Cause Of Pleural Effusion Research Articles

Management of malignant pleural effusion in Italian clinical practice: a nationwide survey

BackgroundPleural disease (PD), particularly malignant pleural effusion (MPE), is a common cause of hospital admission and its prevalence is rising worldwide. Recent advances in diagnostic and therapeutic options, such as Indwelling Pleural Catheters (IPCs), have simplified PD treatment, allowing an effective outpatients management. Therefore, dedicated pleural services can improve PD care, guaranteeing specialized management and optimizing time and cost. We aimed to provide an overview on MPE management in Italy, mainly focused on distribution and characteristics of pleural services and IPCs use.MethodsA nationwide survey, endorsed by the Italian Thoracic Society, was distributed by email to members of selected subgroups in 2021.ResultsNinety (23%) members replied, most of whom being pulmonologists (91%). MPE resulted the most common cause of pleural effusion and was managed with heterogenous approaches, including talc pleurodesis via slurry (43%), talc poudrage (31%), repeated thoracentesis (22%) and IPCs insertion (2%). The setting of IPC insertion was inpatient care in 48% of cases, with a predominance of draining frequency every other day. IPC management mainly relied on caregivers (42%). The presence of a pleural service was reported by 37% of respondents.ConclusionsThe present study provides an extensive overview of MPE management in Italy, showing a highly heterogeneous approach, a scarce prevalence of out-patient pleural services, and a still limited adoption of IPCs, mainly due to lack of dedicated community care systems. This survey emphasizes the need of promoting a higher spreading of pleural services and an innovative healthcare delivery with more favourable cost-benefit ratio.

Study on etiological profile of pleural effusion in tertiary care centre in Dakshin Kannada

Background: Pleural effusion (PE) is a pathological state that often develops in patients with thoracic or systemic diseases and if not diagnosed and treated early, heralds a serious prognosis. Aim of the study was to determine the etiological profile of PE from exudative and transudative pleural fluid. Methods: This cross-sectional study was conducted in participants admitted with PE in the general medicine ward of Yenepoya medical college hospital between the period of January 2021 and December 2021. The patients were analyzed for the socio-demographic characteristics; examination was done with focus on general physical examination, respiratory system, cardiovascular system and gastrointestinal system. SPSS was used for analysis. Results: A total of 80 participants fulfilling inclusion criteria were included in the study. The mean age of participants was 50.28±15.85 years. Among the participants, 36.3% were female and 63.8% were male, with male preponderance in the study. PE, according to Light’s criteria, was differentiated into exudative effusion which accounted for 63.8% and the rest 36.3% were transudative. The most common cause of PE was TB followed by malignancy. The most common malignancy causing effusion was carcinoma of the lung. All the etiologies of PE showed a male preponderance and it was statistically significant (p<0.05). Conclusions: In males, PE was more frequently observed. The main causes of PE were TB and cancer. One of the Clinical indicators including pallor demonstrated a strong correlation with malignant and tuberculous effusions. Malignancy and empyema were substantially correlated with clubbing.

Urinothorax: An Uncommon Cause of Pleural Effusion: A Case Report

A rare cause of pleural effusion is the presence of urine in the pleural space (urinothorax). We report here the case of a urinothorax subsequent to a double J catheter placement. Biochemical analysis of the pleural fluid was highly suggestive. Treatment based on therapeutic thoracentesis and treatment of the underlying uropathy resulted in resolution. Being a rare diagnosis it should always be considered when a pleural effusion appears after a urological procedure. More research is still needed to establish specific diagnosis criterias.

CT Scan Characteristics in Patients Referred with Pleural Effusion: Discriminating between Tuberculosis and Malignancy in a Middle East Country

Background: The current study decided to assess CT scan findings in patients with any kind of pleural effusion to obtain any diagnostic value of this modality of imaging to discriminate malignant conditions from benign ones, especially pleural or pulmonary tuberculosis. Methods: Through a cross-sectional design, patients with pleural effusion enrolled in this study when their diagnosis was known as malignancy or tuberculosis. The findings of chest CT-scan were compared between the two conditions and the frequency and statistically different variables were reported as discriminating factors between malignancy and tuberculosis. Results: Among our findings, male sex was prone to tuberculosis, but pleural thickening >10 mm, lung collapse and lung mass in CT-scan, were the most prevalent findings in malignancy and absent in tuberculosis cases. No significant differences were observed in the free or loculated effusion, air-fluid level and gas, Hounsfield score and loculation involvement between groups. Conclusion: CT scan, despite its unconfirmed diagnostic values, could be considered as a very useful part of diagnosing malignancies against benign or infective causes of pleural effusion, especially in terms of pleural thickening more than 10 mm, lung collapse and lung mass disregarding transudative or exudative as well as uni- or bilateral, free or loculated, mild or severe, or other kinds. CT scan scoring system may be the next topic to work on by authors.

Massive pleural effusion, what should we do in emergency department? a case report

Indonesia has been known as an endemic country of tuberculosis (TB). Most of the cases are pulmonary TB, and pleural effusion is one of the common cases. Untreated pleural effusion can become massive pleural effusion, a true emergency case in the emergency room. In this report we present a 21-years-old female patient with new onset massive pleural effusion due to TB infection. A 21-year-old female patient with no previous medical illness came to ER with shortness of breaths since a week ago. Cough and unmeasured fever have been reported since a month ago. Tachypnea, extreme tachycardia, asymmetric chest movement, decreased vocal fremitus, dullness of percussion, and decreased left pulmonary sound were found. Chest x-ray showed a massive left pleural effusion with tracheal deviation. High flow nasal cannula was given due to blood gas analysis interpreting moderate respiratory distress. Thoracentesis was immediately performed with estimated 1200 CC yellow coloured fluid production. Other laboratory findings include hyponatremia and hypoalbuminemia. This patient was diagnosed with pleural effusion type pulmonary TB, treated with anti-TB drugs, mucolytic, corticosteroid, and analgesics. Serial chest x-rays showed improvement of pleural effusion. In developing countries like Indonesia, the most common causes of pleural effusion was TB infection besides malignancy. A massive pleural effusion diagnosis can be established with history taking, physical examination, chest sonography, chest x-ray, and/or CT-scan. Thoracentesis must be performed within minutes after massive pleural effusion was established.

Hypertonic glucose pleurodesis for preterm neonates with chylothorax.

Chylothorax is a known complication of postcardiac surgery and the most common cause of pleural effusion in neonates. Conservative management is usually adopted, including Nil-per-Oral (NPO), treatment of underlying etiology of infection, and use of octreotide. Chylothorax resistant to medical therapy and drainage is often treated by chemical pleurodesis. Previously used pleurodesis agents have included talc, minocycline, OK-432, bleomycin, and povidone-iodine. 50% Dextrose (D50) has been reported to be useful for pleurodesis in adults. We successfully managed two cases of prematurely born infants with D50 as an alternative chemical sclerosant for chemical pleurodesis in a resistant chylothorax and discussed evidence of its use in the literature.

CONGENITAL CHYLOTHORAX –SUCCESSFUL MANAGEMENT WITH CHEMICAL PLEURODESIS

Congenital chylothorax in newborn is a rare disease but a common cause of pleural effusion in neonate. We report a case of congenital chylothorax associated with congenital heart disease in a term baby managed with intercostal drainage, octrotide and chemical pleurodesis.

An uncommon cause of pleural effusion

An uncommon cause of pleural effusion

Clinical and Etiological Profile of an Exudative Pleural Effusion in a Tertiary Care Center

Background: Pleural effusion is common clinical entity in day-to-day clinical practice. There are various etiologies for pleural effusion. Among those tubercular pleural effusion, parapneumonic effusion, malignant effusion, and congestive heart failure were the most common causes of pleural effusion. Here, we have done a retrospective study to see the etiology of pleural effusion in our tertiary care center. Patients and Methods: This retrospective study conducted in a tertiary care center over 1 year period. A total of 63 patients were included in this study after verifying in patient records of all patients who were admitted with exudative pleural effusion. The demographic data collected and complete history was obtained. Investigations such as complete hemogram, random blood sugar; renal function tests, serum proteins, chest x-ray, and pleural fluid analysis and investigations such as ultrasonogram of the chest and abdomen, echocardiogram, computed tomography scan of chest, fine-needle aspiration cytology, and pleural biopsy reports (if done) were collected. Results: Among the study participants, 40 were male and 23 were female patients with male-to-female ratio of 1.7:1. Mean age of the study population was 48.8 ± 18.7 years. The most common presenting symptom was dyspnea (84%) followed by cough (80%), fever (65%), and chest pain (43%). The most frequent cause of pleural effusion was tuberculosis in 38% of patients, followed by parapneumonic effusion (28.5%) and malignant pleural effusion (22.2%). Three patients had chylothorax, two patients had pancreatic pleural effusion and the diagnosis was unknown in two patients. Mean ± standard deviation (SD) adenosine deaminase (ADA) value of the study population was 45.3 ± 28.1. Mean ± SD of ADA values in tuberculous, parapneumonic, and malignant pleural effusion was 54.5 ± 16.8, 65.2 ± 30.7, and 18.2 ± 11.0, respectively. Conclusions: Tuberculosis is one of the common causes of exudative effusions along with parapneumonic effusions and malignancy. Pleural fluid ADA levels are highly sensitive with good specificity for the diagnosis of etiology of tubercular effusions. However in view of high levels of ADA in pleural fluid in parapneumonic effusions also, other measures such as clinical evaluation, lymphocyte to neutrophil ratio, and glucose levels are necessary to separate both these entities.

Pleural fluid biochemical analysis: the past, present and future.

Identifying the cause of pleural effusion is challenging for pulmonologists. Imaging, biopsy, microbiology and biochemical analyses are routinely used fordiagnosing pleural effusion. Among these diagnostic tools, biochemical analyses are promising because they have the advantages of low cost, minimal invasiveness, observer independence and short turn-around time. Here, we reviewed the past, present and future of pleural fluid biochemical analysis. We reviewed the history of Light's criteria and its modifications and the current status of biomarkers for heart failure, malignant pleural effusion, tuberculosis pleural effusion and parapneumonic pleural effusion. In addition, we anticipate the future of pleural fluid biochemical analysis, including the utility of machine learning, molecular diagnosis and high-throughput technologies. Clinical Chemistry and Laboratory Medicine (CCLM) should address the topic of pleural fluid biochemical analysis in the future to promote specific knowledge in the laboratory professional community.

Chinese expert consensus on diagnosis of pleural effusion

Pleural effusion(PE) is a common medical problem with various causes. The differential diagnosis for PE is often challenging. This consensus was generated by members of the academic group of the pleural and mediastinal diseases(preparatory) of Chinese Thoracic Society and some external experts. The members convened in virtual meetings and conducted an extensive literature investigation and assessed the quality of the evidence using a modified grading of recommendations assessment, development, and evaluation(GRADE) approach. This consensus included three chapters: the initial evaluation of PE, the diagnosis of PE with common causes, and the diagnosis of PE with uncommon causes.The main recommendations of Chapter Ⅰ were as follows:(1) For patients suspected of PE according to medical history and clinical manifestations, thoracic CT or ultrasound is recommended to confirm the presence or absence of PE.(2) Ultrasound-guided thoracentesis is recommended when available. Recommended tests for all sampled pleural effeusions include total protein, lactate dehydrogenase (LDH), adenosine deaminase (ADA), differential cell count, and cytological examination.(3) It is recommended to use Light's criteria to distinguish exudate and transudate. When PE is classified to be exudates with heart failure, it is recommended to detect N-terminal pro-brain natriuretic peptide of PE or serum-pleural fluid albumin gradient to assist the judgment.(4) Pleural biopsy is recommended for patients for whom the causes of PE cannot be identified by the detection of PE samples, and CT or ultrasound-guided pleural biopsy is more accurate. Thoracoscopy is recommended for patients whose etiology cannot be identified by laboratory tests of PE and/or pleural biopsy histopathology.The main recommendations of Chapter Ⅱ were as follows:(1)It is suggested to obtain more samples or use immunocytochemistry to assist the diagnosis and cell typing when initial cytopathology examination shows atypical cells, suspicious malignant or malignant cells. (2) Liquid medium for Mycobacterium tuberculosis culture is recommended to improve the positive rate. Molecular diagnosis (nucleic acid amplification or Xpert MTB/RIF) is recommended when tuberculous PE is suspected. For suspected tuberculous PE where the examination of PE is inconclusive. CT or ultrasound-guided pleural biopsy or thoracoscopy is recommended to obtain pleural tissue for acid-fast staining, Mycobacterium tuberculosis nucleic acid amplification and culture.(3)C-reactive protein (CRP) of PE is recommended to distinguish uncomplicated PPE from complicated PPE. It is suggested to inoculate pleural effusion into blood culture bottles or culturing specimens from ultrasound-guided pleural biopsy to increase the positive rate.The main recommendations of Chapter Ⅲ were as follows:(1) It is recommended to comprehensively analyze the patients' medical history, clinical manifestations, effusion characteristics, and biopsy pathological results to indentify uncommon causes.(2) It is recommended to detect the presence of chylomicrons or cholesterol crystals, with testing of the levels of triglyceride and cholesterol in PE for clinical suspicion of chylothorax or pseudochylothorax. (3) PE may be the result of a combination of various causes, and it is recommended to screen factors such as heart failure, hypoalbuminemia, and thoracic infection for critical patients.(4) For patients with PE whose cause has not been identified by thoracoscopic pleural biopsy, close follow-up for at least 2 years is recommended to exclude malignant diseases.

Mesothelioma – Cytological Studies and Medical Management in a Non-Descript Dog – A Case Report

Mesotheliomas are tumors of low grade malignancy originating from mesothelial cells covering the coelomic cavities such as the pericardium, pleura, peritoneum and vaginal tunic (Seo et al., 2007). The three types of mesotheliomas are epithelial, fibrous (arcomatous) and biphasic (mixed). The epithelial form, which closely resembles the carcinoma and adenocarcinoma, is the most common type of mesothelioma in dogs (Echandi et al., 2007). Pleural effusion is one of the most classical characteristic feature of mesothelioma. They cause minimal tissue invasion and rarely metastasis to other regions (Vural et al., 2007). In addition to viral or genetic factors long term exposure to dusts such as asbestos, iron or silica plays a major role in the pathogenesis of this neoplasm. It is more common in older animals than younger animals (Echandi et al., 2007). The major clinical sign of this condition occurs due to the accumulation of fluid in the body cavities (Seo et al., 2007). The cytological analysis of the fluid helps to determine the cause of pleural effusion and to make rapid diagnosis (Martin et al., 2011). The morphology of the mesothelial cells are round to polygonal in outline, with anisocytosis, anisokaryosis, pleomorphic multi-nucleated cells, minimal eosinophilic or basophilic cytoplasm, mitosis, loose chromatin, evident nucleoli and ovoid to angulated vesicular nucleus (Martin et al., 2011).

Use of Pleural Fluid Digital PCR Analysis to Improve the Diagnosis of Pleural Tuberculosis.

The diagnosis of pleural tuberculosis (TB) remains difficult due to the paucity of Mycobacterium tuberculosis in pleural fluid (PF). This study aimed to improve pleural TB diagnosis using highly sensitive digital PCR (dPCR) technique. A total of 310 patients with evidence of PF were consecutively enrolled, 183 of whom suffered from pleural TB and 127 from non-TB. PF samples were prospectively collected and total DNA was extracted. The copy numbers of M. tuberculosis insertion sequence (IS) 6110 and IS1081 in DNA were quantified using dPCR. The overall area under the curve of IS6110-dPCR was greater than that of IS1081-dPCR (0.85 versus 0.79). PF IS6110 OR IS1081-dPCR (according to their cut-off values, "positive" was defined as either of them was positive, while "negative" was defined as both of them were negative) had higher sensitivity and equal specificity compared with single target-dPCR. The sensitivity of PF IS6110 OR IS1081-dPCR for total, definite, and probable pleural TB was 59.0% (95% CI = 51.5% to 66.2%), 72.8% (95% CI = 62.6% to 81.6%), and 45.1% (95% CI = 34.6% to 55.8%), respectively. Its specificity was 100% (95% CI = 97.1% to 100.0%). PF IS6110 OR IS1081-dPCR showed a higher sensitivity than smear microscopy (57.4% versus 7.1%), mycobacterial culture (55.3% versus 31.8%), and Xpert MTB/RIF (57.6% versus 23.0%). Long antituberculosis treatment time (>1 month) was found to be associated with negative dPCR results in pleural TB patients. This study indicates that PF IS6110 OR IS1081-dPCR is an accurate molecular assay, which is more sensitive than routine etiological tests and has the potential to enhance the definite diagnosis of pleural TB. IMPORTANCE Pleural TB is one of the most frequent causes of pleural effusion, especially in areas with high burden of TB. Due to the paucibacillary nature of the disease, the diagnostic sensitivities of all available bacteriological and molecular tests remain poor. There is an urgent need to develop new efficient methods. Digital PCR (dPCR) is the third generation of PCR that enables the exact quantification of trace nucleic acids in samples. This study evaluates the diagnostic performance of pleural fluid (PF) dPCR analysis for pleural TB, and shows that PF IS6110 OR IS1081-dPCR has a higher sensitivity than routine etiological tests such as smear microscopy, mycobacterial culture, and Xpert MTB/RIF. This work provides a new choice for improving the definite diagnosis of pleural TB.

CONSIDERING PLEURAL FLUID GLUCOSE LEVELS COULD PREVENT UNNECESSARY PROCEDURES

CONSIDERING PLEURAL FLUID GLUCOSE LEVELS COULD PREVENT UNNECESSARY PROCEDURES

IATROGENIC ESOPHAGEAL PLEURAL FISTULA POST-TRANSESOPHAGEAL ECHOCARDIOGRAM: A CASE REPORT

IATROGENIC ESOPHAGEAL PLEURAL FISTULA POST-TRANSESOPHAGEAL ECHOCARDIOGRAM: A CASE REPORT

Treatment and outcomes of chylothorax in children: 20-year experience of a single institute.

Chylothorax is an uncommon cause of pleural effusion in children. This study aimed to determine the characteristics, treatment strategies, and outcomes of chylothorax in children from a single institute. The 65 episodes of chylothorax in patients aged 0-15 years who were diagnosed and received treatment in Songklanagarind Hospital between January 2001 and December 2020 were retrospectively review and analyzed. Of the 65 episodes, 80% were postoperative chylothorax, and were mostly related to cardiac surgery. The most common treatment strategy employed was dietary modification (64.6%). Octreotide was used as adjunctive therapy in 33.8%. Most cases of chylothorax were successfully treated by conservative treatment, while 10.7% required surgical therapy. The median time to resolution of chylothorax was 21 days [interquartile range (IQR): 8-33 days]. Young children aged <1 year were more likely to require mechanical ventilation and develop ventilator-associated pneumonia and catheter-related complications. The factors associated with death or prolonged hospitalization (>28 days) were non-postoperative chylothorax, use of total parental nutrition (TPN) >14 days, hypoalbuminemia, and ventilator-associated pneumonia. Most (89.2%) cases of chylothorax were successfully treated conservatively using dietary modification and octreotide therapy. The modifiable risk factors for death or prolonged hospitalization were use of TPN >14 days and hypoalbuminemia.

UNCOMMON CAUSES OF RECURRENT UNILATERAL PLEURAL EFFUSIONS

UNCOMMON CAUSES OF RECURRENT UNILATERAL PLEURAL EFFUSIONS

Clinicopathological Study of Pleural Effusion In A Tertiary Care Hospital.

Background: Pleural effusion is an excess fluid that accumulates between two pleural layers. Pleural fluid analysis and cytology are the mainstays for diagnosing various pulmonary diseases. Levels of adenosine deaminase (ADA) are particularly useful in areas where the prevalence of tuberculosis is high. Objectives: To find the clinical profile and various etiology of pleural effusion in respect of age and sex and level of adenosine deaminase in the different causes of pleural effusion. Materials and Methods: This was an observational study carried out in the Department of Laboratory Medicine of a tertiary level teaching hospital, Khwaja Yunus Ali Medical College &amp; Hospital (KYAMCH), Enayetpur, Sirajganj, Bangladesh. Biochemical analysis was done by Olympus AU-400 and cytology was done by Papanicolaou stain. Result: A total of 173 cases of diagnosed pleural effusion was taken in the present study. Tuberculosis was the primary etiology of the total 82 cases (47.39%), followed by malignancy accounting to 30 cases (17.34%). These two were followed by parapneumonic effusion (10.40%). ADA level is highest in TB (167U/L) in comparison with malignancy, transudative cause and other causes. Conclusion: Most common cause of pleural effusion in the tertiary hospital setting is tuberculosis, followed by malignant pleural effusion and ADA level is highest in TB than any other cause. KYAMC Journal Vol. 13, No. 02, July 2022: 98-101

Urinothorax: an under-reported cause of pleural effusions.

Urinothorax: an under-reported cause of pleural effusions.

Diagnostic presentations of different pleural effusion patients to a tertiary care centre

BACKGROUND-Pleural effusion is defined as collection of fluid between the two pleural covering. OBJECTIVE-To evaluate the different etiologies of pleural effusion according to laboratory report. METHODOLOGY-Data was collected in a nonprobability convenience technique with descriptive cross- sectional study in indoor patient of pulmonary medicine department of Balangir Bhima Bhoi medical college from 2017 nov to 2020 nov,202 patients included in this technique.Diagnosis was confirmed by chest -x-Ray, and USG Chest in some cases, .Pleural fluid is aspirated from all and analysed with necessary investigation carried out ,like pleural fluid cytology, Biochemical and culture .computed tomography ,echocardiography and connective tissue profile for evaluating the underlying cause of pleural effusion. RESULT- Out of 202 patients 145 (73%) were male and 57(26)% were female Mean age was 44.8years with 19,832 SD .Among patients of pleural effusion most common cause was tuberculosis (65.3%). followed by Para pneumonic effusion/empyema (11.4%), malignancy both metastatic and primary accounted for (15%), heart failure also showed its presence in 5% of cases. Connective tissue disorder was found to be the cause in only one case (0.5%). In one case (0.5%) pleural effusion remained undiagnosed.