Cause Of Pleural Effusion Research Articles

Bilothorax as an endoscopic retrograde cholangiopancreatography complication and a review of the literature.

Bilothorax, the accumulation of bile in the pleural space, is an uncommon but serious condition often linked to biliary tract or diaphragmatic injury. This case report describes a 70-year-old female with decompensated liver cirrhosis due to primary sclerosing cholangitis, who developed a moderate sized pleural effusion following ERCP and biliary stenting. The patient's pleural effusion persisted for 2 months without respiratory symptoms, indicating a self-limited low-volume leak. She eventually underwent thoracentesis for a non-resolving unilateral effusion, which drained 435 mL of bilious fluid with an elevated pleural fluid bilirubin level, confirming the diagnosis of bilothorax. This case highlights the importance of considering bilothorax as a cause of pleural effusion in patients with biliary tract disease and who undergo high risk procedures including ERCP.

Tuberculosis: Is it the main cause of pleural effusion in patients of Kabul city, Afghanistan?

Background: Pleural effusion is one of the most common pleural diseases, and its causes are various cardiovascular, lung, kidney, cancer, and infectious diseases. Methods: The present study was carried out in the year 2018 at Sadri Ibn Sina Hospital, involving a total of 4564 patients. Out of these, a specific focus was given to 100 patients diagnosed with pleural effusion. Demographic details, such as age, gender, marital status, causes of effusion, occupation, place of residence, effusion location, type of fluid, and any existing comorbidities, were gathered and analyzed using the SPSS software. Results: Based on the findings of this study, tuberculosis accounts for 49% of the cases, pneumonia for 13%, congestive heart failure for 12%, corpulmonary disease for 11%, cancer for 10%, and chronic kidney failure for 4%. Additionally, 1% of the cases experienced pleural embolism as a result of pulmonary embolism. In regards to the liquid type, 77% of it was transudative, while 23% was exudative. Conclusion: Pleural effusion refers to the abnormal buildup of fluid in the pleural cavity, typically caused by either an overproduction of fluid or a compromised lymphatic system's ability to absorb it. This research has firmly established infection, with tuberculosis being the most significant factor, as the leading cause of this condition.

ABORD ANTEROLATERAL DE LA CHARNIERE THORACO-LOMBAIRE : EXPERIENCE D’UN CAS AVEC CHYLOTHORAX PAR PLAIE IATROGENE DU CANAL THORACIQUE.

Despite its advantages, the anterolateral approach to the thoracolumbar spine can present several complications including chylothorax. We present a rare case of thoracic duct injury secondary to an anterolateral surgical approach to the thoracolumbar spine post-vertebromedullary trauma which was successfully treated non-surgically. Observation: This is a 35-year-old patient, hospitalized for the treatment of a spinal trauma whose radiological assessment revealed a type A3 fracture of the 12th thoracic vertebra according to the Ao-spine classification. He had benefited from a corpectomy of the same vertebra followed by the placement of an interbody implant via an anterolateral approach with thoraco-phrenotomy. The immediate aftermath of the operation was marked by the presence in the chest drain of a white lactescent liquid, the chemical study of which revealed the presence of chylomicrons by electrophoresis, lipoproteins and a triglyceride level of 80 g/l, confirming the diagnosis of chylothorax. Conservative medical treatment was instituted consisting of chest drainage for 3 weeks and parenteral nutrition which allowed complete recovery. Conclusion: Iatrogenic chylothorax represents a rare cause of pleural effusion. This case reflects a successful approach to the management of post-dorsal spine surgery lymph leak via anterolateral approach, using drainage and strict dietary changes, which precluded the need for thoracic duct repair surgery. Keywords: Anterolateral approach, Chylothorax, Conservative treatment,

Clinical significance of pleural fluid lactate dehydrogenase/adenosine deaminase ratio in the diagnosis of tuberculous pleural effusion

BackgroundPleural fluid is one of the common complications of thoracic diseases, and tuberculous pleural effusion (TPE) is the most common cause of pleural effusion in TB-endemic areas and the most common type of exudative pleural effusion in China. In clinical practice, distinguishing TPE from pleural effusion caused by other reasons remains a relatively challenging issue. The objective of present study was to explore the clinical significance of the pleural fluid lactate dehydrogenase/adenosine deaminase ratio (pfLDH/pfADA) in the diagnosis of TPE.MethodsThe clinical data of 618 patients with pleural effusion were retrospectively collected, and the patients were divided into 3 groups: the TPE group (412 patients), the parapneumonic pleural effusion (PPE) group (106 patients), and the malignant pleural effusion (MPE) group (100 patients). The differences in the ratios of pleural effusion-related and serology-related indicators were compared among the three groups, and receiver operating characteristic curves were drawn to analyze the sensitivity and specificity of the parameter ratios of different indicators for the diagnosis of TPE.ResultsThe median serum ADA level was higher in the TPE group (13 U/L) than in the PPE group (10 U/L, P < 0.01) and MPE group (10 U/L, P < 0.001). The median pfADA level in the TPE group was 41 (32, 52) U/L; it was lowest in the MPE group at 9 (7, 12) U/L and highest in the PPE group at 43 (23, 145) U/L. The pfLDH level in the PPE group was 2542 (1109, 6219) U/L, which was significantly higher than that in the TPE group 449 (293, 664) U/L. In the differential diagnosis between TPE and non-TPE, the AUC of pfLDH/pfADA for diagnosing TPE was the highest at 0.946 (0.925, 0.966), with an optimal cutoff value of 23.20, sensitivity of 93.9%, specificity of 87.0%, and Youden index of 0.809. In the differential diagnosis of TPE and PPE, the AUC of pfLDH/pfADA was the highest at 0.964 (0.939, 0.989), with an optimal cutoff value of 24.32, sensitivity of 94.6%, and specificity of 94.4%; this indicated significantly better diagnostic efficacy than that of the single index of pfLDH. In the differential diagnosis between TPE and MPE, the AUC of pfLDH/pfADA was 0.926 (0.896, 0.956), with a sensitivity of 93.4% and specificity of 80.0%; this was not significantly different from the diagnostic efficacy of pfADA.ConclusionsCompared with single biomarkers, pfLDH/pfADA has higher diagnostic value for TPE and can identify patients with TPE early, easily, and economically.

Diagnostic yields and safety of thoracoscopic cryobiopsies in Japan: A single-center retrospective observational study

BackgroundThoracoscopy is useful for diagnosing unexplained pleural effusions. A sufficient specimen volume is often difficult to obtain using forceps biopsies (FBs) but can be obtained with pleural cryobiopsies (CBs). This study aimed to assess the utility and safety of CB during thoracoscopy in the Japanese population. MethodsPatients who underwent thoracoscopic CBs at the Japanese Red Cross Medical Center between January 2017 and August 2023 were included in the study. Data were retrospectively analyzed, including clinical data, thoracoscopic findings, specimen size, diagnostic yield, and complications. The number of collected specimens and the freezing time were left to the discretion of the attending physician. ResultsTwenty-six patients underwent thoracoscopic CB. Specimens obtained by CB were larger than those obtained by FB. Primary lung cancer was the most common cause of pleural effusion, followed by malignant pleural mesothelioma. CB contributed to the diagnosis in 24 of 26 cases (92.3%) and FB contributed to the diagnosis in 11 of 18 cases (61.1%). Severe fibrosis could be diagnosed in all 3 cases by CB, but not by FB. The common complications of CB included bleeding at the biopsy site and atelectasis, but no severe complications occurred. ConclusionsThe utility and safety of thoracoscopic CB for diagnosing pleural effusions in Japan were verified. The diagnostic yield, specimen size, and safety profile of CB support the diagnostic utility of this method.

An Uncommon Cause of Pleural Effusion – Part 2

Abstract An uncommon cause of pleural effusion is discussed for the benefit of postgraduate students.

Myeloid-derived suppressor cells in pleural effusion as a diagnostic marker for early discrimination of pulmonary tuberculosis from pneumonia.

Tuberculous pleural effusion (TPE) stands as one of the primary forms of extrapulmonary tuberculosis (TB) and frequently manifests in regions with a high prevalence of TB, consequently being a notable cause of pleural effusion in such areas. However, the differentiation between TPE and parapneumonic pleural effusion (PPE) presents diagnostic complexities. This study aimed to evaluate the potential of myeloid-derived suppressor cells (MDSCs) in the pleural fluid as a potential diagnostic marker for distinguishing between TPE and PPE. Adult patients, aged 18 years or older, who presented to the emergency room of a tertiary referral hospital and received a first-time diagnosis of pleural effusion, were prospectively enrolled in the study. Various immune cell populations, including T cells, B cells, natural killer (NK) cells, and MDSCs, were analyzed in both pleural fluid and peripheral blood samples. In pleural fluid, the frequency of lymphocytes, including T, B, and NK cells, was notably higher in TPE compared to PPE. Conversely, the frequency of polymorphonuclear (PMN)-MDSCs was significantly higher in PPE. Notably, compared to traditional markers such as the neutrophil-to-lymphocyte ratio and adenosine deaminase level, the frequency of PMN-MDSCs emerged as a more effective discriminator between PPE and TPE. PMN-MDSCs demonstrated superior positive and negative predictive values and exhibited a higher area under the curve in the receiver operating characteristic curve analysis. PMN-MDSCs in pleural effusion increased the levels of reactive oxygen species and suppressed the production of interferon-gamma from T cells following nonspecific stimulation. These findings suggest that MDSC-mediated immune suppression may contribute to the pathology of both TPE and PPE. The frequency of PMN-MDSCs in pleural fluid is a clinically useful indicator for distinguishing between TPE and PPE.

Validity of Pleuroscopy in Evaluating Pleural Effusions of Uncertain Etiology at the Cardiothoracic Unit of Minia University Hospital, Egypt.

Pleural effusion is a medical condition where an excessive amount of fluid accumulates in the pleural space. This can be caused by inflammation or malignant growth in the body. Doctors use medical thoracoscopy for both diagnostic and therapeutic purposes. This technique allows them to view the internal pleural surfaces and take biopsies of any abnormal lesions within the pleural cavity. This work aimed to evaluate the diagnostic value of pleuroscopy in patients with undiagnosed exudative pleural effusion. A study was conducted on 61 patients who had undiagnosed exudative pleural effusion and were admitted to the chest department at the cardiothoracic unit of the Minia University Hospital. All patients provided written consent and underwent a complete history and clinical examination. Standard laboratory tests, including routine liver and kidney function tests, a complete blood count, and a coagulation profile, were conducted on all patients, along with chest X-rays. If necessary, a chest CT scan was also performed. Diagnostic thoracentesis was done, and the pleural fluid was analyzed for sugar, protein, and lactate dehydrogenase and sent for bacteriological analysis (Gram stain, culture, and acid-fast bacilli smear) and cytopathological examination. Medical thoracoscopy was performed in cases where an etiological diagnosis was not established. A total of 61 patients with undiagnosed exudative pleural effusions were included. A definitive etiological diagnosis was reached in 58 (95%) patients. In 47 (77%) of the studied group, malignant etiology was confirmed; nine (14.8%) had tuberculous pleurisy, one (1.6%) had empyema, and one (1.6%) had inflammatory/autoimmune pleurisy. A definite diagnosis was not reached in three (5%) patients. The malignant pathology was caused by bronchogenic carcinoma in 20 (42.5%) cases, malignant mesothelioma in 10 (21.3%) cases, metastatic malignant deposits from other organs in six (12.7%) cases, and lymphoma in three (6.5%) cases. No serious adverse events related to the procedure were recorded. The most common minor complications were transient chest pain in 34 (55.7%) patients, followed by surgical emphysema in 10 (16.4%) patients. Pleuroscopy is an effective diagnostic tool for identifying the cause of pleural effusion when it is unclear. It is a minimally invasive and straightforward procedure associated with high diagnostic accuracy and low complication rates.

Concordance between conventional cytology and cell block of suspected malignant pleural effusion: A record-based study in a tertiary care center of eastern India

Background: Cytological study of pleural fluid helps establishing the underlying cause of pleural effusion. It is considered the most important tool in diagnosing malignancy in effusions. However, accurate identification of cellular morphology can be a problem in conventional cytology. Cell block preparation from pleural effusion aids in this diagnosis due to the preservation of tissue architecture, and multiple sections can be obtained for further studies. Aims and Objectives: The objectives of this study were to compare the diagnostic results of conventional cytology and cell block studies of suspected malignant pleural effusions and find out the diagnostic agreement or concordance between the two methods. Materials and Methods: A record-based study was conducted at the Department of Pathology on conventional cytology and cell block study reports of 150 suspected malignant pleural effusion cases over 35 months. The diagnoses were expressed in five categories – non-diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, and malignant. χ2 test was used to identify the percentage of malignancy reported. Agreement of both methods was assessed through Kappa statistics. Results: About 4.67% of cases were reported as malignant by conventional cytology, whereas cell block study diagnosed malignancy in 19.33% of cases. Relative diagnostic agreement between the two methods was 0.73 and concordance by Cohen’s Kappa was 0.34, which signifies fair concordance. Conclusion: Cell block study, though having a fair concordance, is much superior to conventional cytology smears in detecting malignant cells and diagnosing a pleural effusion as malignant.

Pleural effusion in a pediatric ward: clinical feature, etiology and outcome

Background: Pleural effusion is a common respiratory complication in children. We aimed to document clinical feature, etiology, biochemical parameters and outcome of the admitted children with pleural effusion. Methods: This cross-sectional study was conducted from January 2022 to June 2023 at pediatric ward of ICMH. All children from 6 months to 14 years presented with clinical features suggestive of pleural effusion and later supported by radiology and ultrasonography of chest either at presentation or owing to other systemic illness were enrolled. Children aged below 6 months, associated chronic illness and parental denial of giving consent were excluded. In indicated cases pleural fluid was tapped and sent to laboratory for physical, biochemical examination, staining, culture, GeneXpert, LDH and ADA assay. Results: Out of 43 children, 19 underwent pleural tap and rest were managed conservatively. Most of the children were in between 2 to 6 years. There were 22 male and 21 female. Unilateral effusion was found in 25 children and 18 children developed bilateral effusion. All the children had documented fever. Other symptoms were cough, respiratory distress, chest pain, weight loss, abdominal pain, jaundice and blood mixed sputum. Physical signs correlated classical effusion features. The etiologies included DF, TB, para-pneumonic effusion, empyema, nephrotic syndrome, malignancy, acute viral hepatitis, heart failure and acute pancreatitis. There was no mortality and long-term complication in non-malignant cases. Conclusions: DF outnumbered other causes of pleural effusion in recent times owing to recent Dengue outbreak. Tubercular effusion was leading cause among cases undergoing pleural tap.

Features which discriminate between tuberculosis and haematologic malignancy as the cause of pleural effusions with high adenosine deaminase

BackgroundAdenosine deaminase (ADA) is a useful biomarker for the diagnosis of tuberculous pleurisy (TBP). However, pleural effusions with high ADA can also be caused by other diseases, particularly hematologic malignant pleural effusion (hMPE). This study aimed to investigate the features that could differentiate TBP and hMPE in patients with pleural effusion ADA ≥ 40 IU/L.MethodsThis was a retrospective observational study of patients with pleural effusion ADA ≥ 40 IU/L, conducted at a Korean tertiary referral hospital with an intermediate tuberculosis burden between January 2010 and December 2017. Multivariable logistic regression analyses were performed to investigate the features associated with TBP and hMPE, respectively.ResultsAmong 1134 patients with ADA ≥ 40 IU/L, 375 (33.1%) and 85 (7.5%) were diagnosed with TBP and hMPE, respectively. TBP and hMPE accounted for 59% (257/433) and 6% (27/433) in patients with ADA between 70 and 150 IU/L, respectively. However, in patients with ADA ≥ 150 IU/L, they accounted for 7% (9/123) and 19% (23/123), respectively. When ADA between 40 and 70 IU/L was the reference category, ADA between 70 and 150 IU/L was independently associated with TBP (adjusted odds ratio [aOR], 3.11; 95% confidence interval [CI], 1.95–4.95; P < 0.001). ADA ≥ 150 IU/L was negatively associated with TBP (aOR, 0.35; 95% CI, 0.14–0.90; P = 0.029) and positively associated with hMPE (aOR, 13.21; 95% CI, 5.67–30.79; P < 0.001). In addition, TBP was independently associated with lymphocytes ≥ 35% and a lactate dehydrogenase (LD)/ADA ratio < 18 in pleural effusion. hMPE was independently associated with pleural polymorphonuclear neutrophils < 50%, thrombocytopenia, and higher serum LD. A combination of lymphocytes ≥ 35%, LD/ADA < 18, and ADA < 150 IU/L demonstrated a sensitivity of 0.824 and specificity of 0.937 for predicting TBP.ConclusionIn patients with very high levels of pleural effusion ADA, hMPE should be considered. Several features in pleural effusion and serum may help to more effectively differentiate TBP from hMPE.

Pattern and outcome of paediatric pleural effusion seen at Usmanu Dafodiyo University Teaching Hospital, Sokoto: A 5-year retrospective study

Background: Pleural effusion is an abnormal accumulation of fluid in the pleural cavity which present with spectrum of clinico-aetiological manifestations often requiring multidisciplinary approach.&#x0D; Objectives: This study set out to determine the prevalence, aetiology, clinical presentation, treatment modalities and outcome of pleural effusion in children.&#x0D; Materials and Methods: This was a retrospective study where records of children with diagnosis of pleural effusion admitted at UDUTH, Sokoto were obtained between January 2017 and December 2022 and reviewed. Diagnosis was based on clinical presentation and radiological confirmation of pleural effusion. Data was analyzed with SPSS version 20.0.&#x0D; Results: A total of 49 cases were retrieved. The prevalence of pleural effusion was 0.54% (9,056). It was more prevalent in males with ratio of 2.5:1 (χ² = 9.833, P = 0.007). The median age was 9 years (IQR 7). The most common cause of pleural effusion was pneumonia 26 (53.1%) followed by tuberculosis 16 (32.6%), malignancy 3 (6.1%), cardiac and renal causes accounted for 2 (4.1%) each. Cough (100.0%), difficulty in breathing (100.0%), tachypnea (100.0%), respiratory distress (100.0%), and desaturation (98.0%) were the common presentations. Most (77.5%) of them presented with right sided pleural effusion. The majority (93.9%) had closed thoracostomy tube drainage. The outcome showed majority (83.7%) of the cases been discharged, with a median duration of hospital stay of 22days (IQR 17). However, mortality rate for the malignant causes was 100.0%.&#x0D; Conclusion: Infections were the major cause of paediatric pleural effusion with relatively good outcome. Surgical intervention and multidisciplinary team approach are needed to reduce the morbidity and mortality in patients with pleural effusion especially for the malignant causes.

A Study of Tuberculous Pleural Effusion in Province 2, Southern Nepal

Introduction: Tuberculosis (TB) is a major public health problem in developing countries. Tuberculous pleural effusion is the second most common form of extrapulmonary tuberculosis (TB) (after lymphatic involvement) and is the most common cause of pleural effusion in areas where TB is endemic. The aim of this study is to depict the pattern of the Tuberculous Pleural Effusion (TPE) with its clinical presentation and diagnosis along with the different laboratory parameters of the TB patients at a tertiary care center of the Southern Nepal. Materials and Methods: A prospective hospital based cross-sectional study enrolling 107 subjects diagnosed as TBPE presenting to the Department of Internal Medicine, National Medical College was carried out from 15th March, 2023 to 14th October, 2023 (7 months). The different data collected were put in Excel Sheet and analyzed using SPSS version 26. The formal written and verbal consent was taken from the participants and ethical clearance was taken from Institutional Review Committee (IRC), National Medical College, Birgunj (Ref. F-NMC/633/079-080).Results: A total of 107 subjects diagnosed with TBPE showed 67.3 % (n=72) male and 32.7% (n=35) female participants. Majority of the participants (88.8%) presented with fever, and approximately 59% of the participants had chest pain. Almost 65% of them had dyspnea and 77% presented with frank cough. Majority of the participants had right sided effusion. Pleural ,fluid examination showed increased total leukocyte count (mean 3191 cells/cu mm) and with lymphocytic predominance and increased protein content (5.07±0.91 g/dL). Pleural fluid Adenosine Deaminase (ADA)was found to be elevated (86.5±26.4 U/L).Conclusion: The common presentation of the Tuberculous pleural effusion is deranged laboratory parameters of pleural fluid with increased fluid total leukocyte count having lymphocytic predominance and increased protein content along with high ADA levels.

Clinical Profile of Patients with Pleural Effusion Admitted to Bharatpur Hospital

ABSTRACT&#x0D; Background: Pleural effusion occurs when there is disequilibrium between the quantity of fluid entering and leaving the pleural space. The objective of the study was to investigate the association between pleural effusion and underlying medical conditions as heart failure, pneumonia, malignancies of clinical presentations and laboratory findings of all those patients admitted to Bharatpur Hospital during the period of last 1year.&#x0D; Methods: Retrospective data from September 2022 to September 2023 from all the cases diagnosed with pleural effusion will be taken. Altogether 120 cases diagnosed with pleural effusion studied. The collected data was re-checked, reviewed, organized, entered and analyzed in statistical package for social sciences (SPSS) version 20.0.&#x0D; Results: From the findings of the study, 56.7% were male and 60.0% were from outside Chitwan District. Among the various causes of pleural effusion the most common cause was tubercular effusion (30.8%) followed by para-pneumonic effusion (19.2%). Tubercular effusion is Shortness of breath was present in 13.5%, cough in 10.8%. Tubercular pleural effusion is common in the age group 41–50 years and Patients with para-pneumonia, is 97 had lymphocyte and 23 had neutrophil. &gt;3 gm/dl was observed in patients with tubercular effusion and Mean value of ADA for tubercular effusion was 45.8 U/L.&#x0D; Conclusions: Our study concluded that shortness of breath, cough, and Pleural fluid analysis is the diagnostic method to distinguish exudative from transudative pleural effusion. Lymphocyte rich exudative effusion occurs in case of Tubercular effusion and neutrophil rich effusion occurs in para-pneumonic effusion.&#x0D; Key words: pleural effusion, exudative, transudative.

A STUDY OF CLINCOETIOLOGICAL PROFILE OF PATIENTS WITH PLEURAL EFFUSION: A CROSS-SECTIONAL STUDY

Objectives: The objective of this study was to determine the clinical profile, etiology in patients presenting with plural effusion and correlation between etiology, clinical, and radiological findings. Methods: It was a cross-sectional study carried out at the GRMC JAH Department of Medicine, Gwalior, from to July 2013 to October 2014 after getting the permission from the Institutional Ethical Committee. Inclusion criteria were all 100 patients above 14 years of age with clinical and radiological evidence of plural effusion. Patients with history of trauma chest and thoracocentesis were excluded from the study. The demographic variables were gender, age in years, sex, and address. The research variables were breathlessness, fever, cough, chest pain, generalized edema, abdominal pain, hemoptysis, and cause of pleural effusion. Investigations such as complete blood count, retained blood syndrome, renal function test, serum albumin, chest X-ray, pleural fluid analysis, ultrasonography chest and abdomen, echocardiogram, upper gastrointestinal endoscopy, blood culture, fine-needle aspiration cytology, and computed tomography scan. There were eight age groups between below 21 years and above 81 years. Nominal data were analyzed for frequency and (%) and the numeric data were analyzed by Chi-square test p-value. Results: In the present study, maximum cases (66%) presented with exudative type of pleural effusion. Of these 43 cases (65.15%) had tuberculosis, 5 cases (7.5%) had malignancy and 4 cases (6.06%) had pneumonia. About 34% cases presented with transudative type of pleural effusion. Of these 10 cases (29.41%) had hepatic involvement, and 8 cases (23.52%) had congestive cardiac failure. Acute febrile illness 9 (9%), nephrotic syndrome 4 (16%), renal failure 5 (5%), hypoalbuminemea 5 (5%), pancreatitis (1%), and adult respiratory distress syndrome (1%) were other causes of pleural effusion in this study.

A case of tuberculous pleurisy characterized by bleeding and necrosis documented by medical thoracoscope.

Tuberculous pleurisy is a main cause of pleural effusions. The main histological abnormalities in pleural biopsy of tuberculous pleurisy are caseating granulomas and epithelioid cell granuloma. In our case, chronic inflammation of fibrous tissue with bleeding, necrosis, and exudation were observed during a medical thoracoscopy as manifestations of tuberculous pleurisy.

Differential Diagnosis of Pleural Effusion Using Machine Learning.

Rationale: Differential diagnosis of pleural effusion is challenging in clinical practice. Objectives: We aimed to develop a machine learning model to classify the five common causes of pleural effusions. Methods: This retrospective study collected 49 features from clinical information, blood, and pleural fluid of adult patients who underwent diagnostic thoracentesis between October 2013 and December 2018. Pleural effusions were classified into the following five categories: transudative, malignant, parapneumonic, tuberculous, and other. The performance of five different classifiers, including multinomial logistic regression, support vector machine, random forest, extreme gradient boosting, and light gradient boosting machine (LGB), was evaluated in terms of accuracy and area under the receiver operating characteristic curve through fivefold cross-validation. Hybrid feature selection was applied to determine the most relevant features for classifying pleural effusion. Results: We analyzed 2,253 patients (training set, n = 1,459; validation set, n = 365; extra-validation set, n = 429) and found that the LGB model achieved the best performance in both validation and extra-validation sets. After feature selection, the accuracy of the LGB model with the selected 18 features was equivalent to that with all 49 features (mean ± standard deviation): 0.818 ± 0.012 and 0.777 ± 0.007 in the validation and extra-validation sets, respectively. The model's mean area under the receiver operating characteristic curve was as high as 0.930 ± 0.042 and 0.916 ± 0.044 in the validation and extra-validation sets, respectively. In our model, pleural lactate dehydrogenase, protein, and adenosine deaminase levels were the most important factors for classifying pleural effusions. Conclusions: Our LGB model showed satisfactory performance for differential diagnosis of the common causes of pleural effusions. This model could provide clinicians with valuable information regarding the major differential diagnoses of pleural diseases.

Neck mass and bilateral pleural effusions in a 53-year-old female.

Chylothorax indicates the accumulation of chyle in the pleural cavity. It is a rare cause of pleural effusion, especially bilaterally. In clinical practice, the presence of milky fluid in the pleural cavity raises the suspicion of chylothorax. The most common cause is trauma, iatrogenic or non, owing to thoracic duct injury, which transports chyle from the lymphatic system into the bloodstream. The case we describe is of a 53-year-old female who was referred to our hospital with bilateral pleural effusions and a left supraclavicular mass. From the diagnostic studies, the nontraumatic causes of chylothorax were excluded. The potential diagnosis was traumatic chylothorax, a diagnosis of exclusion, as it appeared after muscle stretch and receded with a fat-free diet and repose without any relapse.

DIAGNOSTIC YIELD OF ADA IN TUBERCULAR PLEURAL EFFUSION

Objective: Tuberculosis (TB) is one of the most common causes of pleural effusion in developing countries like India encountered by medical professionals globally. The present study was carried out to evaluate the diagnostic yield of pleural fluid adenosine deaminase (ADA) in tubercular pleural effusion. Methods: This descriptive study was conducted in the Department of Medicine and Pulmonary Medicine, Saheed Laxman Naik Medical College and Hospital from January 1, 2019, to March 31, 2020. All patients &gt;15 years of age with lymphocytic exudative pleural effusion and pleural effusion associated with smear/CBNAAT-positive pulmonary TB patients, who attended the department during the study period, were included in the study. A case was taken as tuberculous employing defined criteria. Patients with transudative effusions, post-traumatic effusions, pregnant and lactating women, and persons on drugs that affect ADA activity like interferon alpha, deoxycoformycin, ribavirin, and viramidine were excluded from the study. Results: The mean ADA value was 93.93±44.63 IU/L among the cases with tuberculous effusion and 56.36±62.81 IU/L in the non-tuberculous effusion group. At a cutoff value of 50.7 IU/L, pleural fluid ADA showed a sensitivity of 87% and a specificity of 74% in diagnosing TB etiology. Conclusion: The mean ADA values were significantly higher in tuberculous pleural effusions when compared to the non-tuberculous group. When this was combined with pleural fluid lymphocyte dominancy, the specificity increased to 96%. Pleural fluid ADA values have a strong association with age. ADA estimation is a simple, cost-efficient, and diagnostically helpful investigation with high reliability.

The diagnostic value of interleukin-36 cytokines in pleural effusions of varying etiologies

BackgroundThe clinical management of pleural effusion (PE) poses challenges due to its diverse etiologies. The objective of this research was to investigate the concentrations of interleukin-36 (IL-36) cytokines in pleural fluid (PF) from different etiologies and assess their diagnostic efficacy in distinguishing the causes of PE. MethodsThis study enrolled 89 patients with confirmed PE, comprising 11 cases classified as transudate, 24 cases as malignant pleural effusion (MPE), 24 cases as tuberculous pleural effusion (TPE), and 30 cases as parapneumonic pleural effusion (PPE). The PPE group was further subdivided into 20 cases of uncomplicated parapneumonic effusion (UPPE) and 10 cases of complicated parapneumonic effusion (CPPE)/empyema. The concentrations of IL-36 cytokines in the PF of all 89 patients were quantified by the enzyme-linked immunosorbent assay (ELISA). ResultsIL-36α exhibited excellent diagnostic accuracy in TPE, achieving a sensitivity of 91.7 % and specificity of 83.1 %, along with a cut-off value of 435.3 pg/ml. IL-36Ra also demonstrated relatively favorable diagnostic performance in PPE, with a sensitivity of 80.0 % and specificity of 76.3 %, along with a cut-off value of 390.8 pg/ml. Multivariable logistic regression models were successfully developed for both TPE and PPE, confirming their diagnostic utility. Furthermore, the levels of IL-36Ra were notably elevated in CPPE/empyema in comparison to UPPE. Moreover, in PF, IL-36γ exhibited positive associations with both IL-36α and IL-36Ra. ConclusionIL-36α and IL-36Ra may serve as novel biomarkers for diagnosing TPE and PPE, respectively. The multivariate models established significantly enhance the diagnostic efficacy of both TPE and PPE. Furthermore, IL-36Ra can function as an indicator for assessing the extent of pleural inflammation. Additionally, the interaction among IL-36 cytokines in PF may contribute to their expression modulation.