Etiology, clinical characteristics, and management of pleural effusion in Ilorin, Nigeria

A practical approach to the diagnosis and management of malignant pleural effusions in resource-constrained settings

No pleural intervention in a patient with confirmed malignant pleural effusion (MPE) prolongs life, but even the recommended interventions for diagnosis and palliation can be costly and therefore unavailable in large parts of the world. However, there is good evidence to guide clinicians working in low- and middle-income countries on the most cost-effective and clinically effective strategies for the diagnosis and management of MPE. Transthoracic ultrasound-guided closed pleural biopsy is a safe method of pleural biopsy with a diagnostic yield approaching that of thoracoscopy. With the use of pleural fluid cytology and ultrasound-guided biopsy, ≥90% of cases can be diagnosed. Cases with an associated mass lesion are best suited to an ultrasound-guided fine needle aspiration with/without core needle biopsy. Those with diffuse pleural thickening and/or nodularity should have an Abrams needle (<1 cm thickening) or core needle (≥1 cm thickening) biopsy of the area of interest. Those with insignificant pleural thickening should have an ultrasound-guided Abrams needle biopsy close to the diaphragm. The goals of management are to alleviate dyspnoea, prevent re-accumulation of the pleural effusion and minimise re-admissions to hospital. As the most cost-effective strategy, we suggest early use of indwelling pleural catheters with daily drainage for 14 days, followed by talc pleurodesis if the lung expands. The insertion of an intercostal drain with talc slurry is an alternative strategy which is noninferior to thoracoscopy with talc poudrage.

Educational aims

To provide clinicians practising in resource-constrained settings with a practical evidence-based approach to the diagnosis and management of malignant pleural effusions.To explain how to perform an ultrasound-guided closed pleural biopsy.To explain the cost-effective use of indwelling pleural catheters.

Comparison of clinical manifestation among Australian Indigenous and non- Indigenous patients presenting with pleural effusion

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.

Comparing the diagnostic accuracy of semi-rigid and rigid pleuroscopy in diagnosis of exudative lymphocyte dominant pleural effusion with

BACKGROUND AND OBJECTIVES

Pleuroscopy is an appropriate technique for visualization and biopsy of the pleural lesions, performed by two different techniques. In this study, we aimed to investigate the diagnostic accuracy of semi-rigid and rigid pleuroscopy in patients with lymphocyte dominant exudative pleural effusion.

MATERIALS AND METHODS

In this study, patients with lymphocyte dominant pleural effusion with negative results for tuberculosis who referred to Imam Khomeini Hospital, Ahvaz, Iran; from 2018 to 2019 were selected by census method and randomized to undergo semi-rigid or rigid pleuroscopy (30 in each group). Patients' demographic, such as age and gender, were recorded and the pathologic results reported by the two pleuroscopy methods were compared and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were reported for each method. All statistical analyses were performed using SPSS v. 21.

RESULTS

Thirty patients were included in each group. The frequency of tuberculosis, malignancy, and other causes of pleural effusion had no difference between the two methods (P > 0.05). Semirigid pleuroscopy had a sensitivity of 81.5%, specificity of 66.6%, PPV of 75.6%, and NPV of 74%, while the relevant values in rigid pleuroscopy were 87.2%, 68.4%, 87.2%, and 68.4%, respectively.

CONCLUSION

These results, consistent with previous studies, indicated that both semi-rigid and semi-flexible pleuroscopy methods are accurate for diagnosis of lymphocyte dominant pleural effusion when performed by skilled specialists and other considerations, such as availability and costs, can be used for selection of each method.