Bloody Effusion Research Articles

Spontaneous hemopneumothorax causing life-threatening hemorrhage: a case report

BackgroundSpontaneous hemopneumothorax is a rare condition that can be life-threatening if not promptly diagnosed and treated. We report a case of early treatment with transcatheter arterial embolization and video-assisted thoracoscopic surgery.Case presentationA 19-year-old Japanese male was diagnosed with left pneumothorax and underwent chest tube drainage. A total of 10 hours after admission, the patient developed dyspnea, chest pain, and sudden massive bloody effusion. Contrast-enhanced computed tomography revealed contrast extravasation near the left lung apex, and spontaneous hemopneumothorax was diagnosed. Angiography revealed bleeding from a branch of the subscapular artery and transcatheter arterial embolization was performed. The patient underwent video-assisted thoracoscopic surgery and recovered uneventfully.ConclusionsAnesthesiologists involved in urgent surgeries must be aware that a patient with spontaneous pneumothorax can develop a hemopneumothorax, even when full lung expansion has been obtained following chest tube drainage, owing to latent aberrant artery disruption. Interprofessional team engagement is essential for spontaneous hemopneumothorax management.

"Burgundy wine" pleural effusion: An unusual manifestation of acute bacterial empyema.

Although empyema diagnosis by thoracentesis is relatively straightforward, the pleural effusion can sometimes be bloody rather than purulent. We report a case of acute empyema with a dark‐red bloody effusion, wherein multiple anaerobic bacteria were detected. Chest imaging findings improved with pleural drainage, intrapleural fibrinolytic therapy, and intravenous antibiotic treatment.

A rare presentation of extragonadal germ cell tumor; massive pericardial effusion with impending tamponade

The clinical manifestations of extragonadal germ cell tumor (EGGCT) depend on its location and are often caused by compression on surrounding structures. Pericardial effusion is absolutely rare as an initial clinical manifestation for this tumor. We report a 31-year-old man presenting to the emergency department with dyspnea. Two-dimensional echocardiography revealed a massive pericardial effusion with impending tamponade. The patient was immediately transferred to the operating room where a cardiac surgeon drained bloody effusion. A mediastinal mass measuring 173×105×105 mm was accidentally noticed during COVID-19 work-up. Fine core needle biopsy of the mass led to the diagnosis of a germ cell tumor, which was treated appropriately. This study shows the importance of proper work-up in pericardial effusion cases with chest CT-scan as an important part of it.

Multiple tumors on the pleura with pleural effusion mimicking malignant mesothelioma

A 68-year-old male presented with left chest pain and was referred to our hospital due to left-sided pleural effusion on a chest X-ray (Fig. 1 A). Initial laboratory data included a white blood cell count of 5650/μL and a C-reactive protein level of 0.36 mg/dL. CT during drainage of bloody effusion showed multiple tumors on the left chest wall and diaphragm, and residual effusion on the dorsal side, without hilar or peripheral lung lesions (Fig. 1B, C). No extrathoracic tumors were detected. Although effusion cytology was positive for malignancy, the histological type could not be determined even with cell block specimens.

Fatal myopericarditis complicated with coronary vein perforation under the triple antithrombotic therapy: a case report

Background Acute pericarditis generally follows a mild clinical course and is rarely fatal. Coronary vein involvement is rarely reported.Case summary We report an autopsy case of cardiac tamponade from idiopathic myopericarditis due to coronary venous perforation under the triple antithrombotic therapy. A 69-year-old man was admitted to our hospital with abnormal findings on electrocardiography, bloody pericardial effusion, and mild elevation of troponin I. Oral anti-inflammatories were started and the patient followed a benign course. However, on hospital Day 5, he suddenly suffered cardiogenic shock with pulseless electric activity due to cardiac tamponade under the combination use of the dual antiplatelet drugs and an anticoagulant drug. He died despite intense medical treatment. Autopsy revealed cardiac tamponade caused by perforation in the coronary venous wall. To the best of our knowledge, this is the first description of fatal myopericarditis as a complication of coronary venous perforation.Discussion The aetiology and mechanism remain unknown; however, we should take care for this rare complication in patients with acute myopericarditis and bloody effusion under the triple antithrombotic therapy.

Active clearance vs conventional management of chest tubes after cardiac surgery: a randomized controlled study

BackgroundChest tubes are routinely used after cardiac surgery to evacuate shed mediastinal blood. Incomplete chest drainage due to chest tube clogging can lead to retained blood after cardiac surgery. This can include cardiac tamponade, hemothorax, bloody effusions and postoperative atrial fibrillation (POAF). Prior published non randomized studies have demonstrated that active tube clearance (ATC) of chest tubes can reduce retained blood complications prompting the ERAS Cardiac Society guidelines to recommend this modality.ObjectiveA randomized prospective trial to evaluate whether an ATC protocol aimed at improving chest tube patency without breaking the sterile field could efficiently reduce complications related to retained blood after cardiac surgery.MethodsThis was a pragmatic, single-blinded, parallel randomized control trial held from November 2015 to June 2017 including a 30-day post index surgery follow-up. The setting was two academic centers affiliated with the Université de Montréal School of Medicine; the Montreal Heart Institute and the Hôpital du Sacré-Coeur de Montréal. Adult patients admitted for non-emergent coronary bypass grafting and/or valvular heart surgery through median sternotomy, in sinus rhythm for a minimum of 30 days prior to the surgical intervention were eligible for inclusion.In the active tube clearance group (ATC), a 28F PleuraFlow device was positioned within the mediastinum. In the standard drainage group, a conventional chest tube (Teleflex Inc.) was used. Other chest tubes were left at the discretion of the operating surgeon.ResultsA total of 520 adult patients undergoing cardiac surgery were randomized to receive either ATC (n = 257) or standard drainage (n = 263). ATC was associated with a 72% reduction in re-exploration for bleeding (5.7% vs 1.6%, p = .01) and an 89% reduction in complete chest tube occlusion (2% vs 19%, p = .01). There was an 18% reduction in POAF between the ATC and control group that was not statistically significant (31% vs 38%, p = .08).Conclusions and relevanceIn this RCT, the implementation of active clearance of chest tubes reduced re-exploration and chest tube clogging in patients after cardiac surgery further supporting recommendations to consider this modality postoperatively.Trial registrationClinical Trials NCT02808897. Retrospectively registered 22 June 2016.

Pulmonary angiosarcoma presenting with diffuse alveolar hemorrhage: a case report

This study aimed to analyze the diagnosis and treatment of one case of pulmonary angiosarcoma (PPA) retrospectively. The main manifestation of this female patient was cough, hemoptysis and dyspnea. Computed tomography (CT) of the chest revealed multiple small nodules and ground-glass patches in both lungs suggesting of diffuse alveolar hemorrhage (DAH). Laboratory examination revealed decreased hemoglobin and platelet counting, normal coagulation function. Results of rheumatic markers testing including antinuclear antibody (ANA), anti-extractable nuclear antigen antibody (ENA), vasculitis marker, and antiphospholipid antibody were negative. Tumor markers were negative. Sputum smear, sputum culture, and alveolar lavage fluid culture showed negative results. The bone marrow smear was essentially normal. The patient received methylprednisolone pulse therapy (250 mg daily × 5 days) and immunoglobin (20 d daily × 7 days) treatment, but her hemoptysis persisted. Bilateral pleural effusion drainage found a large amount of bloody effusion, but cytology of the pleural fluid showed negative results. The clinical symptoms, laboratory results, imaging findings, and pathological features of the patient were summarized, and problems in diagnosis and treatment were discussed. A thoracoscopic lung biopsy was performed and the diagnosis of PPA was confirmed by pathology and immunohistochemistry (IHC) staining. This case suggested that the possibility of PPA should be considered in patients with DAH, but with negative findings in routine examinations, lung biopsy is usually required.

V. V. Tipyakov. A case of excrement in extrauterine pregnancy. (Medical Review. 1893, No. 3).

On February 24, 1893, a bourgeois woman, 27 years old, was admitted to the hospital, almost pulseless, at t 40 C., with complaints of dizziness, severe pain in the lower abdomen, bloody discharge from the genital parts during the last month, and so on. From the spread, it turned out that she gave birth once at the age of 20; after giving birth was sick 3 months. 21/2 months ago, the regulations stopped, pain in the lower abdomen appeared, and afterwards bloody effusion from the genitals joined; 2 days before admission to the hospital, bleeding appeared, the patient lost strength. Objectively: the abdomen is sore at the bottom, the left groin area is swollen; the uterus is enlarged, dense, sensitive, almost immobile; the length of the uterine cavity is 8 cm. The vaults are flattened. The left tube and ovary are palpated in the form of a solid tumor with an unclear fluctuation. On the right and behind the uterus, the tumor is dense, immobile, eat the head of the newborn. - Diagnosis: extrauterine pregnancy, rupture of the fetal baby.

A Review of Current Management of Knee Hemarthrosis in the Non-Hemophilic Population.

The knee joint is one of the most frequently injured joints in the body, and the resulting injury may often lead to the presence of a bloody effusion, or hemarthrosis. The acute management of this condition can have long-lasting implications, and may ultimately result in the early onset of osteoarthritis in this population. Heme, a breakdown product of erythrocytes, and associated pro-inflammatory mediators, are known to have deleterious interactions with cartilage and synovium. The presence of blood in a joint following injury can precipitate these effects and accelerate the degenerative changes in the joint. Currently, there is no consensus on the optimal management of a traumatic knee joint injury with a hemarthrosis. Nontraumatic hemarthosis, seen most commonly in hemophilia patients, has a set of established guidelines that does not routinely recommend drainage of the joint. This article presents a rationale for joint aspiration to minimize the harmful effects of blood following traumatic hemarthrosis.

Comparing complications of small-bore chest tubes to large-bore chest tubes in the setting of delayed hemothorax: a retrospective multicenter cohort study

BackgroundPrevious studies have provided initial data suggesting that small-bore (SB, ≤ 14Fr) chest tubes have the same efficacy as large-bore (LB, > 14 Fr) chest tubes for acute hemothorax (HTX), but data continue to be lacking in the setting of delayed HTX. This study compared complications of SB chest tubes to LB tubes in patients with delayed HTX.MethodsThis was a retrospective observational study across 7.5 yrs. at 6 Level 1 trauma centers. Patients were included if 1) diagnosed with a HTX or > 1 rib fracture with bloody effusion from chest tube; 2) initial chest tube placed ≥36 h of hospital admission. Patients were excluded for hemopneumothoraces. The primary endpoint was having at least one of the following chest tube complications: tube replacement, VATS, tube falling out, tube clogging, pneumonia, retained HTX, pleural empyema. Secondary outcomes included chest tube output volume and drainage rate. Dependent/independent and parametric/non-parametric analyses were used to assess primary and secondary outcomes.ResultsThere were 160 SB patients (191 tubes) and 60 LB patients (72 tubes). Both comparison groups were similar in multiple demographic, injury, clinical features. The median (IQR) tube size for each group was as follows: SB [12 Fr (12–14)] and LB [32 Fr (28–32)]. The risk of having at least one chest tube complication was similar for LB and SB chest tubes (14% vs. 18%, p = 0.42). LB tubes had significantly larger risk of VATS, while SB tubes had significantly higher risk of pneumonia. SB tubes had significantly slower least squares (LS) mean initial output drainage rate compared to LB tubes (52.2 vs. 213.4 mL/hour, p < 0.001), but a non-parametric analysis suggested no significant difference in median drainage rates between groups 39.7 [23.5–242.0] mL/hr. vs. 38.6 [27.5–53.8], p = 0.81. LB and SB groups had similar initial output volume (738.0 mL vs. 810.9, p = 0.59).ConclusionsThere was no clearly superior chest tube diameter size; both chest tube sizes demonstrated risks and benefits. Clinicians must be aware of these potential tradeoffs when deciding on the diameter of chest tube for the treatment of delayed HTXs.

Complex chest wall injury and repair complicated by empyema

A 24-year-old man presented to the emergency department after blunt thoracic trauma. As a vested rider, he was competing in a rodeo bull riding competition when he was thrown and...

HIV AS A RED HERRING IN SANGUINOUS PLEURAL EFFUSION SECONDARY TO THORACIC ENDOMETRIOSIS

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Hemothorax is most commonly due to trauma and iatrogenic causes. However, spontaneous hemothorax and bloody effusions occurring independent of trauma may be secondary to malignancy, infection, rheumatologic, or vascular diseases. We present the case of a young woman with a complex bloody effusion and a medical history that lends itself to a particularly wide differential. CASE PRESENTATION: A 30 year old HIV positive woman from Ghana disclosed two weeks of cough and dyspnea during outpatient follow up with infectious disease. She denied fever, chills, sick contacts and hemoptysis, but endorsed intermittent right flank and shoulder pain. CXR showed complete whiteout of the right lung field and she was sent to the ED. On evaluation she was neither hypoxic, tachycardic, nor tachypneic. She was afebrile and without leukocytosis, though a microcytic anemia was noted. CT-TAP showed a large right pleural effusion, collapse of the right lung, leftward mediastinal shift, as well as intraperitoneal fluid and uterine fibroids. A chest tube was placed and drained 1500ml of sanguinous fluid. Fluid studies indicated an exudative effusion with pleural/serum hematocrit of 5/26.6%, failing to meet criteria for a true hemothorax . Bacterial and mycobacterial cultures were sterile, and cytology showed only hemosiderin laden macrophages. At time of discharge the etiology of the effusion was as of yet undetermined. Outpatient OBGYN evaluation included TVUS confirming fibroids and pelvic ascites and the patient endorsed dysmenorrhea and 5 years of failed attempts to conceive, collectively highly suggestive of endometriosis. At follow up with interventional pulmonology the patient’s pleural effusion had reaccumulated and thoracentesis yielded 1600ml. Cytology and immunohistochemistry were performed and PAX8, ER, and CD10 immunostains returned positive, suggesting presence of endometrial cells in the pleural space, consistent with thoracic endometriosis. DISCUSSION: In our HIV positive patient from a TB endemic region, malignant and infectious etiologies were of particular concern. Conversely, endometriosis has a prevalence of approximately 10%, the prevalence of thoracic endometriosis syndrome (TES) is uncertain but exceedingly rare, and only 14% of TES cases involve hemothorax or sanguinous effusion independent of pneumothorax. Additionally, the typical presenting symptoms of TES, cough, dyspnea, and chest pain are nonspecific. However, right sided laterality of effusion and concomitant pelvic pathology is where TES begins to stand out amongst the differentials. As with all manifestations of TES, hemothorax or bloody effusion has a predilection for right sided laterality greater than 80% of the time, and virtually all cases have concomitant pelvic involvement. CONCLUSIONS: In women of childbearing age with spontaneous hemothorax or bloody effusion, TES is a rare albeit important differential for consideration. Reference #1: Patrini D, Panagiotopoulos N, Pararajasingham J, Gvinidanidze L, Iqbal Y, Lawrence DR. Etiology and management of spontaneous haemothorax. Journal of Thoracic Disease. 2015;7(3):520-6. Reference #2: Martinez FJ, Villanueva AG, Pickering R, Becker FS, Smith DR. Spontaneous hemothorax. Report of 6 cases and review of the literature. Medicine. 1992;71(6):354-68. Reference #3: Joseph J, Sahn S. Thoracic endometriosis syndrome: New observations from an analysis of 110 cases. The American Journal of Medicine. 1996;100(2):164-70. DISCLOSURES: No relevant relationships by Jared Mickelson, source=Web Response No relevant relationships by Randal Rovinski, source=Web Response

Reoperation for postoperative bleeding following pulmonary resection: a report of a single-center experience.

The variety and incidence of postoperative complications seem to have changed with recent progress in thoracic surgery. This study attempted to improve our recognition of postoperative bleeding. Among 1143 patients undergoing pulmonary resection for pulmonary nodules, ten underwent surgical treatment for postoperative bleeding. Clinical and pathologic data were analyzed. Additionally, the relationship between the bleeding point and an increased amount of drained bloody effusion before the second operation was analyzed. The bleeding point was recognized in eight cases: the intercostal artery (n = 4), the lung (n = 2), aberrant vessel of the apex of the lung (n = 1) and the bronchial artery (n = 1). The bleeding points were unknown in two cases in whom the decision to perform a second operation was delayed. Potential reasons or influential factors for bleeding were stapling complications (n = 4), low coagulation ability (n = 2) and intraoperative injury (n = 1). We experienced two cases in which intercostal arterial bleeding was induced by scratching the thoracic wall or the vertebra with the edge of the reinforced stapling line or the sharp edge of a broken staple at the first operation. We divided patients into three groups based on the interval between operations. Bleeding from the arteries seemed to show a higher rate of bleeding per hour than that from the lung parenchyma. The bleeding points and speculated reasons for bleeding varied among patients. We were able to cure all ten cases. It might be dependent on the rapid decision of reoperation in cases with arterial bleeding was suspected.

Acquired hemophilia A presenting as progressive intra-abdominal hemorrhage, muscle hemorrhage and hemothorax postpartum: A case report and literature review.

Acquired hemophilia A (AHA) is a rare antibody-mediated condition in which autoantibodies form against a coagulation factor, most commonly factor VIII (FVIII), causing severe coagulopathy. Here the present report presents a case of AHA in a 35-year-old postpartum woman with continuous polyserous bloody effusions who was admitted to the First Affiliated Hospital of Zhejiang Chinese Medical University (Hangzhou, China) in October 2017 without a history of trauma, anticoagulation treatment or coagulopathy. At presentation, the patient's hemoglobin level was low (70 g/l; normal range: 115–150 g/l) g/l, blood pressure was 89/58 mmHg (normal range, 90–140/60–90 mmHg), and activated partial thromboplastin time was 68.4 sec (normal range: 25.0–36.0 sec), with a normal international normalized ratio (0.94; normal range, 0.8–1.2). The reaction time in thrombography was prolonged (35.8 min; normal range: 5–10 min), coagulation FVIII had markedly decreased activity (12.6%; normal range, 60–150%), and FVIII inhibitor had a high titer [7.4 Bethesda units (BU)/ml; normal range, 0–0.6 BU/ml]. Notably, the patient's autoantibody level was markedly higher than normal (1:320; normal range: <1:100). The patient was successfully treated with bleeding control, eradication of FVIII inhibitor, and treatment of the underlying disease. To the best of our knowledge, this is the first case of AHA with polyserous bloody effusions in a patient with an autoimmune disorder during the postpartum period. Reports of such rare cases will aid the characterization of disease pathogenesis, which may in turn lead to the recognition and timely treatment of this rare disorder.

Clinical characteristics and prognosis of serous body cavity effusions in patients with sepsis: a retrospective observational study

BackgroundCavity effusion is common in patients with infectious diseases. However, the incidence rate and characteristics of serous cavity effusions (SCE) in septic patients are not clear to date. The objective of this study was to investigate the incidence and characteristics of SCE in septic patients and to explore the correlations between the bloody effusions and the illness severity/prognosis in septic patients.MethodsFrom January 2010 to January 2015, a total of 214 patients with severe sepsis and septic shock were enrolled in this retrospective observational study. Thoracentesis or abdominal paracentesis was performed in 45 septic patients because of massive pleural effusions or ascites. The serum concentrations of VEGF, VEGFR, Ang, sICAM-1, sVCAM-1, E-selectin, Serpine1 and VE-cadherin in 45 septic patients underwent paracentesis were measured by enzyme-linked immunosorbent assay (ELISA).ResultsOf the 214 septic patients, 155 (72.4%) had SCE according to imaging or ultrasound manifestations. 45 subjects with SCE underwent therapeutic thoracentesis or abdominal paracentesis. Effusion laboratory analysis showed that exudates were predominant when compared with transudates (95.6% vs. 4.4%), and 16 (35.6%) patients suffered bloody effusions. Compared with patients with non-bloody effusions, those with bloody effusions showed higher critical illness scores (13 vs. 17 for APACHE II; 7 vs. 9 for SOFA), and higher mortality (6.9% vs. 62.5%). Moreover, patients with bloody effusions had delayed TT and APTT, increased D-dimer concentration, and higher serum levels of CRP and PCT (P < 0.05). In addition, the serum levels of Ang2, sVCAM-1 and E-selectin were significantly higher in patients with bloody effusions than in those with non-bloody effusions (P < 0.05). However, the serum level of VEGFR2 was lower in patients with bloody fluids (P = 0.025).ConclusionsThe incidence of serous cavity effusion is high in patients with sepsis. The septic patients with bloody effusions suffer a more inflammatory burden and a worse prognosis compared to septic patients with non-bloody effusions.

Pericardial injury from chest compression: a case report of incidental release of cardiac tamponade

BackgroundAlthough chest compression is a standard technique in cardiopulmonary resuscitation, it is well recognized that manual chest compression causes various internal injuries, of which major injuries are often fatal. Similarly, when cardiac tamponade occurs in patients with type A acute aortic dissection, many patients die before reaching the hospital. We report a rare case in which chest compressions caused pericardial laceration that may have inadvertently played a life-saving role in releasing cardiac tamponade induced by acute aortic dissection.Case presentationA 67-year-old woman developed cardiac arrest soon after complaining of epigastric pain, and after successful resuscitation by manual chest compression, she was transferred to our hospital. On arrival, the patient was 14 on the Glasgow Coma Scale. An ECG showed a normal sinus rhythm, and no arrhythmias or signs of myocardial ischemia were observed. A chest X-ray revealed left pleural effusion, while cardiomegaly and pneumothorax were not identified. Computed tomography revealed type A aortic dissection, mild pericardial effusion, and massive left pleural effusion. No pulmonary embolus was found on the CT. After drainage of bloody effusion from the left pleural space, an emergency operation was begun. During surgery, a pericardial laceration with communication to the left pleural space and a hemothorax were found; however, no cardiac injury was identified. No other intra-thoracic injuries or rupture of the aortic dissection causing the hemothorax were detected. Hemiarch replacement was performed without difficulty, but the patient died of multi-organ failure 30 days after surgery.ConclusionsWe report a case of pericardial injury without skeletal fracture caused by chest compression. The pericardial laceration may have inadvertently served to release the cardiac tamponade induced by the acute aortic dissection, resulting in the hemothorax, and provided time to receive surgery.

Vascular Permeability and Remodelling Coincide with Inflammatory and Reparative Processes after Joint Bleeding in Factor VIII-Deficient Mice.

Vascular remodelling is a prominent feature of haemophilic arthropathy (HA) that may underlie re-bleeding, yet the nature of vascular changes and underlying mechanisms remain largely unknown. Here, we aimed to characterize synovial vascular remodelling and vessel integrity after haemarthrosis, as well as temporal changes in inflammatory and tissue-reparative pathways. Thirty acutely painful joints in patients with haemophilia (PWH) were imaged by musculoskeletal ultrasound with Power Doppler (MSKUS/PD) to detect vascular abnormalities and bloody effusions. Nineteen out of 30 painful joint episodes in PWH were associated with haemarthrosis, and abnormal vascular perfusion was unique to bleeding joints. A model of induced haemarthrosis in factor VIII (FVIII)-deficient mice was used for histological assessment of vascular remodelling (α-smooth muscle actin [αSMA] expression), and monitoring of in vivo vascular perfusion and permeability by MSKUS/PD and albumin extravasation, respectively. Inflammatory (M1) and reparative (M2) macrophage markers were quantified in murine synovium over a 10-week time course by real-time polymerase chain reaction. The abnormal vascular perfusion observed in PWH was recapitulated in FVIII-deficient mice after induced haemarthrosis. Neovascularization and increased vessel permeability were apparent 2 weeks post-bleed in FVIII-deficient mice, after a transient elevation of inflammatory macrophage M1 markers. These vascular changes subsided by week 4, while vascular remodelling, evidenced by architectural changes and pronounced αSMA expression, persisted alongside a reparative macrophage M2 response. In conclusion, haemarthrosis leads to transient inflammation coupled with neovascularization and associated vascular permeability, while subsequent tissue repair mechanisms coincide with vascular remodelling. Together, these vascular changes may promote re-bleeding and HA progression.

Determinants of Survival After Emergency Intrapericardial Cisplatin Treatment in Cancer Patients with Recurrent Hemodynamic Instability After Pericardiocentesis

Pericardial effusion is associated with high mortality in oncology. The etiology of infectious pericarditis and iatrogenic effects of previous radio-/chemotherapy may be always suspected, especially when a subsequent episode is observed. The study included 17 hemodynamically-unstable patients with cancer due to recurrent pericardial bloody effusion after previous pericardiocentesis and analyzed survival determinants after intrapericardial chemotherapy with cisplatin. The mortality rate was not significantly associated with the level of N-terminal pro-B type natriuretic peptide, low hemoglobin (<12 g/dl), elevated white blood cell account (>104/μl), large volume (>1500 ml) and long duration (>8 days) of pericardial drainage, cardiac arrhythmias, positive culture test results nor fever occurring during cisplatin administration. Subsequent systemic anticancer therapy was the strongest factor determining a longer survival (hazard ratio(HR)=0.31, 95% confidence interval(CI)=0.11-0.9; p=0.03). Efficacy of rescue intrapericardial chemotherapy with cisplatin is independent of parameters of hemodynamic instability and levels of inflammatory markers in recurrent pericardial effusion.

Hemorrhagic pleural effusion related to acquired coagulation factor VIII deficiency: A case report.

A patient with acquired hemophilia A (AHA) with hemorrhagic pericardial effusions was admitted to Xiamen Chang Gung Hospital (Xiamen, China) in August 2015. The patient had been experiencing progressive dyspnea for 1 week. Bloody effusion (~6.3 l) was drained from the membrane surrounding the heart over a period of 20 days. Biochemical, cytological and radiological examinations were unable to elucidate the reason for the effusion. Coincidentally, it was discovered that activated partial thromboplastin time prolongation could not be corrected by plasma mixing. Furthermore, immunologic and functional assays identified that the patient had factor VIII-deficient plasma. Finally, the coagulopathy was treated by infusion of cryoagglutinin and steroids to eradicate the coagulation inhibitor. The production of cardiac bloody effusions did not recur. Notably, the patient was diagnosed with AHA accompanied by the rare complication of pericardial effusions. The present case was the first to report AHA with the complication of pericardial effusions.

Diagnostic Values of sVEGFR-1 and Endostatin in Malignant Pleural Effusions in Patients with Lung Cancer.

The diagnosis of malignant pleural effusion (MPE) remains a common clinical challenge because of the sensitivity of conventional cytology for the detection is insufficient. Thus, a sensitive clinical marker for diagnosis is required. The aim of this study was to assess the role of two anti-angiogenic cytokines, soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and endostatin, in diagnosing MPE. Effusion samples from 44 patients with MPE caused by lung cancer and from 36 patients with benign pleural effusion (BPE) were collected. The concentrations of sVEGFR-1 and endostatin in pleural fluid were determined by an enzyme-linked immunosorbent assay (ELISA). The diagnostic performance was measured by receiver operating characteristic curves (ROCs). The levels of sVEGFR-1 and endostatin in MPE due to lung cancer were significantly higher than those in BPE (p < 0.05). The sensitivity and specificity of endostatin were 52.27% and 86.11%, respectively, while for sVEGFR-1, the sensitivity was 88.64% and the specificity was 58.33%. Interestingly, the combination of sVEGFR1 and endostatin produced better sensitivity and specificity of 72.73% and 83.33%, respectively. In addition, the levels of sVEGFR-1 and endostatin were significantly related to each other (p < 0.05), and the levels of endostatin in bloody effusions were significantly higher than those in non-bloody effusions (p < 0.05). Our study indicated that the levels of sVEGFR-1 and endostatin were significantly elevated in MPE. The combined detection of sVEGFR-1 and endostatin may be useful in the diagnosis of MPE.