Diagnosis Of Exudative Pleural Effusion Research Articles

To Study the Combined Use of Pleural Fluid Lymphocyte / Neutrophil Ratio and ADA for the Diagnosis of Tuberculous Pleural Effusion

INTRODUCTION - Pleural effusion is the abnormal collection of fluid in the pleural space. It is classified into exudates and transudates based on Light's criteria. Among the extra pulmonary presentations after tuberculous lymphadenitis, pleural TB is the second frequent. Although many biochemical parameters, such as lactate dehydrogenase (LDH), C-reactive protein (CRP), adenosine deaminase (ADA), interferon-gamma, and procalcitonin levels have been studied in the context of the diagnosis of exudative pleural effusion, its diagnosis is still challenging. AIMS & OBJECTIVES- To determine whether the combined use of ADA activity and lymphocyte/neutrophil ratio would provide a more efficient means for diagnosing tuberculous pleural effusion than the use of ADA alone. MATERIAL & METHODS- Hospital based Observational study was conducted over 8 months with total number of 100 Patients diagnosed as having pleural effusion based on clinical features and chest radiography in GEMS MEDICAL COLLEGE AND HOSPITAL. Biochemical, cytological and microbiology studies were done by obtaining pleural fluid by thoracocentesis. RESULTS - out of 100 cases, 84 cases were tubercular and had high level of ADA in comparison to rest of 16 non tubercular cases. At level of 50 IU/L of ADA activity test had sensitivity of 97.6%, specificity 87.5% which was increased to 100% and 92.8% in combination with test of Lymphocytic/Neutrophilic ratio - 0.75 CONCLUSION- The combined use of ADA along with the L/N ratio would provide a more efficient means for diagnosing tuberculous pleural effusion than the use of ADA alone.

Comparison between thoracoscopic pleural cryobiopsy and conventional forceps biopsy in diagnosis of exudative pleural effusion: Assiut University experience

Abstract Context Exudative pleural effusion is a diagnostic dilemma that includes many steps; one of them is obtaining a definite diagnosis through pleural biopsy. Cryoprobes are being increasingly used for obtaining larger specimens with fewer crush artifacts. However, the safety and feasibility of cryoprobe biopsy compared with standard forceps for pleural biopsy have not been fully assessed. Aims To evaluate the diagnostic value, size, and quality of the specimens obtained by flexible cryoprobe in comparison with those obtained by flexible forceps probe during medical thoracoscopy in patients with exudative pleural effusion and to assess the possible complications from the procedure. Settings and design This interventional prospective study was carried out at the endoscopy unit at Chest Department and Tuberculosis Assiut University Hospital. Patients and methods This study included 60 patients with undiagnosed exudative pleural effusion. Medical thoracoscopy was carried out for all the patients, and pleural biopsies were taken from the parietal pleura using a conventional rigid forceps probe and flexible cryoprobe in the same settings. Results Cryoprobe biopsy established a definite diagnosis in 55/60, with 91.6% diagnostic yield, whereas forceps biopsy had a definite diagnosis in 53/60, with 88.3% diagnostic yield. The size of cryoprobe biopsy was significantly larger in comparison with the forceps biopsy (26.56 ± 22.16 vs. 17.38 ± 12.08 mm2; P<0.001). The depth of pleural biopsy was evaluated by the presence of extrapleural fat cells, which were significantly higher in cryoprobe biopsy in comparison with forceps biopsy [21 (35%) vs. 11 (18.3%); P=0.03]. There were no significant complications or procedure-related deaths. Conclusions Cryobiopsy is a possible safe and effective alternative to conventional forceps probe biopsy in the diagnosis of exudative pleural effusion with a larger, deeper, and less number of biopsies. It was also found that cryoprobe biopsy had a better diagnostic yield, sensitivity, and accuracy.

The Role of Pleural Fluid C-Reactive Protein in the Diagnosis of Exudative Pleural Effusions.

Background and objectivePleural effusion develops when there is disequilibrium between pleural fluid formation and absorption. Light's criteria are currently used to differentiate transudative from exudative effusion. If the pleural effusion is exudative, it requires extensive diagnostic workup to identify the local cause of the effusion. Pleural fluid cell count and differentials, glucose level, adenosine deaminase (ADA), fluid GeneXpert for Mycobacterium tuberculosis (MTb), fluid culture, and cytology are currently used for further evaluation of exudative pleural effusions. However, the sensitivity and specificity of the above tests are not dependable. The pleural fluid C-reactive protein (CRP) is likely to reflect serum CRP levels because the CRP in the pleural fluid may be caused by increased diffusion from the blood due to inflamed capillary leakage. In this study, we aimed to examine the role of pleural fluid CRP levels in the differential diagnosis of exudative effusion.Materials and methodsBased on Light's criteria, this study included 100 patients with exudative pleural effusion. Serum CRP and pleural fluid CRP were assessed with the CRP-Turbilatex-quantitative turbidometric immunoassay method based on the principle of an agglutination reaction. Receiver operating characteristic (ROC) curves were generated by plotting sensitivity against 1-specificity, and the area under the curve (AUC) with a 95% confidence interval (CI) was calculated. After data collection, statistical analysis was performed using SPSS Statistics v28.0 (IBM, Armonk, NY).ResultsOur study showed a significant difference in pleural fluid CRP levels (p<0.001). Pleural fluid CRP was significantly higher in the empyema and parapneumonic groups compared to tuberculous and malignant effusions. The optimal cut-off value of CRP ≥47.4 mg/dl yielded 87.5% sensitivity and 92.5% specificity in differentiating parapneumonic effusion from tuberculous effusion. Pleural fluid CRP proved to be an excellent marker for distinguishing parapneumonic effusion from malignancy (cut-off value ≥49.2 mg/dl, 75% sensitivity, and 85.7% specificity) and parapneumonic plus empyema from tuberculous effusion plus malignant effusion (cut-off value ≥47.4 mg/dl, 84.6% sensitivity, and 90.8% specificity).ConclusionPleural fluid CRP levels can be used as an additional tool in the differential diagnosis of exudative effusion. It significantly differentiates parapneumonic effusion and empyema from tuberculous and malignant effusions.

The diagnostic dilemma of an exudative pleural effusion and the emerging role of thoracoscopic pleural biopsy in these patients: A study from South India

Objectives: Pleural effusion is one of the common presentations of several several diseases in clinical practice. The pathology behind a pleural effusion is often not clear on pleural fluid analysis. In developing countries like India, empirical antitubercular treatment is started assuming exudative pleural effusion to be tuberculosis. Over some time with more emphasis on evidence-based medicine, this is not a right approach. Thoracoscopic examination and biopsy visceral are a minimally invasive procedure which is underutilized in our practice. The study was conducted to evaluate the definitive etiological diagnosis of exudative pleural effusion and to analyze the diagnostic yield of thoracoscopic biopsy in the diagnosis of exudative pleural effusion. Material and Methods: The study was conducted in the Department of Medicine and Oncology, Command Hospital Airforce, Bengaluru, India. All adult patients with exudative pleural effusion (according to light’s criteria) reporting to the hospital from January 2019 to December 2020 were included and subjected for analysis. Results: Out of a total of 100 patients who were included in the study, there was male predominance with 78 males and 22 females. Thoracoscopic biopsy remained conclusive in 100% of cases. Malignancy was the most common etiology with 48% of cases while tuberculosis was seen in 38%, 12% had inflammation, and 2 (02%) had mucormycosis. TB PCR sensitivity and specificity of TB PCR were 42% and 100%, respectively. MTB culture showed sensitivity of 11%. MTB culture of biopsy showed sensitivity of 26%. The specificity in both the methods was 100%. Conclusion: Thoracoscopy is an ideal method for the diagnosis of pleural effusion with suspected exudative pathology. It gives an accurate diagnosis and helps differentiate between tuberculosis and malignancy which are the most common etiologies in India, thereby leading to early appropriate and specific treatment in such patients. Malignancy was the most common etiology in our study.

Histomorphological Spectrum of Pleural Biopsy Specimen of Exudative Pleural Effusion in a Tertiary Care Hospital in Bangladesh

Background: The commonest manifestation of pleural pathology is pleural effusion. Most of the time, in spite of routine biochemical and cytological examination of pleural fluid we can’t evaluate the etiology of pleural effusion. Aim: Aim of present study was to make an etiological diagnosis of exudative pleural effusion by pleural biopsy and histopathological examination. Study design and setting: Fifty consecutive patients of pleural effusion were selected from the outpatient and indoor department of a tertiary medical college hospital in Sylhet. It was a prospective and observational study. It was conducted over a period of one and a halfyears. Material and method: In all the cases, cytological examination of pleural fluid (for malignant cell) and pleural biopsy by Abram’s needle were done. Subsequently, histopathological diagnoses were made to determine the etiology of effusion. Results: Out of 50 subjects, males outnumbered females, Age is ranged between 19 and 85 years. According to the histopathological examination of the submitted pleural biopsy specimen, granulomatous inflammation is the most common etiology (40%) followed by chronic inflammation of non-specific origin (38%) and malignancy (22%). Conclusion: This study represents the result of the experience acquired over one and half years in the histopathological interpretation of pleural biopsies and its correlation with cytology of the pleural fluid. Pleural biopsy is a useful, minimally invasive procedure with no or little complication and has more sensitivity and specificity than pleural fluid cytology smears.

Video Assisted Thoracoscopic Surgery in Exudative Pleural Effusion and its Complication Management: An Experience in a Community Hospital

Background: Exudative pleural effusions are common presentation of pleural disease. Long standing pleural effusion might complicate with loculations and cortex formation. Video assisted thoracoscopic surgery can be a useful tool for the diagnosis and the management of the complications. The aim of the study is to determine the cause and treat the complications related to the exudative pleural effusions.&#x0D; Materials and Methods: It is a retrospective analysis of prospectively collected data of all patients with exudative pleural effusions subjected to surgical management. Data were collected over a period of four years in a community hospital in Kathmandu.&#x0D; Results: Of 38 patients who underwent Video assisted thoracoscopic surgery only 33 were eligible for analysis. Male to female ratio was 2.3:1 with male (23) dominance. Twenty six (78.8%) had lymphocyte predominance and 23 (69.7%) had Adenosine deaminase level of more than 40 International unit in pleural fluid analysis. In histopathological examination most common finding was granulomatous inflammation 13 (39.4%), 9 (27.3%) were malignancy and 9 (27.3%) were nonspecific chronic inflammation. Of malignancies adenocarcinoma 3 (9.09%) was the most common finding, mesothelioma 2(6.06%) and 4 (12.12%) other.&#x0D; Conclusion: Video assisted thoracoscopic surgery has a role to play in diagnosis of exudative pleural effusions, particularly when there is dilemma in diagnosis. Video assisted thoracoscopic surgery definitely has a role in diagnosis and treatment of the complications related to pleural effusions.

Assessment of the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions

Pleural effusion is divided into exudative and transudative effusion, and the distinction between exudate and transudate requires multiple investigations of biochemical parameters and their comparison in pleural fluid and serum. This study aimed to assess the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions. This epidemiological and cross-sectional study was performed on 50 patients aged between 18 to 90 years with the diagnosis of exudative pleural effusion referred to Imam Khomeini Hospital in Ahvaz in 2018 and 2019. Demographic and clinical information of patients were collected. The pleural effusion was diagnosed based on physical examination and chest radiography. Pleural effusion was confirmed by thoracentesis. A pleural fluid sample was taken from all patients, and the levels of CEA, CA125, and CRP markers were measured in the pleural fluid. Differentiation of transudate and exudate pleural effusions was performed using Light criteria. The mean CEA and CA125 level of pleural fluid were significantly higher, and the mean CRP level of pleural fluid was significantly lower in patients with malignant diagnoses (P &lt;0.05). Cut-off value with highest sensitivity and specificity in differentiating types of exudative pleural effusions was obtained for CEA tumor marker (greater than 49.8), CA125 tumor marker (greater than 814.02), and CRP marker (less than 7.56). Also, in differentiating types of exudative pleural effusions, CEA tumor marker had sensitivity (89.03%) and specificity (78.42%); CA125 tumor marker had sensitivity (53.18%) and specificity (62.44%), and CRP marker had sensitivity (82.16%), and specificity (89.05%) were. Although the tumor markers had high specificity in the present study, the low sensitivity of some of these tumor markers reduced their diagnostic value. On the other hand, given the numerous advantages of tumor markers, such as low cost and non-invasive, combining them with another can increase the diagnostic value and accuracy.

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.

Accurate and Rapid Diagnosis of Exudative Pleural Effusion.

Background: Accurate diagnosis of exudate pleural effusion is definitely important. Few studies have been published on this topic. The current work present evidence for the importance of the pleural fluid markers like high sensitivity-C reactive protein [hsCRP]; tumor necrosis factor alpha [TNFα]; and cholesterol levels measurement in differentiating types of exudative from transudative pleural effusion. Aim: The current study was to determine and evaluate the diagnostic importance of measured levels of pleural fluid cholesterol, high sensitivity-CRP and tumor necrosis factorα in diagnosing and differentiating transudate from exudate pleural effusion. Methods: This study was carried out on 100 patients suffering from pleural effusion who subjected to diagnostic evaluation at Al Sahel Teaching Hospital. The full biochemical analysis of the pleural fluid, pleural fluid culture, and cytology examination were also performed. TNFα, hs CRP, and cholesterol level were assessed in the samples of pleural fluid. Results: One hundred patients were initially evaluated, in accordance to Light's criteria, of 100 patients suffering from pleural effusion, 67 had exudative effusions while 33 patients had transudative pleural effusion. The concentrations of pleural fluid hs CRP and TNFα, found to be significantly elevated in the exudative nature group of pleural fluid than the transudative pleural effusion group (p < 0.05). Also, pleural fluid cholesterol level was elevated in the exudative pleural effusion than transudative pleural effusion (P< 0.001). Conclusion: Patients presented with pleural effusion, simple markers of elevated pleural fluid hsCRP, TNFα, and cholesterol levels may be helpful in discrimination between exudates and transudates effusion.

Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated?

BackgroundThe aim of this study is to compare the diagnostic efficacy and safety of video-assisted thoracoscopic surgery (VATS) with awake VATS (AVATS) pleural biopsy in undiagnosed exudative pleural effusions.MethodsThe diagnostic efficacy of pleural biopsy by uniportal VATS under general anesthesia or AVATS under local anesthesia and sedation performed by the same surgeon in patients with undiagnosed exudative pleural effusion between 2007 and 2020 were retrospectively evaluated. Test sensitivity, specificity, positive predictive value and negative predictive value were compared as well as age, gender, comorbidities, procedure safety, additional pleural-based interventions, duration time of operation and length of hospital stay.ResultsOf 154 patients with undiagnosed exudative pleural effusion, 113 (73.37%) underwent pleural biopsy and drainage with VATS, while 41 (26.62%) underwent AVATS pleural biopsy. Sensitivity, specificity, positive predictive value and negative predictive value were 92, 100, 100, and 85.71% for VATS, and 83.3, 100, 100, and 78.9% for AVATS, respectively. There was no significant difference in diagnostic test performance between the groups, (p = 0.219). There was no difference in the rate of complications [15 VATS (13.3) versus 4 AVATS (9.8%), p = 0.557]. Considering additional pleural-based interventions, while pleural decortication was performed in 13 (11.5%) cases in the VATS group, no pleural decortication was performed in AVATS group, (p = 0.021). AVATS group was associated with shorter duration time of operation than VATS (22.17 + 6.57 min. Versus 51.93 + 8.85 min., p < 0.001). Length of hospital stay was relatively shorter in AVATS but this was not statistically significant different (p = 0.063).ConclusionsOur study revealed that uniportal AVATS pleural biopsy has a similar diagnostic efficacy and safety profile with VATS in the diagnosis and treatment of patients with undiagnosed pleural effusion who have a high risk of general anesthesia due to advanced age and comorbidities. Accordingly, uniportal AVATS pleural biopsy may be considered in the diagnosis and treatment of all exudative undiagnosed pleural effusions.

Modified thoracoscopic pleural cryo-biopsy in diagnosis of exudative pleural effusion of undetermined etiology

BackgroundRigid thoracoscopy is the gold standard tool for diagnosing exudative pleural effusion, but sometimes it is difficult to obtain sufficient biopsies using the conventional forceps. This study evaluated the efficacy, safety, and diagnostic value of a modified technique using cryoprobe to obtain pleural biopsies during thoracoscopy.ResultsThis is a single-center prospective study in patients that underwent rigid thoracoscopy using conventional rigid forceps followed by a cryoprobe at the same setting after injection of subpleural mixture of adrenaline and xylocaine. Biopsies were reviewed by an independent pathologist; any complications were recorded, and all patients were followed-up post-procedure. Twenty-four patients (12 males; mean age was 56 ± 15.1years) were included. The diagnostic yield of both rigid forceps biopsy (RFB) and cryoprobe biopsy (CPB) was 100%. CPB had more surface area than RFB with no difference regarding largest diameter (p = 0.064). RFB and CPB had similar results regarding presence of fat cells. CPB had much less crushed cells than RFB with better tissue preservation (p = 0.004). No significant complications were reported.ConclusionsThe modified cryoprobe biopsy is a highly effective and safe way for obtaining pleural biopsy besides affording good quality and size of the biopsy especially in thick firmly adherent pleura.

Improving the yield of diagnostic medical thoracoscopy for undiagnosed exudative pleural effusions using a rigid diagnostic algorithm.

Establishing the etiology of exudative pleural effusions in the setting of an unrewarding pleural fluid analysis often requires biopsies from the parietal pleura. However, it may be noted that diagnosis such as pulmonary embolism and connective tissue diseases can result in an exudative pleural effusion where a pleural biopsy can yield nonspecific results. Medical thoracoscopy (MT) is a minimally invasive procedure performed under local anesthesia or moderate sedation with excellent yield and favorable safety profile. We analyzed the diagnostic yield of MT for exudative pleural effusions after employing a rigid diagnostic algorithm. The study was undertaken to ascertain the yield of MT in establishing the diagnosis in diagnosis of exudative pleural effusions, to find out the relative contribution of pleural tuberculosis (TB) as a cause of undiagnosed exudative pleural effusion, to describe the etiology of undiagnosed exudative pleural effusion in patients undergoing MT and to determine the correlation between pleural fluid adenosine deaminase (ADA) levels and TB pleuritis in patients undergoing MT. This was a retrospective study. Patients with undiagnosed exudative pleural effusion were included in the study. MT was performed with semirigid thoracoscope (Olympus LTF 160) under local anesthesia and conscious sedation. Gross appearance and ADA level of pleural fluid were noted. Pleural biopsy material was subjected to histopathology examination and culture for mycobacteria along with cartridge-based nucleic acid amplification test for TB. The yield of MT for establishing the etiology of pleural effusion and the relative contribution of tuberculous pleuritis as a cause of undiagnosed pleural effusion was ascertained. Correlation of pleural fluid ADA levels was done with a final diagnosis of TB pleuritis in patients undergoing MT. Twenty-five patients with undiagnosed exudative pleural effusion underwent thoracoscopy of which 16 were male and 9 were female. MT was able to establish the diagnosis in all cases, providing a diagnostic yield of 100%. Histopathological examination of biopsy specimens yielded a diagnosis of malignant involvement of pleura in 10 patients and granulomatous pleuritis consistent with TB in 14 patients. Pleural TB contributed to 60% of undiagnosed pleural effusions in the present study. The mean ADA value among those who turned positive was 56.338 and 35.300 among those who turned negative using genexpert, which was found to be statistically significant. A value of 31 IU/L showed a sensitivity of 93.3% and specificity of 99.8% and hence can be taken as a cut off value for the diagnosis of pleural TB based on receiver-operating characteristic analysis. TB contributed to 60% of undiagnosed exudative pleural effusions in the present study. MT had 100% yield in the diagnosis of undiagnosed exudative effusions. Pleural fluid ADA levels may help in differentiating TB versus malignant effusion.

Comparison between closed pleural biopsy and medical thoracoscopy for the diagnosis of undiagnosed exudative pleural effusions: a systematic review and meta-analysis.

BackgroundExudative pleural effusion (EPE) is a common diagnostic challenge. The utility of medical thoracoscopy (MT) and closed pleural biopsy (CPB) to aid in the diagnosis of EPE has been reported in many published studies. Herein, we perform a systematic review and meta-analysis to compare the diagnostic yield and safety of CPB and MT in EPE.MethodsFour databases were searched for studies reporting the diagnostic yield of CPB and MT for EPE. The quality of the included studies was evaluated according to the quality assessment of diagnostic accuracy studies (QUADAS) tool. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and complication risks were compared between the two groups.ResultsTen studies dealing with CPB and twenty-three studies dealing with MT for the diagnosis of EPE were included in this meta-analysis. Pooled sensitivity, specificity, PLR, NLR and DOR of CPB group was 77%, 99%, 32.55, 0.22, 165.71, respectively, while pooled sensitivity, specificity, PLR, NLR and DOR of MT group was 93%, 100%, 10.82, 0.08, 162.81, respectively. The area under the summary receiver operating characteristic (SROC) curve of CPB and MT were both 0.97. The ability of CPB to diagnose non-malignant diseases was like MT (69% vs. 68%), while the ability was lower than that of MT to diagnose malignant diseases (72% vs. 92%). The pooled diagnostic accuracy of CPB and MT for mesothelioma was 26% (95% CI, 14–38%) and 42% (95% CI, 22–62%) (P<0.001), respectively. The rate of complications with CBP was lower than that reported for MT.ConclusionsCBP is a relatively accurate tool with a lower complication rate compared to MT in the diagnosis of EPE, especially in diagnosing non-malignant diseases. We confirm the utility of MT in the diagnostic workup of malignancy (especially mesothelioma); however, in selected cases, CPB could be used as the first diagnostic approach with a favorable safety profile.

Role of Pleural Fluid C-Reactive Protein in the Aetiological Diagnosis of Exudative Pleural Effusion

Introduction: Pleural effusions, the result of the accumulation of fluid in the pleural space, are a major diagnostic problem due to its anatomical nature with no direct access. There is variation in management, depending on the pleural disease. The pleural effusion can either exhibit specific or nonspecific characteristics. Aim: To determine the clinical significance and diagnostic role of pleural fluid C-Reactive Protein (CRP) level in the aetiological diagnosis of exudative pleural effusion. Materials and Methods: This was a cross-sectional study performed during the study period of September 2013 to December 2014. A total of 53 Patients identified with pleural effusion were recruited in the study and pleural fluid was subjected for the measurement of CRP level. Pleural fluid CRP was assessed with CRP-Turbilatex-Quantitative turbidimetric immunoassay method which is based on the principle agglutination reaction. The data was subjected to statistical analysis using Epi info software version 3.4.3. The Receiver Operating Characteristic (ROC) curve was plotted to illustrate the diagnostic ability. The smallest cut-off value was the minimum observed test value minus 1, and the largest cut-off value was the maximum observed test value plus 1. All the other cut-off values were the averages of two consecutive ordered observed test values. Results: Among the 53 patients in the study, 42 had exudative effusions (79.20%) and 11 had transudative effusions (20.80%). The common cause of exudative effusion was tuberculosis 26 (61.90%), followed by 9 malignancy (21.40%) and 7 parapneumonic effusion (16.70%). In our study, the pleural fluid CRP was statistically significant (p&lt;0.001) marker to differentiate exudative effusions with CRP-value &lt;30 suggestive of malignancy, CRP-value 30-50 mg/L suggestive of tuberculosis and CRP-value &gt;70 mg/L suggestive of parapneumonic effusions. Conclusion: Determination of pleural fluid CRP is a useful diagnostic marker for differentiating exudative and transudative effusions. Also, Pleural fluid CRP is a statistically significant marker in differentiating tubercular effusions from nontubercular exudative effusions.

Our Closed Pleural Biopsy Results in Our Patients With Pleural Effusion

Objective: We retrospectively analyzed patients who underwent closed pleural biopsy for diagnostic purposes among our patients who were followed up in our clinic for the last 5 years due to pleural effusion. Material and Method: Of the 155 patients who underwent closed pleural biopsy in our clinic between January 2015 and January 2020, 125 patients whom we could contact were included in the study. Postero anterior lung (PAAG) radiographs and lateral chest radiographs were examined. Pleural fluid amount according to the PAAG graph; It was defined as minimal (fluid that closes the costophrenic angle and does not erase the entire diaphragm), medium (fluid covering less than 2/3 of the hilus) and massive (fluid covering more than 2/3 of the hemithorax). Results: When the complaints of our cases were evaluated. The most common complaint was the shortness of breath with 35 (28%) people, while 24 (19.2%) people had cough and 21 (16.8%) chest pain, respectively. A statistically significant difference was observed in the complaints of the patients in terms of the amount of dyspnea and fluid (p = 0.04). When the biopsy pathology results of our patients were examined, 43 (34.4%) patients were malignant, 29 (23.2%) patients had nonspecific inflammation, 28 (22.4%) patients had chronic inflammation and 25 (20%) patients had granulomatous inflammation. Conclusion: Considering its low cost, easy use in experienced hands, and low complication rates, and its applicability with local anesthesia, closed pleural biopsy should always be considered as a first-line diagnostic tool in the diagnosis of exudative pleural effusion.

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.

The value of exfoliative cell cytology in the diagnosis of exudative pleural effusions.

The sensitivity and specificity of exfoliative cell cytology for the diagnosis of exudative pleural effusions varies widely according to the etiologic causes. The aim of this study is to assess the diagnostic value of exfoliative cell cytology for the identification of exudative pleural effusions. This is a retrospective study of the patients with an exudative pleural effusion admitted at our clinic in the last twenty years. We have conducted the clinical, the cytological findings, and the diagnostic results of six hundred patients from hospital records. Male to female ratio was 2.2:1 with a mean age of 42.8 years (range 18-78 years) among the patients. Samples were processed and evaluated according to the standard methods. Cytology results were reviewed and the patients were stratified according to the final diagnosis of their disease. Of the six hundred exudative effusions, 240 were malignant on exfoliative cytology pleural fluid alone. Adenocarcinoma was the most common type of malignancy. Tuberculosis was the second most frequent etiology for the exudative effusions followed by infection and collagen vascular diseases. Diagnostic accuracy of cytology showed a good correlation with the final diagnosis with an overall 70.1% sensitivity, 62.5% specificity, and a 95.9% positive predictive value for all exudative pleural effusions. Cytologic examination of the pleural fluid is a simple non-invasive procedure as the initial step for the diagnostic work up of patients with a pleural effusion. Exfoliative cytology provides high a final diagnostic yield for the identification of an exudative pleural effusion etiology. Furthermore, cytologic analysis leads the clinician into the correct diagnostic pathway as the most informative laboratory tool even when it was not diagnostic by itself for equivocal cases.

Retrospective study to evaluate the results of medical thoracoscopy in diagnosis of exudative pleural effusion at chest department El-Hussein university hospital in the period from July 2013 to July 2018

Background: Thoracoscopy is a minimally invasive procedure that allows visualization of the pleural space and intrathoracic structures. It enables taking pleural biopsies under direct vision, therapeutic drainage of effusions, and pleurodesis in one sitting. Persistent and recurrent exudative pleural effusions become common and thoracocentesis and blind pleural biopsy procedures do not give a definitive diagnosis in many patients. Therefore, thoracoscopy today remains the gold standard for these cases. In tuberculous pleuritis, the combined yield of histology and culture for rigid thoracoscopy was nearly 100%. Objective: This study was carried out to analyze our five years experience of medical thoracoscopy in the management of undiagnosed exudative pleural effusion at chest department El-Hussein University Hospital. Materials and Methods: All patients with undiagnosed exudative pleural effusion who underwent thoracoscopy during the period between July 2013 to July 2018 at Al Hussein University Hospital were included in the study. All patients were subjected to thorough history taking, clinical examination, routine laboratory investigations, pleural fluid analysis and medical thoracoscopy with multiple pleural biopsies. All patients data, thoracoscopy results and complications were recorded. Results: Thoracoscopy was successful for giving final diagnosis in 122 patients (84.13%) from total 145 patients. Malignancies reported in 113 patients (77.9%) of patients and TB reported in 6.2% of patients. Mesothelioma was the most common diagnosis in 67 patients(46.2%) Minor complications occurred only in 14 out of 145 patients (9.65%), 4 patients (2.8%) developed cellulitis, 8 patients (5.5%) developed surgical emphysema, and 2 patient (1.4%) developed bleeding. Conclusion: Medical thoracoscopy is an easy, safe procedure with high diagnostic sensitivity for pleural effusion of uncertain etiology.

Retrospective study to evaluate the results of medical thoracoscopy in diagnosis of exudative pleural effusion at chest department El-Hussein university hospital in the period from July 2013 to July 2018

Background: Thoracoscopy is a minimally invasive procedure that allows visualization of the pleural space and intrathoracic structures. It enables taking pleural biopsies under direct vision, therapeutic drainage of effusions, and pleurodesis in one sitting. Persistent and recurrent exudative pleural effusions become common and thoracocentesis and blind pleural biopsy procedures do not give a definitive diagnosis in many patients. Therefore, thoracoscopy today remains the gold standard for these cases. In tuberculous pleuritis, the combined yield of histology and culture for rigid thoracoscopy was nearly 100%. Objective: This study was carried out to analyze our five years experience of medical thoracoscopy in the management of undiagnosed exudative pleural effusion at chest department El-Hussein University Hospital. Materials and Methods: All patients with undiagnosed exudative pleural effusion who underwent thoracoscopy during the period between July 2013 to July 2018 at Al Hussein University Hospital were included in the study. All patients were subjected to thorough history taking, clinical examination, routine laboratory investigations, pleural fluid analysis and medical thoracoscopy with multiple pleural biopsies. All patients data, thoracoscopy results and complications were recorded. Results: Thoracoscopy was successful for giving final diagnosis in 122 patients (84.13%) from total 145 patients. Malignancies reported in 113 patients (77.9%) of patients and TB reported in 6.2% of patients. Mesothelioma was the most common diagnosis in 67 patients(46.2%) Minor complications occurred only in 14 out of 145 patients (9.65%), 4 patients (2.8%) developed cellulitis, 8 patients (5.5%) developed surgical emphysema, and 2 patient (1.4%) developed bleeding. Conclusion: Medical thoracoscopy is an easy, safe procedure with high diagnostic sensitivity for pleural effusion of uncertain etiology.

Malignant pleural mesothelioma: diagnostic value of medical thoracoscopy and long-term prognostic analysis

BackgroundMalignant pleural mesothelioma (MPM) is marked by its difficult diagnosis and poor prognosis. Medical thoracoscopy (MT) is an effective and safe procedure for the diagnosis of exudative pleural effusions and many factors associated with poor prognosis of MPM. We conducted this study to investigate the value of MT for diagnosing of MPM and to identify prognostic factors for MPM patients.MethodsFrom July 2005 through June 2014, a total of 833 patients with undiagnosed pleural effusions underwent MT and pleural biopsies were taken. Clinical data of all patients with MPM were retrospectively analyzed, and those with complete follow-up data were analyzed for prognostic factors.ResultsEventually, MPM was the final diagnosis in 40 patients. Diagnostic efficiency of MT for MPM was 87.5%, since diagnosis of MPM failed to be established in 5 patients during the initial MT. Median survival was 17.1 mo (95% confidence interval: 13.6–20.7 mo). MT findings of pleural adhesion and plaques were adverse prognostic factors for MPM. In addition, old age, male gender, smoking history, histological type, poor staging, no treatment, low total protein level in pleural fluid, and computed tomographic findings such as pulmonary consolidation or infiltration, mediastinal lymphopathy, pulmonary mass or nodules, and pleural nodularity were also poor prognostic factors for MPM.ConclusionsMT is safe with a high positive rate in the diagnosis of MPM, and pleural adhesion and plaques seen under MT may be the adverse prognostic factors for MPM. Multiple clinical characteristics can affect the survival of MPM patients.