who underwent delayed thoracotomy in the form of overriding of the ribs (n = 3) and postoperative air leak (n = 4). There was no mortality in our series. Conclusion: Early initiation of management of ET with intercostal tube drainage is simple, safe, effective even in complicated cases, and has less complications. Thoracotomy with decortication should be reserved for ICD failure cases.
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Affiliation(s)
- Kartik Chandra Mandal
- Department of Pediatric Surgery, Dr. B. C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Gobinda Mandal
- Department of Pediatric Medicine, Dr. B. C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Pankaj Halder
- Department of Pediatric Surgery, Dr. B. C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Dipanwita Mitra
- Department of Anesthesiology, Dr. B. C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Bidyut Debnath
- Department of Pediatric Surgery, Dr. B. C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Mala Bhattacharya
- Department of Pediatric Medicine, Dr. B. C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
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16
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Denault A, Canty D, Azzam M, Amir A, Gebhard CE. Whole body ultrasound in the operating room and intensive care unit. Korean J Anesthesiol 2019; 72:413-428. [PMID: 31159535 PMCID: PMC6781205 DOI: 10.4097/kja.19186] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022] Open
Abstract
Whole body ultrasound can be used to improve the speed and accuracy of evaluation of an increasing number of organ systems in the critically ill. Cardiac and abdominal ultrasound can be used to identify the mechanisms and etiology of hemodynamic instability. In hypoxemia or hypercarbia, lung ultrasound can rapidly identify the etiology of the condition with an accuracy that is equivalent to that of computed tomography. For encephalopathy, ocular ultrasound and transcranial Doppler can identify elevated intracranial pressure and midline shift. Renal and bladder ultrasound can identify the mechanisms and etiology of renal failure. Ultrasound can also improve the accuracy and safety of percutaneous procedures and should be currently used routinely for central vein catheterization and percutaneous tracheostomy.
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Affiliation(s)
- André Denault
- Department of Anesthesiology and Critical Care Medicine, Faculté de Médecine, Université de Montréal, Institut de Cardiologie de Montréal, and Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - David Canty
- Department of Surgery, University of Melbourne, Australia.,Department of Medicine, Monash Medical Centre, Monash University, Clayton, Melbourne, and Department of Anesthesia, Monash Medical Centre and Royal Melbourne Hospital, Victoria, Australia
| | - Milène Azzam
- Department of Anesthesiology, Jewish General Hospital, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Alexander Amir
- Department of Anesthesiology, Montreal General Hospital, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Caroline E Gebhard
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
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17
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Karpathiou G, Hathroubi S, Patoir A, Tiffet O, Casteillo F, Brun C, Forest F, Rahman NM, Peoc'h M, Froudarakis ME. Non-specific pleuritis: pathological patterns in benign pleuritis. Pathology 2019; 51:405-411. [DOI: 10.1016/j.pathol.2019.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/06/2019] [Accepted: 01/13/2019] [Indexed: 01/02/2023]
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18
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Froudarakis ME. Thematic series: Novel insights in pleural diseases: Pleural disease: A continuously improved information. THE CLINICAL RESPIRATORY JOURNAL 2019; 13:269-271. [PMID: 30953578 DOI: 10.1111/crj.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Marios E Froudarakis
- Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
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19
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Duysinx B, Heinen V, Corhay JL, Vaillant F, Gomez A, Louis R. [Medical thoracoscopy in respiratory medicine: The Liège University Hospital experience]. Rev Mal Respir 2019; 36:688-696. [PMID: 31030998 DOI: 10.1016/j.rmr.2019.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/04/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The incidence of pleural disease continues to increase worldwide. Medical thoracoscopy remains the standard method for exploration of the pleural cavity. METHOD We report the retrospective evaluation, the efficacy and the observed complications in 1024 medical thoracoscopies undertaken in the University Hospital of Liège between 2000 and 2017. RESULTS In total, 100 pneumothoraces and 400 benign and 501 malignant pleural diseases were identified. The main indication for thoracoscopy remains the diagnosis of an exudative, lymphocytic pleural effusion of unknown aetiology after thoracocentesis. The diagnostic sensibility of thoracoscopy was 99.2% in distinguishing benign from malignant pleural disease. Talc pleurodesis was performed in 69.5% of the total population and in 66.1% of pleural effusions or thickening. Failure of pleurodesis was observed in 11% of the patients with recurrent pneumothorax and in 7.8% of neoplastic pleural effusion. We report a mortality of 0.6% in the 30 days post procedure, long duration of drainage in 8.3% and serious complications in 4.7%. In 22/1024 (2.1%) thoracoscopic evaluation was not feasible because of dense pleural fibrosis. CONCLUSION Medical thoracoscopy is a safe, well-tolerated procedure with high accuracy in the diagnostic and therapeutic management of pleural disease.
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Affiliation(s)
- B Duysinx
- Service de pneumologie, CHU de Sart-Tilman B35, B4000 Liège, Belgique.
| | - V Heinen
- Service de pneumologie, CHU de Sart-Tilman B35, B4000 Liège, Belgique
| | - J-L Corhay
- Service de pneumologie, CHU de Sart-Tilman B35, B4000 Liège, Belgique
| | - F Vaillant
- Service de pneumologie, CHU de Sart-Tilman B35, B4000 Liège, Belgique
| | - A Gomez
- Service de pneumologie, CHU de Sart-Tilman B35, B4000 Liège, Belgique
| | - R Louis
- Service de pneumologie, CHU de Sart-Tilman B35, B4000 Liège, Belgique
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20
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Lépine PA, Thomas R, Nguyen S, Lacasse Y, Cheah HM, Creaney J, Muruganandan S, Martel S, Lee YCG, Delage A. Simplified Criteria Using Pleural Fluid Cholesterol and Lactate Dehydrogenase to Distinguish between Exudative and Transudative Pleural Effusions. Respiration 2019; 98:48-54. [PMID: 30826806 DOI: 10.1159/000496396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/19/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND An important part of the investigation of pleural effusion is the identification of markers that help separate exudate from transudate. OBJECTIVES The purposes of this study were to compare the accuracy of published and new sets of criteria to distinguish between exudative and transudative pleural effusions, and to determine whether serum biochemical analysis is necessary. METHODS An externally validated cohort study was performed. Pleural effusions were determined to be transudative or exudative on the basis of an assessment of the medical record by two clinicians blinded to biochemical results. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating characteristic curve were determined for each proposed combination of criteria. RESULTS Pleural fluid analysis was available for 311 thoracenteses in the main cohort and for 112 thoracenteses in the validation cohort. The best sensitivity (97% [95% CI 94-99]) and negative likelihood ratio (0.04 [95% CI 0.02-0.08]) for identifying exudative effusions were observed with criteria combining pleural fluid lactate dehydrogenase greater than 0.6 the upper limit of normal serum lactate dehydrogenase and pleural fluid cholesterol greater than 1.04 mmol/L (40 mg/dL). The overall diagnostic accuracy was similar to Light's criteria. Findings were similar in the validation cohort. CONCLUSIONS Our proposed criteria using simultaneously pleural fluid lactate dehydrogenase and pleural fluid cholesterol can identify an exudate with a sensitivity and an overall diagnostic accuracy similar to Light's criteria. It avoids simultaneous blood sampling, thus reducing patient discomfort and potential costs.
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Affiliation(s)
- Pierre-Alexis Lépine
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Quebec City, Québec, Canada,
| | - Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Washington, Australia.,Institute for Respiratory Health, University of Western Australia, Perth, Washington, Australia
| | - Sébastien Nguyen
- Université de Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Québec, Canada
| | - Yves Lacasse
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Quebec City, Québec, Canada
| | - Hui Min Cheah
- Institute for Respiratory Health, University of Western Australia, Perth, Washington, Australia
| | - Jenette Creaney
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Washington, Australia.,Institute for Respiratory Health, University of Western Australia, Perth, Washington, Australia
| | - Sanjeevan Muruganandan
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Washington, Australia.,Institute for Respiratory Health, University of Western Australia, Perth, Washington, Australia
| | - Simon Martel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Quebec City, Québec, Canada
| | - Y C Gary Lee
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Washington, Australia.,Institute for Respiratory Health, University of Western Australia, Perth, Washington, Australia
| | - Antoine Delage
- Université de Sherbrooke, Hôpital Charles-Lemoyne, Greenfield Park, Québec, Canada
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Karpathiou G, Peoc’h M. Pleura revisited: From histology and pathophysiology to pathology and molecular biology. CLINICAL RESPIRATORY JOURNAL 2019; 13:3-13. [DOI: 10.1111/crj.12982] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/27/2018] [Accepted: 11/14/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Georgia Karpathiou
- Department of Pathology; North Hospital, University Hospital of St-Etienne; St-Etienne France
| | - Michel Peoc’h
- Department of Pathology; North Hospital, University Hospital of St-Etienne; St-Etienne France
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22
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Brun C, Gay P, Cottier M, Karpathiou G, Patoir A, Tiffet O, Barral FG, Vergnon JM, Froudarakis ME. Comparison of cytology, chest computed and positron emission tomography findings in malignant pleural effusion from lung cancer. J Thorac Dis 2018; 10:6903-6911. [PMID: 30746236 DOI: 10.21037/jtd.2018.11.127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Malignant pleural effusion (MPE) is a common medical problem in lung cancer (LC). Pleural fluid cytology (PFC), chest computed tomography (CCT) and positron emission tomography (PET) findings are helpful as first line approach. The objectives of this study were to evaluate whether there is a correlation between PFC, CCT and PET in patients with MPE due to LC. Methods We selected patients from our electronic files. Data of PFC, pleural biopsy (PB), CCT and PET have been recorded and analyzed. Results A total of 101 consecutive patients (66 males, 65.3%) with a mean age of 66.2±31 years were selected. Types of LC were adenocarcinoma in 71 patients (70.2%), squamous in 13 (12.8%), small-cell in 12 (11.8%) and large cell in 5 (4.9%). CCT showed nodules in 6 (5.9%), pleural thickening in 8 (7.9%) and both in 17 (16.8%) patients. PFC was positive in 55/91 thoracentesis (60.4%) and 32/52 thoracoscopy (61.5%), while PB in 38/40 performed (95%). PET fixation was found in 32/47 (68%) patients who had MPE at diagnosis. When we associate PFC to CCT and PET findings, the yield in our study becomes 90%. No correlation was observed between CCT findings and PFC (P=0.62) between PFC and PET fixation (P=0.63) or between CCT and PET (P=0.06). Conclusions In our cohort of LC patients with MPE, we observed a high sensitivity for PFC, while in most of the cases no findings were observed in CCT. PET had a relative low sensitivity. However, when all 3 methods were combined the yield was 90%.
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Affiliation(s)
- Clement Brun
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Pierre Gay
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Michele Cottier
- Departments of Cytology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Georgia Karpathiou
- Departments of Pathology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Arnaud Patoir
- Departments of Thoracic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Oliviet Tiffet
- Departments of Thoracic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Fabrice-Guy Barral
- Departments of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Jean-Michel Vergnon
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Marios E Froudarakis
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
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23
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Pericardial and Pleural Metastases: Clinical, Histologic, and Molecular Differences. Ann Thorac Surg 2018; 106:872-879. [DOI: 10.1016/j.athoracsur.2018.04.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 11/22/2022]
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24
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Rosolen DCB, Faria DK, Faria CS, Antonangelo L. Performance of the UroVysion ® FISH assay for the diagnosis of malignant effusions using two cutoff strategies. Cancer Med 2018; 7:1967-1977. [PMID: 29577646 PMCID: PMC5943432 DOI: 10.1002/cam4.1442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/09/2018] [Accepted: 02/17/2018] [Indexed: 12/27/2022] Open
Abstract
The cytological examination of cavity fluids has limited sensitivity in the diagnosis of malignancy. Aneuploidy, which is commonly observed in neoplastic cells, could potentially be used as an ancillary diagnostic tool. To evaluate the detection of aneuploid cells in cavitary effusion samples using the fluorescence in situ hybridization (FISH) assay UroVysion® with some adaptations and two different cutoff strategies. Seventy samples of pleural or peritoneal fluid with positive (n = 40), negative (n = 15), or suspicious (n = 15) oncotic cytology were subjected to FISH assay with the multitarget UroVysion® kit, which is composed of probes that hybridize to the centromeric region of chromosomes 3, 7, and 17 and to the locus 9p21. FISH performance was evaluated using two different cutoffs: (1) the manufacturer's cutoff (M‐FISH) and 2) a proposed cutoff (P‐FISH). Using M‐FISH, the diagnostic sensitivity was 57.1%, specificity 87.5%, and accuracy 60.0%; with P‐FISH, the sensitivity was 87.3%, specificity 71.4%, and accuracy 85.7%. When combined with cytology, the sensitivity, specificity, and accuracy were 88.0%, 83.3%, and 87.8%, respectively. Malignant cells presented a predominance of chromosomal gains. The UroVysion® test using the P‐FISH cutoff was effective in demonstrating aneuploid cells in all malignant effusions, confirming the diagnosis of malignancy even in cases with suspicious cytology.
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Affiliation(s)
- Débora C B Rosolen
- Division of Clinical Pathology, Department of Pathology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Daniel K Faria
- Division of Clinical Pathology, Department of Pathology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Caroline S Faria
- Faculdade de Medicina, Medical Investigation Laboratory (LIM03), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Leila Antonangelo
- Division of Clinical Pathology, Department of Pathology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Faculdade de Medicina, Medical Investigation Laboratory (LIM03), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Abstract
Objectives: It is not always possible to move critically ill patients to the operating or endoscopy room for a pleuroscopy. Bedside pleuroscopy is indicated for these patients. The aim of this study was to investigate the safety and complications of bedside pleuroscopy in an Intensive Care Unit (ICU). Materials and Methods: The patients who had undergone routine examinations for pleural effusion, with no established diagnosis at the previous admission were included in this analysis. Patients received local analgesia with bedside pleuroscopy performed by a chest physician in the ICU with continuous monitoring. Results: Twenty-five patients (17 males and 8 females) with a mean age of 74 ± 3 years were enrolled. Their mean APACHE II score was 23 ± 1. The duration of drainage from the pigtail catheter was a mean 3.9 ± 0.2 days, and mean ventilator usage was 6 ± 0.7 days. The length of stay in the ICU was 11 ± 1 days. Most pleural effusions occurred on the right side (17/25, 68%). Fifteen patients (60%) had malignant effusions, four (16%) had parapneumonic effusions, three (12%) had empyema, and two (8%) had tuberculosis. Complications occurred in 11 (44%) patients. There were no major complications such as bleeding or procedure-related death. The most common complication was transient chest pain (n = 6, 24%). Conclusions: Pleuroscopy performed at the bedside in the ICU is a simple and safe procedure. It has the potential for use in critical patients as serious complications are rare.
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Affiliation(s)
- Hean Ooi
- Department of Preventive Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,Department of Pulmonology and Critical Care, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
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26
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Wang Z, Wu YB, Xu LL, Jin ML, Diao XL, Wang XJ, Tong ZH, Shi HZ. Diagnostic value of medical thoracoscopy in malignant pleural effusion induced by non-Hodgkin's lymphoma. Oncol Lett 2017; 14:8092-8099. [PMID: 29344253 DOI: 10.3892/ol.2017.7226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/21/2016] [Indexed: 11/05/2022] Open
Abstract
Malignant pleural effusion (MPE) appears in up to 20% of patients with non-Hodgkin's lymphoma (NHL). The present study aimed to assess the efficacy of medical thoracoscopy (MT) in the diagnosis of patients with MPE induced by NHL. Between July 2005 and June 2014, 833 patients with pleural effusions of unknown etiology underwent MT in Beijing Chaoyang Hospital (Beijing, China), where diagnostic thoracocentesis or/and blind pleural biopsy had failed to yield an answer. Demographic, radiographic, thoracoscopic, histological and immunophenotyping data of 10 NHL patients with MPE were then retrospectively analyzed. Under medical thoracoscopy, pleural nodules (in n=6 patients), hyperemia (n=5), plaque-like lesions (n=4), pleural thickening (n=3), cellulose (n=3), ulcer (n=2), adhesion (n=2), and scattered hemorrhagic spots (n=1) were observed on the surface of parietal pleura. Histopathological and immunohistochemical analysis of pleural biopsy samples led to a correct diagnosis of B-cell NHL in 7 patients and T-lymphoblastic NHL in 2 patients. Data from the present study demonstrated that pleural biopsy through MT achieved a definite diagnosis of NHL in 9 out of 10 (90%) patients with MPE induced by NHL. Therefore, MT is a useful method for diagnosing MPE induced by NHL.
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Affiliation(s)
- Zhen Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yan-Bing Wu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Li-Li Xu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Mu-Lan Jin
- Department of Pathology, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Xiao-Li Diao
- Department of Pathology, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Xiao-Juan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Zhao-Hui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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Cao B, Huang Y, She DY, Cheng QJ, Fan H, Tian XL, Xu JF, Zhang J, Chen Y, Shen N, Wang H, Jiang M, Zhang XY, Shi Y, He B, He LX, Liu YN, Qu JM. Diagnosis and treatment of community-acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. CLINICAL RESPIRATORY JOURNAL 2017; 12:1320-1360. [PMID: 28756639 PMCID: PMC7162259 DOI: 10.1111/crj.12674] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/25/2017] [Indexed: 02/05/2023]
Abstract
Community‐acquired pneumonia (CAP) in adults is an infectious disease with high morbidity in China and the rest of the world. With the changing pattern in the etiological profile of CAP and advances in medical techniques in diagnosis and treatment over time, Chinese Thoracic Society of Chinese Medical Association updated its CAP guideline in 2016 to address the standard management of CAP in Chinese adults. Extensive and comprehensive literature search was made to collect the data and evidence for experts to review and evaluate the level of evidence. Corresponding recommendations are provided appropriately based on the level of evidence. This updated guideline covers comprehensive topics on CAP, including aetiology, antimicrobial resistance profile, diagnosis, empirical and targeted treatments, adjunctive and supportive therapies, as well as prophylaxis. The recommendations may help clinicians manage CAP patients more effectively and efficiently. CAP in pediatric patients and immunocompromised adults is beyond the scope of this guideline. This guideline is only applicable for the immunocompetent CAP patients aged 18 years and older. The recommendations on selection of antimicrobial agents and the dosing regimens are not mandatory. The clinicians are recommended to prescribe and adjust antimicrobial therapies primarily based on their local etiological profile and results of susceptibility testing, with reference to this guideline.
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Affiliation(s)
- Bin Cao
- National Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital, Capital Medical University, Beijing 100029, China
| | - Yi Huang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China
| | - Dan-Yang She
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Qi-Jian Cheng
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
| | - Hong Fan
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan 610041, China
| | - Xin-Lun Tian
- Department of Pulmonary Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jing Zhang
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yu Chen
- Department of Respiratory and Critical Care Medicine, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - Ning Shen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Hui Wang
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xiang-Yan Zhang
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Guizhou 550002, China
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing 210002, China
| | - Bei He
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Li-Xian He
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - You-Ning Liu
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Jie-Ming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
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Grünig H, Nikolaidis PT, Moon RE, Knechtle B. Diagnosis of Swimming Induced Pulmonary Edema-A Review. Front Physiol 2017; 8:652. [PMID: 28912730 PMCID: PMC5583207 DOI: 10.3389/fphys.2017.00652] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/16/2017] [Indexed: 12/16/2022] Open
Abstract
Swimming induced pulmonary edema (SIPE) is a complication that can occur during exercise with the possibility of misdiagnosis and can quickly become life threatening; however, medical literature infrequently describes SIPE. Therefore, the aim of this review was to analyse all individual cases diagnosed with SIPE as reported in scientific sources, with an emphasis on the diagnostic pathways and the key facts resulting in its diagnosis. Due to a multifactorial and complicated pathophysiology, the diagnosis could be difficult. Based on the actual literature, we try to point out important findings regarding history, conditions, clinical findings, and diagnostic testing helping to confirm the diagnosis of SIPE. Thirty-eight cases from seventeen articles reporting the diagnosis of SIPE were selected. We found remarkable differences in the individual described diagnostic pathways. A total of 100% of the cases suffered from an acute onset of breathing problems, occasionally accompanied by hemoptysis. A total of 73% showed initial hypoxemia. In most of the cases (89%), an initial chest X-Ray or chest CT was available, of which one-third (71%) showed radiological signs of pulmonary edema. The majority of the cases (82%) experienced a rapid resolution of symptoms within 48 h, the diagnostic hallmark of SIPE. Due to a foreseeable increase in participation in swimming competitions and endurance competitions with a swimming component, diagnosis of SIPE will be important, especially for medical teams caring for these athletes.
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Affiliation(s)
- Hannes Grünig
- Institut für Radiologie, Luzerner KantonsspitalLuzern, Switzerland
| | | | - Richard E. Moon
- Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University Medical CenterDurham, NC, United States
| | - Beat Knechtle
- Gesundheitszentrum St. GallenSt. Gallen, Switzerland
- Institute of Primary Care, University of ZurichZurich, Switzerland
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29
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Froudarakis ME, Plojoux J, Kaspi E, Anevlavis S, Laroumagne S, Karpathiou G, Roca E, Adler D, Dutau H, Astoul P. Positive pleural cytology is an indicator for visceral pleural invasion in metastatic pleural effusions. CLINICAL RESPIRATORY JOURNAL 2017; 12:1011-1016. [DOI: 10.1111/crj.12619] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marios E. Froudarakis
- Department of Respiratory Medicine, Medical School; Democritus University of Thrace; Alexandroupolis Greece
| | - Jerôme Plojoux
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
- Division of Pulmonary Medicine; University Hospitals of Geneva; Geneva Switzerland
| | - Elise Kaspi
- INSERM, GMGF UMRS 910; Aix-Marseille University; Marseille France
- Hôpital la Timone; Service de Biologie Cellulaire; Marseille France
| | - Stavros Anevlavis
- Department of Respiratory Medicine, Medical School; Democritus University of Thrace; Alexandroupolis Greece
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
| | - Georgia Karpathiou
- Department of Pathology; University Hospital of Ioannina; Ioannina Greece
| | - Elisa Roca
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
| | - Dan Adler
- Division of Pulmonary Medicine; University Hospitals of Geneva; Geneva Switzerland
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
- Aix-Marseille University; Marseille France
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30
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Anevlavis S, Froudarakis ME. Advances in pleuroscopy. CLINICAL RESPIRATORY JOURNAL 2017; 12:839-847. [DOI: 10.1111/crj.12597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/11/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Stavros Anevlavis
- Department of Respiratory Medicine, Medical School of Alexandroupolis; Democritus University of Thrace; Greece
| | - Marios E. Froudarakis
- Department of Respiratory Medicine, Medical School of Alexandroupolis; Democritus University of Thrace; Greece
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31
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Saba MA, Valeh T, Ehteram H, Haddad Kashani H, Ghazi Zahedi M. Diagnostic Value of Neuron-Specific Enolase (NSE) and Cancer Antigen 15-3 (CA 15-3) in the Diagnosis of Pleural Effusions. Asian Pac J Cancer Prev 2017; 18:257-261. [PMID: 28240844 PMCID: PMC5563110 DOI: 10.22034/apjcp.2017.18.1.257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Pleural effusion diagnosis plays an important role in determining treatment strategies. The aim
of this study was to determine the diagnostic capacity of tumor markers CA 15-3 and NSE solely or in combination
in differentiating the nature of pleural fluid. Methods and Materials: In this cross-sectional study we evaluated 93
patients with pleural effusions (44 malignant and 49 benign). NSE and CA 15-3 serum and pleural levels were measured
simultaneously using immunoenzyme assay kits. Diagnosis was established on the basis of cytological study. Results:
Sensitivity and specificity of CA 15-3 serum and pleural level measurement were 70.4%, 49.0%, and 79.5% and 49.0%,
respectively. Serum NSE levels had 75.0% sensitivity and 69.4% specificity while the respective pleural figures were
75.0% and 73.5%. The combination of NSE and CA 15-3 serum and pleural levels had the highest sensitivity (93.2%),
although combined serum levels had the lowest sensitivity (47.7%). With an accuracy of 74.2%, pleural levels of NSE
had the highest diagnostic potential. Conclusion: Measuring NSE and CA 15-3 tumor markers is a suitable approach
to distinguish the nature of pleural effusions, with NSE pleural levels demonstrating the highest diagnostic accuracy.
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Affiliation(s)
- Mohammad Ali Saba
- Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, Iran.
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EXP CLIN TRANSPLANTExp Clin Transplant 2016; 14. [DOI: 10.6002/ect.tondtdtd2016.p55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Chalhoub M, Ali Z, Sasso L, Castellano M. Experience with indwelling pleural catheters in the treatment of recurrent pleural effusions. Ther Adv Respir Dis 2016; 10:566-572. [PMID: 27655919 PMCID: PMC5933596 DOI: 10.1177/1753465816667649] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Recurrent pleural effusions are frequently encountered in clinical practice.
Whether malignant or nonmalignant, they often pose a challenge to the practicing
clinician. When they recur, despite optimum medical therapy of the underlying
condition and repeated thoracenteses, more invasive definitive approaches are
usually required. Since its introduction in 1997, the PleurX catheter became the
preferred method to treat recurrent malignant pleural effusions. Since then, a
number of publications have documented its utility in managing recurrent
nonmalignant pleural effusions. The purpose of this paper is to review the use
of the PleurX catheter in recurrent pleural effusions.
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34
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Voulgaris T, Anevlavis S, Karpathiou G, Forest F, Koulelidis A, Froudarakis M. Dabigatran can cause eosinophilic pleural and pericardial effusion with blood eosinophilia. CLINICAL RESPIRATORY JOURNAL 2016; 12:799-801. [PMID: 27460941 DOI: 10.1111/crj.12537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/24/2016] [Indexed: 12/26/2022]
Abstract
Eosinophilic pleural effusions (EPE) account for 5%-8% of all exudative pleural effusions. A pleural effusion is defined as eosinophilic if it contains 10% or more eosinophils. We present the case of a 70-year-old man with EPE, blood eosinophilia and pericardial effusion due to dabigatran, a novel anti-thrombin agent.
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Affiliation(s)
- Thanasis Voulgaris
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Stavros Anevlavis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Georgia Karpathiou
- Department of Pathology, North Hospital, University Hospital of St. Etienne, St-Etienne, France
| | - Fabien Forest
- Department of Pathology, North Hospital, University Hospital of St. Etienne, St-Etienne, France
| | - Andreas Koulelidis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Marios Froudarakis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
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35
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Tomoda C, Ogimi Y, Saito F, Masaki C, Akaishi J, Matsuzu K, Suzuki A, Uruno T, Ohkuwa K, Shibuya H, Kitagawa W, Nagahama M, Sugino K, Ito K. Outcome and characteristics of patients with malignant pleural effusion from differentiated thyroid carcinoma. Endocr J 2016; 63:257-61. [PMID: 26655349 DOI: 10.1507/endocrj.ej15-0631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Metastatic differentiated thyroid carcinoma (DTC) is an uncommon cause of malignant pleural effusion (MPE) and the characteristics and clinical course have been rarely described. Herein, we report a retrospective review of the clinical course of 18 patients (15 women and 3 men) with MPE from DTC who underwent treatment at our institution between January 2005 and December 2014. MPE from DTC was diagnosed based on cytology and/or level of thyroglobulin in the pleural fluid. Pathologically, papillary carcinoma was found in 16 patients and follicular carcinoma in 2 patients. Median ages at initial diagnosis of DTC and MPE were 64 years (range, 22-79) and 74 years (range, 39-86), respectively. All patients showed radiologically apparent lung metastases, with MPE developing after 0-212 months (median, 25). In 16 patients (88.9%), other coexistent distant metastases at the time of MPE diagnosis were found in the bone (n = 10), brain (n = 5), and skin (n = 2). All patients were treated conservatively with palliative thoracentesis or chest tube drainage with or without pleurodesis. Recurrent MPE after treatment was seen in 9 patients; discharge to home health care after treatment for MPE was possible for 14 patients. The overall survival after initial diagnosis varied considerably from 14 months to 37 years, but the median survival after appearance of MPE was 10 months (range, 1-28). Systemic therapy for iodine-resistant recurrent thyroid disease may need to be considered as a treatment option for patients with MPE.
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MESH Headings
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/physiopathology
- Adenocarcinoma, Follicular/secondary
- Adenocarcinoma, Follicular/surgery
- Adult
- Aged
- Carcinoma/pathology
- Carcinoma/physiopathology
- Carcinoma/surgery
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/physiopathology
- Carcinoma, Papillary/secondary
- Carcinoma, Papillary/surgery
- Female
- Hospitals, Urban
- Humans
- Japan
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/physiopathology
- Lung Neoplasms/secondary
- Lung Neoplasms/therapy
- Lymph Node Excision/adverse effects
- Male
- Middle Aged
- Neoplasm Staging
- Palliative Care
- Pleural Effusion, Malignant/diagnosis
- Pleural Effusion, Malignant/etiology
- Pleural Effusion, Malignant/physiopathology
- Pleural Effusion, Malignant/therapy
- Prognosis
- Retrospective Studies
- Survival Analysis
- Thyroid Cancer, Papillary
- Thyroid Gland/pathology
- Thyroid Gland/surgery
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/physiopathology
- Thyroid Neoplasms/surgery
- Thyroidectomy/adverse effects
- Young Adult
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Affiliation(s)
- Chisato Tomoda
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
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ENFOQUE DIAGNÓSTICO EN EL PACIENTE CON DERRAME PLEURAL. REVISTA MÉDICA CLÍNICA LAS CONDES 2015. [DOI: 10.1016/j.rmclc.2015.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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38
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Sun ML, Shang B, Gao JH, Jiang SJ. Rare case of primary pleural lymphoma presenting with pleural effusion. Thorac Cancer 2015; 7:145-50. [PMID: 26813352 PMCID: PMC4718130 DOI: 10.1111/1759-7714.12256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/11/2014] [Indexed: 12/22/2022] Open
Abstract
Primary pleural lymphoma is rare and has been described in association with human immunodeficiency virus (HIV) infection or pyothorax. We report a rare case of primary pleural lymphoma in a 73-year-old man who presented with chest pain and no history of HIV infection or pyothorax. Chest imaging showed pleural thickening and pleural effusion. Thoracoscopic pleural biopsy was performed. Histopathological and immunohistochemical examinations conformed to that of a diffuse large B-cell lymphoma. Physicians should be aware of this rare location of primary lymphoma and implement thoracoscopy as soon as possible.
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Affiliation(s)
- Mei-Ling Sun
- Department of Respiratory Medicine Provincial Hospital Affiliated to Shandong University Jinan China
| | - Bin Shang
- Department of Thoracic Surgery Provincial Hospital Affiliated to Shandong University Jinan China
| | - Jian-Hua Gao
- Department of Respiratory Medicine Wendeng Central Hospital Weihai China
| | - Shu-Juan Jiang
- Department of Respiratory Medicine Provincial Hospital Affiliated to Shandong University Jinan China
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39
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Feasibility of bioelectrical impedance spectroscopy measurement before and after thoracentesis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:810797. [PMID: 25861647 PMCID: PMC4377452 DOI: 10.1155/2015/810797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 02/19/2015] [Indexed: 11/30/2022]
Abstract
Background. Bioelectrical impedance spectroscopy is applied to measure changes in tissue composition. The aim of this study was to evaluate its feasibility in measuring the fluid shift after thoracentesis in patients with pleural effusion. Methods. 45 participants (21 with pleural effusion and 24 healthy subjects) were included. Bioelectrical impedance was analyzed for “Transthoracic,” “Foot to Foot,” “Foot to Hand,” and “Hand to Hand” vectors in low and high frequency domain before and after thoracentesis. Healthy subjects were measured at a single time point. Results. The mean volume of removed pleural effusion was 1169 ± 513 mL. The “Foot to Foot,” “Hand to Hand,” and “Foot to Hand” vector indicated a trend for increased bioelectrical impedance after thoracentesis. Values for the low frequency domain in the “Transthoracic” vector increased significantly (P < 0.001). A moderate correlation was observed between the amount of removed fluid and impedance change in the low frequency domain using the “Foot to Hand” vector (r = −0.7). Conclusion. Bioelectrical impedance changes in correlation with the thoracic fluid level. It was feasible to monitor significant fluid shifts and loss after thoracentesis in the “Transthoracic” vector by means of bioelectrical impedance spectroscopy. The trial is registered with Registration Numbers IRB EK206/11 and NCT01778270.
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Archontogeorgis K, Anevlavis S, Zarogoulidis P, Jain A, Karpathiou G, Giatromanolaki A, Sivridis E, Bouros D, Froudarakis ME. Pleuroscopy in 'Idiopathic' eosinophilic pleural effusions. CLINICAL RESPIRATORY JOURNAL 2014; 9:475-80. [PMID: 24865235 DOI: 10.1111/crj.12165] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 05/02/2014] [Accepted: 05/16/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Idiopathic eosinophilic pleural effusions (IEPEs) comprise the eosinophilic pleural effusions for which a specific aetiology cannot be established. There are no reports investigating IEPE on the basis of a systematically applied pleuroscopy approach and entailing an appropriate patient follow-up till the final outcome is established; existing series rather combine clinical and thoracocentesis criteria to establish the idiopathic character of the diagnosis. OBJECTIVES The aim of our study was to assess the clinical outcome of patients with IEPE, who underwent a systematic diagnostic approach by pleuroscopy. METHODS We studied 10 patients with IEPE among 175 consecutive patients who underwent pleuroscopy for undiagnosed pleural effusion. Pleural biopsies were obtained from observed lesions. All patients were followed up by means of clinical examination and imaging. RESULTS The diagnosis of IEPE was established in 10 patients (median age was 50.5 years, range 35-91). Macroscopic examination of the pleura showed diffuse thickening with pleural plaques in eight patients, consistent with diffuse pleural eosinophilic inflammation histologically proven. In two patients, macroscopic examination showed scattered nodules associated with non-caseating granulomas histologically. In all 10 patients, a specific aetiology could not be established. Follow-up was available for all patients ranging from 24-102 months (median 60 months). No patient received a specific treatment during the follow-up period. No relapse of a pleural effusion was documented during this period. CONCLUSION Pleuroscopy is mandatory in diagnosing IEPE. Negative histology and a long follow-up showed a benign course. These findings suggest that we should call these effusions 'indeterminate'.
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Affiliation(s)
- Kostas Archontogeorgis
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stavros Anevlavis
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paul Zarogoulidis
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ajay Jain
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgia Karpathiou
- Department Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Efthimios Sivridis
- Department Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Demosthenes Bouros
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Marios E Froudarakis
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Na MJ. Diagnostic tools of pleural effusion. Tuberc Respir Dis (Seoul) 2014; 76:199-210. [PMID: 24920946 PMCID: PMC4050067 DOI: 10.4046/trd.2014.76.5.199] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 04/04/2014] [Accepted: 04/11/2014] [Indexed: 01/31/2023] Open
Abstract
Pleural effusion is not a rare disease in Korea. The diagnosis of pleural effusion is very difficult, even though the patients often complain of typical symptoms indicating of pleural diseases. Pleural effusion is characterized by the pleural cavity filled with transudative or exudative pleural fluids, and it is developed by various etiologies. The presence of pleural effusion can be confirmed by radiological studies including simple chest radiography, ultrasonography, or computed tomography. Identifying the causes of pleural effusions by pleural fluid analysis is essential for proper treatments. This review article provides information on the diagnostic approaches of pleural effusions and further suggested ways to confirm their various etiologies, by using the most recent journals for references.
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Affiliation(s)
- Moon Jun Na
- Respiratory Division, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
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42
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Froudarakis ME. Should we really compare indwelling pleural catheters to any pleurodesis? Respiration 2014; 88:18-21. [PMID: 24821005 DOI: 10.1159/000362693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Marios E Froudarakis
- Department of Pneumonology, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Abstract
PURPOSE OF REVIEW This review analyzes the current literature available on appropriate measurement of pleural fluid pH and currently used methods of measurement. RECENT FINDINGS Current literature continues to support the superiority of blood gas analyzers (BGAs) in the accurate measurement of pleural fluid pH. Despite the compelling evidence, roughly 30-50% of the laboratories across the United States continue to use inaccurate methods for pleural fluid pH measurement. Nearly 40% of pulmonologists were incorrect in believing their laboratory uses BGA for the analysis of pleural fluid pH. SUMMARY It is apparent that the clinical utility of pleural fluid pH is often undermined by its inappropriate measurement. Physicians must be made aware of their laboratory's method of measurement if pleural fluid pH is to be used in the evaluation of pleural diseases. If pleural fluid pH measurement is not done accurately, then other pleural fluid characteristics may be used to aid the clinician.
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44
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Anevlavis S, Kouliatsis G, Sotiriou I, Koukourakis MI, Archontogeorgis K, Karpathiou G, Giatromanolaki A, Froudarakis ME. Prognostic factors in patients presenting with pleural effusion revealing malignancy. ACTA ACUST UNITED AC 2014; 87:311-6. [PMID: 24457947 DOI: 10.1159/000356764] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/14/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The survival of patients with malignant pleural effusion is considered generally poor. Most of the studies reporting results of prognostic factors are retrospective, using pleural thoracentesis for diagnosis. The objectives of our study were to reveal possible prognostic factors in patients initially presenting with undiagnosed pleural effusion proven to be malignant by diagnostic thoracoscopy. METHODS Ninety consecutive patients, 48 of whom were male (53%), with a median age of 69 years (range 37-93) and a performance status (PS) of 0/1 (63%) and with initially undiagnosed pleural effusion that was proven to be malignant by thoracoscopy were evaluated. Survival time was defined as the time from thoracoscopic diagnosis to death or the last follow-up. A regression analysis was used to determine significant clinical and biological prognostic factors. RESULTS Lung carcinoma (44.4%), breast carcinoma (24.4%), and mesothelioma (12.2%) were the most frequent tumors diagnosed. The median overall survival was 11 months (range 0.5-55). The survival of the patients was related to the following factors: histology of the primary tumor (p = 0.008), PS (p < 0.001), white blood cells (p = 0.018), and the blood neutrophil-to-lymphocyte (N/L) ratio (p = 0.002). Multiple regression showed PS, histology, and the N/L ratio. CONCLUSION The factors affecting survival in our patients were PS, primary tumor histology, and the N/L ratio. These factors may help physicians select patients for treatment and/or interventional procedures.
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Affiliation(s)
- Stavros Anevlavis
- Department of Pneumonology, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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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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Diagnostic utility of sonar guided biopsy in tuberculous effusion. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Rodriguez-Panadero F, Romero-Romero B. Current and future options for the diagnosis of malignant pleural effusion. ACTA ACUST UNITED AC 2013; 7:275-87. [PMID: 23550710 DOI: 10.1517/17530059.2013.786038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Malignant pleural effusion (MPE) is a frequent problem faced by clinicians, but tumor pleural involvement can be seen without effusion. AREAS COVERED Imaging, pleural fluid analysis, biomarkers for MPE, needle pleural biopsy and thoracoscopy. To prepare this review, we performed a search using keywords: 'diagnosis' + 'malignant' + 'pleural' + 'effusion' (all fields) in PubMed, and found 4106 articles overall (until 16 January 2013, 881 in the last 5 years). EXPERT OPINION Ultrasound techniques will stay as valuable tools for pleural effusions. Biomarkers in pleural fluid do not currently provide an acceptable yield for MPE. In subjects with past history of asbestos exposure, some serum or plasma markers (soluble mesothelin, fibulin) might help in selecting cases for close follow-up, to detect mesothelioma early. Needle pleural biopsy is justified only if used with image-techniques (ultrasound or CT) guidance, and thoracoscopy is better for both diagnosis and immediate palliative treatment (pleurodesis). Animal models of MPE and 'spheroids' are promising for research involving both pathophysiology and therapy. Considering the possibility of direct pleural delivery of nanotechnology-developed compounds-fit to both diagnosis and therapy purposes ('theranostics')-MPE and mesothelioma in particular are likely to benefit sooner than later from this exciting perspective.
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Affiliation(s)
- Francisco Rodriguez-Panadero
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias (UMQUER), Hospital Universitario Virgen del Rocío, Seville, Spain.
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Serous Fluids. Cytopathology 2013. [DOI: 10.1007/978-1-4471-2419-1_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Eldaboosy SAM, El-shamly M, Halima KM, Shaarawy AT, Alwakil I, Osama M. Medical video assisted thoracoscopy – minimally invasive diagnostic tool for diagnosis of undiagnosed pleural effusion. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Maslove DM, Chen BTM, Wang H, Kuschner WG. The diagnosis and management of pleural effusions in the ICU. J Intensive Care Med 2013; 28:24-36. [PMID: 22080544 DOI: 10.1177/0885066611403264] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pleural effusions are common in critically ill patients. Most effusions in intensive care unit (ICU) patients are of limited clinical significance; however, some are important and require aggressive management. Transudative effusions in the ICU are commonly caused by volume overload, decreased plasma oncotic pressure, and regions of altered pleural pressure attributable to atelectasis and mechanical ventilation. Exudates are sequelae of pulmonary or pleural infection, pulmonary embolism, postsurgical complications, and malignancy. Increases in pleural fluid volume are accommodated principally by chest wall expansion and, to a lesser degree, by lung collapse. Studies in mechanically ventilated patients suggest that pleural fluid drainage can result in improved oxygenation for up to 48 hours, but data on clinical outcomes are limited. Mechanically ventilated patients with pleural effusions should be semirecumbant and treated with higher levels of positive-end expiratory pressure. Rarely, large effusions can cause cardiac tamponade or tension physiology, requiring urgent drainage. Bedside ultrasound is both sensitive and specific for diagnosing pleural effusions in mechanically ventilated patients. Sonographic findings of septation and homogenous echogenicity may suggest an exudative effusion, but definitive diagnosis requires pleural fluid sampling. Thoracentesis should be carried out under ultrasound guidance. Antibiotic regimens for parapneumonic effusions should be based on current pneumonia guidelines, and anaerobic coverage should be included in the case of empyema. Decompression of the pleural space may be necessary to improve respiratory mechanics, as well as to treat complicated effusions. While small-bore catheters inserted under ultrasound guidance may be used for nonseptated effusions, surgical consultation should be sought in cases where this approach fails, or where the effusion appears complex and septated at the outset. Further research is needed to determine the effects of pleural fluid drainage on clinical outcomes in mechanically ventilated patients, to evaluate weaning strategies that include pleural fluid drainage, and to better identify patients in whom pleural effusions are more likely to be infected.
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Affiliation(s)
- David M Maslove
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
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