Appearance Of Pleural Effusion Research Articles

Characteristics of early pleural effusions after orthotopic heart transplantation: comparison with coronary artery bypass graft surgery.

ObjectivesPleural effusions appearing within the first 30 postoperative days following coronary artery bypass grafting (CABG) are classified as early and believed to be directly related to the surgery. The characteristics of such effusions are well-described. Orthotopic heart transplantation is also known to be complicated by pleural effusions; however, their characteristics have not been systematically reported. We assessed the features of early postoperative pleural effusions after heart transplantation and compared them to those of early effusions following CABG.MethodsWe retrospectively collected demographic, clinical, and laboratory data for patients who underwent either orthotopic heart transplantation (study group) or CABG (comparison group) at our institution and whose postoperative course within 30 days was complicated by new or worsening pleural effusion that prompted drainage. Patients subjected to analysis consisted only of those with sufficiently complete laboratory profiles to permit adequate characterization of the nature of their pleural fluid.ResultsOut of 251 orthotopic heart transplant recipients, seven (2.8%) were found to have sufficiently complete pleural fluid results to be included in the study group. Out of 1,506 patients who underwent CABG, 32 (2.1%) had sufficiently complete pleural fluid results and formed the comparison group. The radiological appearance of pleural effusions in both groups was similar: bilateral in at least half and exclusively moderate to large. Effusions complicating both surgeries were exudative in close to 90% of cases. For those with available leukocyte differential counts, the pleural fluid of the post-orthotopic heart transplantation group was more often neutrophilic (3/5, 60%), whereas the fluid of the post-coronary artery bypass grafting group was more often lymphocytic (22/32, 69%) and tended to be hemorrhagic (median RBC count 33,000 cells/µL vs. 10,000 cells/µL). None of the comparisons of pleural fluid characteristics between the two groups reached statistical significance.ConclusionsThis small, descriptive study is the first to systematically report the fluid characteristics of pleural effusions complicating orthotopic heart transplantation within the first 30 postoperative days and to compare this group to those who developed effusions after CABG. Our findings revealed both similarities and differences in the pleural fluid characteristics between these two types of patients.

Withdrawal: Characteristics of early pleural effusions after orthotopic heart transplantation: comparison with coronary artery bypass graft surgery.

Anant Jain (2021) Characteristics of early pleural effusions after orthotopic heart transplantation: comparison with coronary artery bypass graft surgery, (https://doi.org/10.4081/monaldi.2021.1740). The above article from the Monaldi Archives for Chest Disease published online on 24 November 2021, has been withdrawn by agreement between the journal's Editors-in-Chief, the Authors and PAGEPress Scientific Publications. This action has been agreed upon due to an administrative error by the publisher which caused the article to be published as an Accepted Article. The author is not responsible for this error. The publisher regrets any confusion this error may have caused.

Eventration of Diaphragm or Pseudo Pleural Effusion

Background : Physicians frequently encounter chest-x ray reports of pleural effusion in patients. Thoracocentesis is the second step to diagnosis, but if there isn’t any effusion actually, thoracocentesis may lead to complication. Case Report: A 47-year-old man with a history of dyspnea and dry cough and posteroanterior (PA) chest x-ray (and right lateral decubitus) report of pleural effusion referred for thoracocentesis, but vesicular sounds at over the lungs were normal. Spiral lung CT scan revealed localized eventration of diaphragm. Conclusion: Localized eventration of right diaphragm may cause the appearance of pleural effusion in PA and also right lateral decubitus chest x-ray.

P119 Pleural Service Provision and Training Opportunities in a District General Hospital in North East Lincolnshire

IntroductionBTS Pleural disease guidelines in 2010 strongly recommend thoracic ultrasound guidance for all pleural procedures for pleural fluid, and at least level 1 competency is required to safely perform independent...

Does pleural fluid appearance really matter? The relationship between fluid appearance and cytology, cell counts, and chemical laboratory measurements in pleural effusions of patients with cancer.

BackgroundPrevious reports have suggested that the appearance of pleural effusions (i.e., the presence or absence of blood) might help to establish the etiology of the effusions. This study explores the relationship between pleural fluid appearance and the results of chemical and cytological analyses in a group of patients with recurrent symptomatic pleural effusions and a diagnosis of cancer.MethodsMedical records were reviewed from all 390 patients who were diagnosed with cancer, who underwent thoracentesis before placement of an intrapleural catheter (IPC) between April 2000 and January 2006. Adequate information for data analysis was available in 365 patients. The appearance of their pleural fluid was obtained from procedure notes dictated by the pulmonologists who had performed the thoracenteses. The patients were separated into 2 groups based on fluid appearance: non-bloody and bloody. Group differences in cytology interpretation were compared by using the chi square test. Cellular counts, chemical laboratory results, and survival after index procedure were compared by using the student's t test.ResultsPleural fluid cytology was positive on 82.5% of the non-bloody effusions and on 82.4% of the bloody ones. The number of red blood cells (220.5 × 103/μL vs. 12.3 × 103/μL) and LDH values (1914 IU/dl vs. 863 IU/dl) were statistically higher in bloody pleural effusions.ConclusionThe presence or absence of blood in pleural effusions cannot predict their etiology in patients with cancer and recurrent symptomatic pleural effusions.

Computed tomography appearances of local recurrence after stereotactic body radiation therapy for stage I non-small-cell lung carcinoma

The aim of this study was to characterize computed tomography (CT) manifestations of local recurrence after stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer (NSCLC). A total of 27 stage I NSCLC patients who were treated with SBRT, including 5 patients with local recurrence, were retrospectively analyzed for serial CT examinations. A bulging margin appeared in 4 of the 5 cases (80%) with local recurrence and 1 of 22 cases (5%) without local recurrence. Air bronchograms were seen in 3 of 5 cases with local recurrence and 21 of 22 cases without local recurrence, but they subsequently disappeared in all 3 cases (100%) with local recurrence and in 4 of the 21 cases (19%) without local recurrence. Ipsilateral pleural effusion was observed in all 5 cases (100%) with local recurrence and in 5 of 22 cases (22%) without local recurrence. The opacity increased in size even after 12 months from the completion of SBRT in cases with local recurrence, whereas it decreased or did not change in size in cases without recurrence. Local recurrence should be suspected on CT when there was (1) a bulging margin, (2) disappearance of air bronchograms, (3) appearance of pleural effusion, or (4) increase in the abnormal opacity after 12 months.

A case of gastric cancer detected incidentally following to chylothorax, followed by change in the appearance of pleural effusion with cancer progression

A case of gastric cancer detected incidentally following to chylothorax, followed by change in the appearance of pleural effusion with cancer progression

Sonographic Septation in Lymphocyte-Rich Exudative Pleural Effusions

The purpose of this study was to evaluate the role of the sonographic features of lymphocyte-rich exudative pleural effusions in the differential diagnosis of tuberculosis and lung cancer in an area with a high incidence of tuberculosis. Medical records of patients undergoing chest sonography between January 2003 and June 2005 (30 months) were reviewed retrospectively. The enrolled patients included 73 with lung cancer-related pleural effusions and 93 with tuberculous pleural effusions. The sonographic appearances of the pleural effusions were defined in terms of 4 patterns: anechoic, homogeneously echogenic, complex septated, and complex nonseptated. Among the 73 lung cancer-related pleural effusions, there were sonographic appearances of an anechoic pattern in 11% (8/73), a complex septated pattern in 4% (3/73), and a complex nonseptated pattern in 85% (62/73). In 93 tuberculous pleural effusions, there were sonographic appearances of an anechoic pattern in 12% (11/93), a complex septated pattern in 47% (44/93), and a complex non-septated pattern in 41% (38/93). Apparently, a complex septated pattern in the sonographic appearance of lymphocyte-rich pleural effusions is a useful diagnostic predictor for differentiating tuberculosis from lung cancer (95% confidence interval, -0.57 to -0.29). If we define the complex septated pattern in the sonographic appearance of lymphocyte-rich exudative pleural effusions as a predictor for tuberculous pleural effusions, we can achieve sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio values of 47%, 96%, 94%, 59%, and 12, respectively. A complex septated pattern in the sonographic appearance is a useful predictor of tuberculosis in lymphocyte-rich exudative pleural effusions.

Technical and Prognostic Outcomes of Double-Balloon Pericardiotomy for Large Malignancy-Related Pericardial Effusions

To investigate both the use of immediate or elective double-balloon pericardiotomy (DBP) in patients with a large amount of malignancy-related pericardial effusion, and the prognosis of this subgroup. Observational study after DBP intervention. Tertiary referral center. Fifty patients with malignancy, mainly lung and breast cancer, who were admitted to our critical care unit with a large amount of pericardial effusion. All received echocardiographic-guided pericardiocentesis. Group 1 consisted of 12 patients (24%) who received immediate DBP, and group 2 consisted of 38 patients (76%) who received delayed DBP 2.5 +/- 1.7 days later (mean +/- SD) after emergency pericardiocentesis with pigtail catheter drainage. After the procedure, and at 1 month, 3 months, and 6 months, echocardiography and chest radiography were performed to check for pneumothorax, pericardial effusion reaccumulation, or the appearance of pleural effusion after pigtail catheter removal. The procedure was successful and without recurrence in 44 patients (88%). Procedural complications were fever in 4 patients (33%) and 10 patients (26%) in group 1 and group 2, respectively (p = 0.72), and mild pneumothorax in 2 patients (17%) and 1 patient (3%) in group 1 and group 2, respectively (p = 0.14). Fifty percent of the patients died within 4 months, while 25% survived to 11 months. High serum calcium, a low albumin/globulin ratio, and positive results on pericardial effusion cytology were poor prognostic factors for long-term survival. Both immediate and delayed DBP are a safe and effective method of relieving large pericardial effusions in patients with cancer. Successful DBP without recurrence of pericardial effusion was achieved in 88% of all patients. Survival was related to the extent of the disease.

Hyperoxia-induced alterations of rat alveolar lavage composition and properties.

Although lethal exposures of most animal species to oxygen result in a reduced amount of surfactant phospholipids (PL), hyperoxia in rats leads to elevated levels of PL on the alveolar surface. Because of this different response, a study was made of the amount, composition, surface properties, and subfraction distribution (obtained by differential centrifugation) of alveolar lavage materials from rats exposed to > 95% oxygen for 64 h. The exposures lead to severe lung damage, which includes the appearance of pleural effusion, pulmonary edema, and increased protein levels on the alveolar surface. However, the PL levels of lavage fluid are increased two- to threefold, and the PL composition is altered. In O2-exposed rats, only 39(+/- 1)% of the phospholipid is disaturated phosphatidylcholine (DSPC), the major surface active component of surfactant, as compared to 46(+/- 1)% DSPC in lavage from control animals. The distribution of PL and DSPC in subfractions of lavage materials obtained by differential centrifugation is approximately reversed following hyperoxia. In lavage from control animals, 36% of the PL is in the heavier, more dense subfractions and 64% is in the lighter, less dense subfractions, while 72% is heavier and 28% lighter in lavage from O2-exposed animals. Measurements of surface properties with the Wilhelmy balance indicate that the ability of the lavage materials to reduce surface tension is impaired following hyperoxia. Thus, lethal exposures of rats to oxygen lead to increased amounts of surfactant on the alveolar surface, but the surface properties of the surfactant are impaired, probably due to reduced levels of DSPC, increased amounts of protein, and alterations in its physical form.

The Role of Chest CT Scans in the Management of Empyema

Background To decide the optimal antibiotics and application of chest tube, examination of pleural fluid is fundamental in the management of empyema. Some criteria for drainage of pleural fluid have been recommended but some controversies have been suggested. Recently, newer radiologic methods including ultrasound and computed tomography scanning, have been applied to the diagnosis and management of pleural effusions. We undertook a retrospective analysis of 30 patients with pleural effusion who had CT scans of the chest in order to apply the criteria of Light et at retrospectively to patients with loculation and to correlate the radiologic appearance of pleural effusions with pleural fluid chemistry. Method We analyzed the records of 30 out of 147 patients with pleural effusion undergoing chest CT scans. Results 1) Six of the pleural fluid cultures yielded gram negative organisms and three anaerobic bacterias and one Staphylococcus aureus and one non-hemolytic Streptococci. No organism was cultured in nineteen cases(63.0%). 2) The reasons for taking chest CT scans were to rule out malignancy or parenchymal lung disease(46.7%), Poor response to antibiotics(40.0%), hard to aspirate pleural fluid(10.0%) and to decide the site for chest tube insertion(3.3%). 3) There was no significant correlations between ATS stages and loculation but there was a tendency to Inoculate in stage III. 4) There was a significant inverse relationship between the level of pH and loculation(P<0.05) but there appeared to be no relationship between pleural fluid, LDH, glucose, protein, loculation and pleural thickening. 5) In 12 out of 30, therapeutic measures were changed according to the chest CT scan findings. Conclusion We were unable to identify any correlations between the plerual fluid chemistry, ATS stages and loculations except pH, and we suggest that tube thoracotomy should be individualized according to the clinical judgement arid serial observation. All patients with empyema do not need a chest CT scan but a CT scan can provide determination of loculation, guiding and assessing therapy which should decrease morbidity and hospital stay.

Interrelationship of pleural and pulmonary interstitial liquid.

When the lung interstitium fills with liquid, lung interstitial liquid may flow across the visceral pleura into the pleural space. This route of interstitial liquid flow does not apparently depend on the type of edema because it is used equally in both hydrostatic and increased permeability edema. The route of flow depends mostly on the quantity and location of extravascular lung water. In experimental studies of hydrostatic and increased permeability edema, pleural effusion develops when extravascular lung water has reached a certain level for a certain amount of time. The necessary level of edema appears to be greater than 5.0 g/g dry lung, whether in hydrostatic edema [5.2-6.2 g/g dry lung (14); 5.0-6.5 g/g dry lung (4)] or in increased permeability edema due either to ANTU [5.1-9.3 g/g dry lung (45)], oleic-acid [6.5-8.0 g/g dry lung (58)], or alveolar P. aeruginosa [5.4-6.7 g/g dry lung (J. Wiener-Kronish, unpublished observations)]. The amount of lung edema necessary for pleural effusion formation is similar to the amount of edema Bhattacharya and co-workers found to be associated with the steep rise in subpleural pressure (7). The time before appearance of pleural effusion appears to be approximately 2 hr after the development of lung edema, whether the effusion results from hydrostatic edema (14) or increased permeability edema due to ANTU (48) or oleic acid (58). This delay may be necessary for the interstitial liquid to accumulate and the interstitial pressure to increase in the subpleural tissues to the point that liquid flows across the visceral pleura at a rate greater than the rate at which the parietal lymphatics can clear it. Consequences of a pleural route of edema clearance are several. Pleural effusion that develops in the course of lung edema represents lung interstitial edema and can be sampled in lieu of sampling lung lymph. Indeed, pleural liquid may be a better sample of lung interstitial liquid than is alveolar edema liquid. The flow of lung interstitial liquid to the pleural space can protect against the development of alveolar edema by transferring excess liquid from the lung interstitium to the pleural space, where the effects on lung function are relatively minor. Obliteration of the pleural space may either lower the threshold for development of alveolar edema in the adjacent lungs, or slow the clearance of established edema; with chronic edema, other routes of clearance would likely adapt to compensate for the loss of the pleural clearance route.