Cause Of Exudative Pleural Effusion Research Articles

Reanalysis and validation of the transcriptional pleural fluid signature in pleural tuberculosis.

Pleural tuberculosis (PlTB), the most common site of extrapulmonary TB, is characterized by a paucibacillary nature and a compartmentalized inflammatory response in the pleural cavity, both of which make diagnosis and management extremely challenging. Although transcriptional signatures for pulmonary TB have already been described, data obtained by using this approach for extrapulmonary tuberculosis and, specifically, for pleural tuberculosis are scarce and heterogeneous. In the present study, a set of candidate genes previously described in pulmonary TB was evaluated to identify and validate a transcriptional signature in clinical samples from a Brazilian cohort of PlTB patients and those with other exudative causes of pleural effusion. As a first step, target genes were selected by a random forest algorithm with recursive feature elimination (RFE) from public microarray datasets. Then, peripheral blood (PB) and pleural fluid (PF) samples from recruited patients presenting exudative pleural effusion were collected during the thoracentesis procedure. Transcriptional analysis of the selected top 10 genes was performed by quantitative RT-PCR (RT-qPCR). Reanalysis of the public datasets identified a set of candidate genes (CARD17, BHLHE40, FCGR1A, BATF2, STAT1, BTN3A1, ANKRD22, C1QB, GBP2, and SEPTIN4) that demonstrated a global accuracy of 89.5% in discriminating pulmonary TB cases from other respiratory diseases. Our validation cohort consisted of PlTB (n = 35) patients and non-TB (n = 34) ones. The gene expressions of CARD17, GBP2, and C1QB in PF at diagnosis were significantly different between the two (PlTB and non-TB) groups (p < 0.0001). It was observed that the gene expressions of CARD17 and GBP2 were higher in PlTB PF than in non-TB patients. C1QB showed the opposite behavior, being higher in the non-TB PF. After anti-TB therapy, however, GBP2 gene expression was significantly reduced in PlTB patients (p < 0.001). Finally, the accuracy of the three above-cited highlighted genes in the PF was analyzed, showing AUCs of 91%, 90%, and 85%, respectively. GBP2 was above 80% (sensitivity = 0.89/specificity = 0.81), and CARD17 showed significant specificity (Se = 0.69/Sp = 0.95) in its capacity to discriminate the groups. CARD17, GBP2, and C1QB showed promise in discriminating PlTB from other causes of exudative pleural effusion by providing accurate diagnoses, thus accelerating the initiation of anti-TB therapy.

Different Infective and Non-Infective Etiology of Exudative Pleural Fluid Effusion: Experience of 50 Cases in Bangladesh

Background: Several diseases are responsible for the causation of exudative pleural fluid effusion among patients. Objective: The purpose of the present study was to identify the etiologies of exudative pleural fluid effusion. Methodology: This cross-sectional study was carried out at medicine indoor department of Sylhet MAG Osmani Medical College Hospital, Sylhet over a period of six month from October 2009 to March 2010. Patients who were admitted with pleural effusion were selected as the study population. Pleural fluid was collected by a physician. The laboratory tests were performed in the Department of Laboratory medicine of the Hospital. The different etiologies were determined by the different diagnostic tests. Results: A total of 50 cases were selected consecutively in the study. Out of 50 patients, 28.0% was in the range of 41 to 50 years followed by 26.0% between 31 to 40 years. Tuberculosis was the most common cause of exudative pleural effusion and among 50 cases of effusion 30 were due to tuberculosis (60%). Malignancy was found as the 2nd common cause of exudative pleural effusion (24.0%). Pneumonia was found as the 3rd common cause of exudative pleural effusion (10.0%). Conclusion: In conclusion tuberculosis is the most common cause of exudative pleural effusion followed by malignancy. Bangladesh Journal of Medical Microbiology, January 2023;17(1):10-14

Sodium Valproate-induced Eosinophilic Exudative Pleural Effusion

A 34-year-old woman presented with a 3-day history of dyspnea. She denied any preceding fever, night sweats, cough, pleurisy, or coryzal symptoms. She was maintained on sodium valproate 800 mg b.i.d., phenytoin 100 mg o.d., folate 5 mg o.d., and clonazepam 2 mg nocte for a known seizure disorder. Clinical examination and radiologic imaging revealed a large left-sided pleural effusion with the associated collapse of the left lower lung lobe. A chest tube was inserted for diagnostic and therapeutic purposes and ≈500 mls of serous fluid was drained. The pleural fluid analysis confirmed an exudative pleural effusion. Extensive evaluation excluded known causes of exudative pleural effusion, and a diagnosis of sodium valproate-induced pleural effusion was made. Sodium valproate was tapered off and topiramate was added to the patient’s antiepileptic regimen. We recommend physicians be cognizant of sodium valproate-associated pleural effusion, even in the setting of chronic use.

Combined analysis of C-reactive protein in pleural fluid and serum is effective in the differential diagnosis of exudative pleural effusions.

BackgroundExudative pleural effusion (EPE) is one of the common pleural manifestations of various diseases. Differential diagnosis of EPE is imperative clinically as it identifies different causes of EPE, thereby, enabling effective treatments. Thoracoscopy is a useful tool for differential diagnosis of EPE; however, some patients refuse thoracoscopic examination due to its invasive nature. In addition, the specificity and sensitivity of existing routine tests of EPE are unsatisfactory. Therefore, there is a great need to establish an effective method for the differential diagnosis of EPE.MethodsThis study was a single-institution retrospective analysis of diagnostic efficiency of C-reactive protein (CRP) and procalcitonin (PCT) between March 2018 and September 2018. A total of 87 patients diagnosed with EPE were enrolled. All participants underwent diagnostic thoracentesis. The EPE was examined using biochemical, routine, microbiological, and cytological methods. Pathological cytology detection was necessary for those suspected of malignant PE. Benign PE originates in patients with pneumonia, empyema, and tuberculosis. The levels of CRP and PCT in EPE and serum were measured before treatment. Correlation analysis and receiver-operating characteristic (ROC) curve analysis were conducted to determine the underlying relationship between levels of CRP and PCT, and for differential diagnosis.ResultsThe ROC analysis showed that the sensitivity and specificity for the analysis of pleural fluid CRP (p-CRP) were higher (cut-off: 17.55 pg/mL; sensitivity: 75.00%, specificity: 83.90%) than that of serum CRP (s-CRP, cut-off: 23.90 pg/mL; sensitivity: 71.00%, specificity: 80.4%) in the differential diagnosis for EPE. However, the analysis of pleural fluid PCT (p-PCT) and serum PCT (s-PCT) did not demonstrate correlations with EPE. Combined analysis of p-CRP (cut-off: 17.55 mg/dL) with s-CRP (cut-off: 23.9 pg/mL) showed the highest diagnostic accuracy (88.4%) in diagnosing infectious EPE.ConclusionsThe data support the close relationship between combined analysis of p-CRP with s-CRP and effective and accurate differential diagnosis of EPE, due to its higher sensitivity and specificity. However, as a highly sensitive marker for diagnosing bacterial infections, neither s-PCT nor p-PCT, showed correlations with the differential diagnosis of EPE.

Comparison of Heffner Criteria and Light Criteria in Differentiating Exudative and Transudative Pleural Effusion

Pleural effusion is present when there is &gt;15ml of fluid is accumulated in the pleural space. It can be divided into two types; exudative and transudative pleural effusion. Tuberculosis and parapneumonic effusion are the common cause of exudative pleural effusion whereas heart failure accounts for most of the cases of transudative pleural effusion. This study was a hospital based cross sectional study performed at Nepal Medical College during the period of January 2016-December 2016. A total of 50 patients who fulfilled the inclusion criteria were enrolled. Pleural effusion was confirmed by clinical examination and radiology. After confirmation of pleural effusion, pleural fluid was aspirated and was analysed for protein, LDH, cholesterol. The Heffner criteria was compared with Light criteria to classify exudative or transudative pleural effusion. Among 50 patients, 30 were male and 20 were female. The mean age of patient was 45.4±21.85 years. The sensitivity and specificity of using Light criteria to detect the two type of pleural effusion was 100% and 90.9%, whereas using Heffner criteria was 94.87%, 100% respectively(P&lt;0.01). There are variety of causes for development of pleural effusion and no one criteria is definite to differentiate between exudative or transudative effusion. In this study Light criteria was more sensitive whereas Heffner criteria was more specific to classify exudative pleural effusion. Hence a combination of criteria might be useful in case where there is difficulty to identify the cause of pleural effusion.

Cryobiopsy In Flexi-Rigid Pleuroscopy in a Region with Low Mesothelioma Prevalence

Background: The use of conventional flexible forceps during flex-rigid pleuroscopy can be challenging when sampling hard and thickened pleura. Pleuroscopic cryobiopsy is an emerging field, with various early studies demonstrating good yield and minimal complications. Objectives: To review the authors’ early experience of pleuroscopic cryobiopsy in their centre and highlight its utility in the diagnosis of mesothelioma. Method: Six cases of undiagnosed pleural effusion that underwent pleuroscopic cryobiopsy via flexi-rigid pleuroscopy between July 2017 and June 2019 were retrospectively analysed. Results: The cohort had a median age of 59 years, consisting of two females and four males with a median age of 57 years. Mean (aggregate) tissue sample diameter was 9.2±1.9 mm. Cryobiopsy established a definitive diagnosis in all six cases: one case of malignant mesothelioma, one pleural tuberculosis, two small cell carcinomas, and two adenocarcinomas. Immunohistochemical staining was performed in all five of the malignant samples (100%). There were no major complications reported. Conclusions: Based on the case series, pleuroscopic cryobiopsy is a feasible adjunct to conventional forceps biopsy, a safe procedure in the authors’ setting, gives high diagnostic yield, and enables differentiation between the different causes of exudative pleural effusion. A large, prospective study is required to validate this retrospective series.

New Biomarkers Used in the Diagnosis of Tuberculosis-Related Pleural Effusions

AbstractTuberculosis-related pleural effusion (TPE) is reported in 12 to 38% of thoracic tuberculosis (TB) cases in the pediatric population. In TPE, the pleural fluid bacilli load is very low, generally resulting in negative acid-fast bacill (AFB) staining and Mycobacterium culture. In the pleural fluid, AFB stain positivity is reported in &lt;20%, and Mycobacterium tuberculosis positive culture in 18 to 38%. In childhood, this ratio is even lower. Also, pleural effusion (PE) mycobacterial culture gives late results (2–8 weeks). Therefore, TPE is diagnosed with pleura biopsy and pleural liquid examination. However, pleura biopsy is a more invasive operation and the diagnosis rates vary. The clinical and laboratory findings are not typical; it is very hard to distinguish between TPE and another cause of exudative PE. This situation makes it essential for research on reliable new biomarkers that can provide fast and accurate diagnosis of TPE. Adenosine deaminase (ADA) activity being above 40 to 50 U/L (despite varying depending on age) strongly suggests TPE. Other new biomarkers featured in TPE diagnosis are interferon-γ, cytokines, and nucleic acid multiplication tests. However, the results of ADA and other potential biomarkers shown to be beneficial in TPE diagnosis should always be interpreted with clinical and microbiological findings because no biomarker can provide information about M. tuberculosis culture and drug resistance. Especially in countries with high resistance against TB drugs, performing pleura biopsy, culture and drug resistance tests are important with regard to diagnosis and therapy planning.

Diagnostic value of procalcitonin in pleural effusion

Background A wide range of diseases can cause pleural effusion. Its diagnosis and management remain a clinical challenge, bearing a significant cost to both patients and health care system. Objective To assess the role of procalcitonin (PCT) level in discriminating transudative from exudative pleural effusion and in differentiation between some types of exudative effusion. Patients and methods A total of 45 patients having pleural effusion were enrolled in this study and were divided into two groups. Group I included 15 patients having transudative pleural effusion. Group II included 30 patients having exudative pleural effusion. This group was subdivided into group IIa, which included 10 patients having tuberculous effusion; group IIb, which included 10 patients having malignant effusion; and group IIc, which included 10 patients having parapneumonic effusion. Quantitative measurement of PCT in both serum and pleural fluid was done using enzyme-linked immunosorbent assay. Results Exudative effusion had significantly higher levels of serum and pleural PCT when compared with transudative one. Regarding serum and pleural PCT levels in different types of exudative effusion, highest level was in parapneumonic followed by malignant, and then tuberculous pleural effusion, and the difference between them was statistically significant. Conclusion Measurement of both serum and pleural PCT may be used to differentiate transudative from exudative type of pleural effusion and may be used also to discriminate parapneumonic from other causes of exudative pleural effusion.

Contemporary Approach to the Diagnosis of Malignant Pleural Effusion.

Advanced malignancy is a prevalent cause of exudative pleural effusion. The management of malignant pleural effusion (MPE) has been the subject of several recent randomized controlled trials and excellent reviews. Less attention has been focused on another controversial and challenging aspect of MPE: establishing the diagnosis. Before selecting the optimal management strategy, the presence of an MPE must first be correctly identified with an emphasis on minimizing invasiveness and discomfort in a patient with late-stage cancer. The aim of the present review is to summarize the current knowledge about MPE diagnostics and to propose an algorithm for the diagnosis of MPE in established or suspected malignancy.

Pleural effusion related to IgG4.

Purpose of reviewThe causes of exudative pleural effusions are diverse and frequently remain unclear despite exhaustive examinations. Recently recognized IgG4-related disease (IgG4-RD) is a fibroinflammatory disorder that can affect nearly any organ including the lungs. This review will focus on the involvement of IgG4 in exudative pleural effusion of unknown cause.Recent findingsIgG4 is found to be involved in a proportion of patients with undiagnosed pleural effusions. Pleural involvement in IgG4-RD can be seen in isolation or association with other organ disease. Pleural thickening and/or effusion are common clinical features of IgG4-related pleural lesions, and this condition is histologically characterized by a lymphoplasmacytic infiltrate enriched in IgG4-positive plasma cells in the pleura. Although the pathogenesis of IgG4-RD is poorly understood, there is a growing body of evidence that indicates an antigen-driven process requiring T-cell and B-cell interaction in which autoantibodies, plasmablasts, follicular helper T cells and CD4+ cytotoxic T lymphocytes participate.SummaryThe possibility of IgG4-related pleural lesion should be considered in patients with pleural effusion of unexplained cause when lymphoplasmacytic infiltration is seen in a pleural biopsy specimen. This condition is responsive to systemic steroid therapy.

IDENTIFICATION OF Mycobacterium tuberculosis BY POLYMERASE CHAIN REACTION (PCR) TEST AND ITS RELATIONSHIP TO MGG STAINING OF PLEURAL FLUID IN PATIENTS WITH SUSPECTED TUBERCULOUS PLEURAL EFFUSION

Pleural effusion is a condition characterized by the accumulation of excessive pleural fluid in pleural cavity as a result of transudation and exudation. The most commonly reported cause of exudative pleural effusion is Mycobaterium tuberculosis. This study was aimed to identify Mycobacterium tuberculosis in pleural fluid through PCR test and to examine the relationship between PCR test and MGG staining of pleural fluid in patients with suspected tuberculous pleural effusion, which was performed in Clinical Pathological Laboratory Installation of dr. Wahidin Sudirohusodo hospital in Makassar and Faculty Research Unit Laboratory in Hasanuddin University from March to November 2012. This study was a cross sectional study. Subjects in this study consisted of 75 patients (41 males and 34 females[AA1] ) with average age of 40-49 years (30.7%). Pleural effusion patients with suspected tuberculosis who had a positive PCR result was 58.7%, negative PCR result was 41.3% and positive rivalta result in 82.7%, negative rivalta result in 17.3%. Statistical analysis using independent T-test indicated a non-significant relationship between PCR test and average MN and PMN cell percentage in MGG staining (P &gt; 0.005). This study concluded that in MGG staining, average MN cell percentage was higher in PCR TB (+) group compared to PCR (-) group, but the difference was not significant.

Histopathological diagnoses on pleural biopsy specimens over a 15-year period at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa: A retrospective review.

Pleural effusions are a common reason for presentation to healthcare facilities. Blind closed pleural biopsy can be a useful tool to diagnose their cause, especially in resource-limited settings. To determine the aetiology, frequency and change in profile of histopathological diagnoses made at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, South Africa, over the period 1 January 2001 - 31 December 2015. Pleural biopsies performed at CHBAH and analysed by histopathologists from the National Health Laboratory Service at the hospital over the study period were retrospectively reviewed by accessing reports from two databases (DISA and TrakCare). The subjects' ages, genders, HIV status and histopathological diagnoses as well as adenosine deaminase and Ziehl-Neelsen results were recorded. A total of 1 013 samples were included in the study, with 780 considered adequate for assessment. The most common diagnosis was granulomatous inflammation (48.1%, n=375), with the most common type being necrotising granulomatous inflammation (73.6%, n=276). Ten percent of biopsies (n=78) showed malignancy, most commonly adenocarcinoma, with 46.2% (n=36) metastatic and 23.1% (n=18) primary lung adenocarcinoma. The odds of being diagnosed with malignancy showed increasing statistical significance above the age of 40 years: 40 - 49 years odds ratio (OR) 8.7, 95% confidence interval (CI) 1.1 - 66.9 (p=0.038); 50 - 59 years OR 12.4, 95% CI 1.6 - 95.0 (p=0.015); ≥60 years OR 23.0, 95% CI 3.1 - 171.3 (p=0.002). HIV seropositivity was associated with lower odds of being diagnosed with malignancy compared with HIV-negative patients (OR 0.5, 95% CI 0.2 - 0.9; p=0.040), with greater odds of a 'non-cancer' diagnosis in HIV-positive patients (including granulomatous inflammation and pleuritis (OR 2.16, 95% CI 1.03 - 4.51; p=0.040)). Blind closed pleural biopsy has a role to play in the diagnosis of exudative pleural effusions in resource-limited settings, particularly for patients suspected to have tuberculosis (TB) or malignancy. TB remains a common cause of exudative pleural effusions. Patients aged &gt;40 years presenting with an exudative pleural effusion should routinely have pleural biopsy performed. However, this study showed a high frequency of inadequate specimens from closed pleural biopsy. Training in the performance of this procedure to increase diagnostic rates is recommended.

Assessment of Adenosine Deaminase Level and the Utility of Polymerase Chain Reaction in Diagnosis of Tuberculous Pleural Effusion

Background: Extrapulmonary tuberculosis is one of the major causes of exudative pleural effusion. The paucibacillary nature of effusion suggests the need of markers and methodologies for accurate diagnosis and prognosis of tuberculosis as well as to differentiate it from other non-tubercular causes of pleural effusion.Objectives: This study was focused to evaluate the utility of polymerase chain reaction (PCR) in detection of tuberculosis antigen and to assess the level of Adenosine Deaminase (ADA) in tubercular pleural effusion (TPE) and contrast it with other causes.Methods: This is a cross-sectional study where 100 samples of pleural effusion suspected to be tuberculosis were analyzed by PCR for the detection of IS6110 segment of DNA. The level of ADA was then determined and compared in both PCR positive and negative samples. The cut-off value of ADA was &gt;40 U/L for TPE. Student t test was applied to compare the means with statistical significance set at p&lt;0.05.Results: Out of 100 samples analyzed, 45% were positive for TPE and remaining 55% were non-tuberculosis pleural effusion as detected by PCR. The level of ADA was above cut-off (&gt;40 U/L) in 43% TPE samples whereas all the non-tuberculosis effusion had ADA &lt;40 U/L (p&lt;0.001).Conclusion: The ADA level was significantly higher in TPE than in non-tuberculosis cases, and PCR was able to detect suspected cases of tuberculosis effusion in almost half of the cases. This finding suggests the diagnostic utility of combined use of ADA and PCR in diagnosis of TPE. J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page: 5-9

Integrated semi-targeted metabolomics analysis reveals distinct metabolic dysregulation in pleural effusion caused by tuberculosis and malignancy

BackgroundTuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) are the 2 most frequent causes of exudative pleural effusions (PEs). However, the clinical differentiation is challenging. MethodsMetabolic signatures in pleural effusion from 156 patients were profiled. An integrated semi-targeted metabolomics platform was incorporated for high throughput metabolite identification and quantitation. In this platform, orbitrap based mass spectrometry with data dependent MS/MS acquisition was applied in the analysis. In-house database containing ~1000MS/MS spectra were established and “MetaInt” was developed for metabolite alignment. ResultsUsing this strategy, lower levels of amino acids, citric acid cycle intermediates and free fatty acids accompanied with elevated acyl-carnitines and bile acids were observed, demonstrating increased energy expenditure caused by TPE. Kynurenine pathway from tryptophan was significantly enhanced in TPE. The ratio of tryptophan/kynurenine exhibited decent performance in differentiating TPE from MPE with sensitivity of 92.7% and specificity of 86.1%. After two further independent validations, it turns out that the ratio of tryptophan/kynurenine can be applied confidently as a potential biomarker together with adenosine deaminase (ADA) for clinical diagnosis of TPE. ConclusionsConclusively, the integrated in-house platform for high throughput semi-targeted metabolomics analysis reliably identified great potential of tryptophan/kynurenine ratio as a novel diagnostic biomarker to distinguish pleural effusion caused by tuberculosis and malignancy.

Etiological causes of exudative pleural effusion in patients treated in a teaching hospital

The aim of this study was to find out the common etiological causes of exudative pleural effusion in patients before starting treatment. Fifty patients, diagnosed with pleural effusion on admission were randomly selected from Medicine and Paediatric wards of Khulna Medical College Hospital during the period from March 2016 to November 2016. Etiological diagnosis was established by sequential clinical history and findings on physical examination, laboratory tests, chest radiograph, CT scan of the chest and pleural fluid analysis. Patients who remained undiagnosed were subjected to fibro-optic bronchoscopy, thoracoscopic pleural biopsy, and histopathology. Among the patients having pleural effusion, there were tuberculosis, pneumonia, malignancy and systemic lupus erythematosus in 27 (54%), 11 (22%), 7 (14%) and 1 (2%), respectively. Despite all investigations, 4 (8%) were remained undiagnosed etiologically. Most of the pleural effusion cases were diagnosed as tuberculosis. Early and adequate treatment resulted in complete recovery of the patients.Mediscope Vol. 4, No. 1: Jan 2017, Page 30-33

138: THE EVALUATION OF CONCENTRATION OF CALPROTECTIN, IN PLEURAL FLUID WITH CAUSES OF EXUDATIVE PLEURAL EFFUSION IN THE PATIENTS REFERRED TO SHAHID SAYYAD SHIRAZI HOSPITAL OF GORGAN IN 2014

Background and aims:Nowadays, routine invasive techniques to diagnose the causes of exudative pleural effusion are going to be replaced by new noninvasive methods such as biomarkers which with the same...

Study of serum interferon gamma in tubercular pleural effusions

Background: Pleural effusions (PEs) are a common reason for admission in Acharya Vinoba Bhave Rural Hospital, and in developing countries like India, tuberculosis (TB) is the most common cause of exudative PE. The diagnosis of tuberculous PE with standard analysis of pleural fluid is often inaccurate. Pleural tissue histopathology and culture for Mycobacterium tuberculosis are considered the gold standard, but the procedure is invasive, requires skilled clinicians, and does not provide immediate results. To address these limitations, we evaluated whether serum interferon gamma (IFN-γ) can be used as a diagnostic aid for tubercular PEs and to compare its efficacy with adenosine deaminase (ADA) and cytology of pleural fluid. Materials and Methods: The sample size was 86 patients aged 16 years and above and who were diagnosed having tubercular PE either on the basis of ADA or cytology or by both methods, and serum IFN-γ levels were evaluated in these patients. Results: Serum IFN-γ was significantly raised in patients with tubercular PE. Conclusion: Pleural fluid ADA and IFN-γ are almost equally sensitive in diagnosing tubercular effusion; however, in cases where obtaining pleural fluid or other diagnostic material is difficult, serum IFN-γ can be considered as aid in diagnosing TB.

Pleural biopsy in the diagnosis of lymphocytic exudative pleural effusion

Pleural effusion is a common clinical problem in developed as well as developing countries. Tuberculosis and malignancy are common causes of exudative pleural effusion with lymphocytic predominance`. It is very difficult to diagnose the underlying cause by clinical, radiological or even pleural fluid analysis. These cases usually require pleural biopsy for definitive diagnosis2. Pleural biopsy is a safe ad reliable procedure ad is recomended to perform in all cases of exudative pleural effusion. Objective of this study was to list the frequency of patients with lymphocytic exudative pleural effusion diagnosed on pleural biopsy. This study was conducted at the Institute of Chest Medicine Mayo Hospital Lahore. A total of 50 patients, who fulfilled the criteria, were included in this study and underwent closed pleural biopsy. These were then investigated by histopathology. Histopathological examination of pleural biopsy was performed by department of pathology King Edwerd Medical College Lahore. A total of 5 0 patients underwent; closed pleural biopsy. Adequate pleural tissue was obtained in 30 patients (60% of cases) the most common diagnosis made was granulomatous inflammation most likely tuberculosis. Histopathological evaluation of pleural biopsy specimens can lead to diagnosis in 46% of patients with exudative lymphocytic pleural effusion.

Long-term Outcome of Patients with Undiagnosed Pleural Effusion

IntroductionThe cause of exudative pleural effusion cannot be determined in some patients. The long-term outcomes of patients with undiagnosed pleural effusion were analyzed. MethodsPatients with exudative pleural effusion whose diagnostic procedures included pleural biopsy using video-assisted thoracoscopic surgery carried out between 2008 and 2012 were evaluated retrospectively. Patients diagnosed with nonspecific pleuritis were included. Fifty-three patients with available follow-up data were included in the study. ResultsForty men and 13 women (mean age 53.9±13.9years) were included. Median follow-up time was 24months. No diagnosis was given in 27 patients (51%), and a clinical diagnosis was given in 26 patients (49%) during the follow-up period. Malignant disease (malignant mesothelioma) was diagnosed in 2 (3.7%) patients. Other diseases were parapneumonic effusion in 12, congestive heart failure in 8, and miscellaneous in 4 patients. Volume of effusion at the time of initial examination and re-accumulation of fluid after video-assisted thoracoscopic surgery were associated with malignant disease (P=.004 and .0001, respectively). ConclusionAlthough the probability is low, some patients with exudative pleural effusion undiagnosed after pleural biopsy via video-assisted thoracoscopic surgery may have malignant disease. Patients with an initially large volume of effusion that re-accumulates after examination should be closely monitored.

Expression Profiles of Cytokine mRNAs in the Pleural Fluid Reveal Differences Among Tuberculosis, Malignancies, and Pneumonia-Exudative Pleural Effusions.

Tuberculosis (TB) and malignant diseases are the most common causes of lymphocytic pleural effusion in adults. Serum and pleural fluid cytokine levels have been analyzed to help in the differential diagnosis, but with limited results. This study investigates transcription levels of selected cytokine genes in pleural effusion of patients under investigation for TB. This was a prospective study that included adult patients under investigation for pleural effusion in Brazil. The expression of 19 cytokine genes was analyzed by RT-qPCR. The majority of cytokine-related genes expressed in pleural fluid of TB patients were similar in non-TB patients, except for RORA and RORC genes, which showed a statistically higher level in TB. All cytokines in the Th17 pattern were induced in TB patients' pleural fluid. Patients with malignant pleural effusion expressed higher levels of IFN-α1, IFN-β1, TNF-α, IL-4 and IL-6, and suppression of TGFβ-1. There is still a lot to understand about the cytokine roles in the pro- and anti-inflammatory environment of exudative pleural effusions. The data presented here showed an increased expression of Th17 pattern cytokines genes in TB patients that could be used as markers to differentiate tuberculous pleuritis from other common causes of exudative pleural effusion.