Evaluation Of Pleural Effusion Research Articles

The Assessment of Pleural Effusion Using CT Pulmonary Angiography-A Review

Background: Pleural effusion is a common clinical presentation with various etiologies, including pulmonary embolism (PE), which remains underdiagnosed. The association between PE and pleural effusion, particularly the exudative type, necessitates a thorough understanding of the diagnostic role of computed tomography pulmonary angiography (CTPA). Objective: This review aims to elucidate the prevalence and characteristics of pleural effusions in PE patients and to evaluate the effectiveness of CTPA in the diagnosis of unilateral pleural effusions of unknown etiology. Methods: A systematic search across databases such as Google Scholar, PubMed, and NCBI yielded 39 articles, from which 20 met the inclusion criteria focused on the diagnostic utility of CTPA for unilateral pleural effusion. Studies were appraised for relevance to PE and pleural effusion, methodological rigor, and contribution to the field. Results: The review revealed that pleural effusions associated with PE typically present modestly and peak around the third day post-embolism. Persistent or late-onset effusions may suggest recurrent embolism or other pathologies. Contrast-enhanced CT demonstrated variable sensitivity and specificity in detecting malignant pleural effusions, suggesting the need for cautious interpretation and possible further invasive investigation. Conclusion: CTPA plays a critical role in the evaluation of pleural effusion, especially when PE is suspected. An integrated diagnostic approach, including pleural-phase thoracic CT, is recommended for patients with suspected malignant pleural effusions to improve clinical outcomes.

Evaluation of pleural effusion in Minia Cardiothoracic University Hospital, Egypt : two year study

Evaluation of pleural effusion in Minia Cardiothoracic University Hospital, Egypt : two year study

Application of POCUS lung ultrasound in infants with bronchiolitis: a prospective study

BACKGROUND: Acute bronchiolitis is a viral infection of the lower respiratory tract typical of the pediatric age and of the winter season. It represents the leading cause of hospitalization in the first year of life in industrialized countries. Several authoritative scientific societies have issued guidelines for the diagnostic and therapeutic management of bronchiolitis, and they limit the use of radiological imaging in the diagnosis of the pathology, which is mostly clinical.METHODS: For this reason, in the light of the amount of work published in the literature on the application of lung ultrasound in the diagnosis and follow-up of pneumonia, the idea of its use in the integrated evaluation of patients with clinical suspicion has gained ground of bronchiolitis and especially POCUS. This study has the following objectives: 1) verify the existence of a clinical-ultrasound correlation; 2) ability of the clinical score and the ultrasound score to predict the need for ventilatory support; 3) compare point-of-care lung ultrasound and chest X-ray.RESULTS: This work adds to the numerous studies already published which have investigated the potential of lung ultrasound performed by clinicians in cases of bronchiolitis, beyond now validated contexts, such as the evaluation of pleural effusions and pneumothorax.CONCLUSIONS: The advantages of LUS are considerable: safe, rapid, accurate, simple, executable and repeatable technique at the patient’s bed, free from exposure to ionizing radiation and, therefore, it would be desirable to spread it more widely in the pediatric field.

Semi-rigid Thoracoscopy: Initial Experience from A Tertiary Care Hospital

Thoracoscopy is usually carried out using rigid metallic instruments. Recently, video flex-rigid or semi-rigid thoracoscopes have been introduced. These have the advantage of easy maneuverability, although the biopsy samples are smaller as compared to those with rigid thoracoscopy. We have looked at the usefulness of flex rigid thoracoscope in the diagnosis and treatment of pleural diseases, remained undiagnosed after thoracentesis and closed biopsy. Retrospective analysis of data of patients who underwent thoracoscopy for the evaluation of pleural disease. Thoracoscopy was done in 21 patients using a flex-rigid thoracoscope in our institution. The indication was pleural effusion with inconclusive or negative pleural fluid cytology and blind pleural biopsy in 18 of the 21 patients. Thoracoscopic biopsy was positive in 12 of the 18 patients (66.7%). Of the six who had a negative biopsy, the procedure indirectly helped in patient management in five. There were no significant procedure-related complications. Thoracoscopy with flex-rigid thoracoscope is a useful diagnostic tool in the evaluation of pleural effusions with negative blind pleural biopsy and cytology.

Evaluation of pleural effusions developed after abdominal operations

Evaluation of pleural effusions developed after abdominal operations

Pleural Effusion

Pleural effusions can occur in a wide variety of clinical situations. The most important test for the initial diagnosis and evaluation of a pleural effusion is the chest radiograph. Further investigation, such as imaging, pleural fluid analysis, pleural biopsy, and thoracoscopy, may be required to determine the etiology of the pleural effusion. This review covers the clinical evaluation, investigative studies, and management of pleural effusion, as well as basic facts of the pleura. An algorithm shows the approach to the patient with a pleural effusion. Figures show chest radiographs of patients with pleural effusion; six computed tomographic scans (showing right-side empyema showing a loculated effusion; a free-flowing, sickle-shaped, right-side effusion; parapneumonic effusion [PPE] at diagnosis, after initial chest tube placement, and after fibrinolytics; and left-side chylothorax secondary to lymphoma); an algorithm to manage known malignant pleural effusions; and a photograph of a PleurX catheter after placement and subcutaneous tunneling. Tables list the pathophysiologic mechanisms of pleural effusion, differential diagnosis for pleural effusions, relationship between pleural fluid appearance and causes, pleural fluid tests for causative assessment, practical guidelines for definitive management of malignant pleural effusion, and categorization of PPE by risk of poor outcome. Techniques for bedside thoracentesis and tube thoracostomy as well as for bedside fibrinolytic use are also presented. This review contains 1 management algorithm, 8 figures, 6 tables, and 92 references.

Role of thoracoscopic pleural biopsy in evaluation of pleural effusion

Context: Evaluation of a patient with pleural effusion involves clinical, radiological and cytological evaluation of pleural fluid and histological evaluation of pleural biopsy. It is not always possible to identify the exact etiology of pleural effusion based on cytological examination alone. Pleural biopsy is sensitive in up to 91% of cases. Aims: The Aim of the paper is to study the diagnostic yield of thoracoscopic pleural biopsy and to ascertain the etiology of pleural effusions. Materials and Methods: The material for this study is pleural biopsies received in the department of pathology in a tertiary care hospital. A total of 103 biopsies were studied in three years (2013-2015). Biopsies were fixed in buffered formalin and routinely processed. A panel of histochemical stains and immuno histochemical markers were done when required. Statistical Analysis used: None. Results: A total of 103 biopsies were studied. M: F ratio is 2.1:1. Youngest patient was 16 years and oldest was 80 years. Most common diagnosis was tuberculosis, diagnosed in 32 cases (32.6%), other lesions diagnosed were acute infection 10 cases (10.2%), chronic inflammation 24 cases (24.5%), adenocarcinoma 13 (13.2%), squamous cell carcinoma 5 (5.1), lymphoma 5 (5.1%), mesothelioma four cases(4.08%), one each of small cell carcinoma, poorly differentiated carcinoma, solitary fibrous tumour, xanthogranulomatous inflammation, extra medullary hematopoiesis, benign mesothelial hyperplasia constituting (1.0%) each. Four biopsies were inadequate and excluded from the study. Conclusions: Thoracoscopic pleural biopsy has a very high sensitivity 91% and a specificity of 100% in diagnosing pleural effusions. It is a safe procedure. Material obtained can be used for ancillary techniques in cases of diagnostic dilemmas. Keywords: Pleural effusion, Pleural Biopsy, Thoracoscopy.

Role of pleural fluid-serum protein carbonyl gradient in differentiating exudative and transudative effusions

Background: Pleural effusions often cause a diagnostic dilemma. The first step in the evaluation of pleural effusions is the distinction between exudates and transudates.
 Aims and Objectives: The current study was designed to distinguish these two broad subgroups of pleural effusions, based on the protein carbonyl gradient between pleural fluid and serum.
 Materials and Methods: Forty-four exudative and thirty-six transudative pleural effusion cases based on clinical findings and evaluation by Light’s criteria were selected. Protein carbonyl was measured by established photometric method using dinitrophenylhydrazine (DNPH) method in pleural fluid and serum of all the cases.
 Results: Oxidative stress, estimated by the protein carbonyl gradient between pleural fluid and serum, was found to be higher in exudates when compared to transudates. No significant difference was existent between exudates of different aetiology. However, the gradient was higher in exudates from males compared to females. No such difference was found among transudates.
 Conclusions: Carbonyl stress being a simple easily measurable biochemical parameter, pleural fluid to serum protein carbonyl gradient may serve as a useful tool for differentiating pleural effusions based on pathogenesis.

Protocolo diagnóstico y tratamiento del derrame pleural agudo

Pleurae are the two layers of serous membranes that line the lungs, mediastinum, diaphragm and chest wall. Pleural cavity is the space between both membranes. Pleural effusion is a buildup of fluid in the pleural space. Clinical history and physical examination are the basis in the evaluation of pleural effusion. Complementary tests are required to diagnosis. Treatment varies with symptomatology (dyspnea), etiology (hemodynamic, infectious, or inflammatory), and pleural fluid characteristics.

Pleural effusions in hematologic malignancies and their management with indwelling pleural catheters

Pleural effusions in patients with hematologic malignancy may represent malignant pleural effusion (MPE) or occur secondary to infection, treatment effects, and other common causes. The impact of MPE on prognosis in this cohort remains unclear. Indwelling pleural catheters (IPCs) are routinely placed for palliation of recurrent symptomatic MPEs, but perceived concerns over infection and bleeding may limit their use in patients with hematologic malignancies. However, recent evidence suggests IPCs are both well tolerated and effective in this cohort. In this review, the evaluation of pleural effusions in hematologic malignancies and their management with an IPC are outlined. Two retrospective studies have been published regarding the use of IPCs in hematologic malignancies. Lymphomatous effusions are the most common cause of MPE in this cohort. The rates of complications and pleurodesis with IPC in hematologic malignancies are similar to those with solid organ tumors. Pleural effusions in patients with hematologic malignancies may be managed safely with an IPC. Sterile technique, barrier protection, standardized algorithms for placement and removal, and quality assurance initiatives are crucial to centers that place IPCs for all patients. The safety of IPC in hematologic malignancies warrants a paradigm shift in the management of pleural disease for this cohort.

Practice Pearls for Performing Pleural Ultrasound with Focus on Pleural Effusion and Pleural Thickening

Ultrasonography can provide guidance for several diagnostic and therapeutic procedures, and is now considered the standard of care for the evaluation of patients with pleural diseases. Ultrasonography is a particularly useful tool in the evaluation of pleural effusion and pleural thickening, with advantages such as portability, low cost, and safety.

Lung ultrasound in adult and paediatric cardiac surgery: is it time for routine use?

Respiratory complications are common causes of morbidity and the need of repeated X-ray examinations after cardiac surgery. Ultrasound of the chest, including the lung parenchyma, has been recently introduced as a new tool to detect many pulmonary abnormalities. Despite this, the use of lung ultrasound (LUS) in adult and congenital cardiac surgery remains limited. In particular, lung ultrasound has been mainly used in the evaluation of pleural effusion (PLE), but no consensus exists on methods to quantify the volume of the effusion. Usefulness of LUS for the assessment of diaphragmatic motion in children has also been highlighted, but no clear recommendation exists regarding its routine use. Accuracy of LUS in detecting pulmonary congestion after adult cardiac surgery has been demonstrated, whereas studies in children are still scarce, and data on pneumothorax and lung consolidations are limited in the paediatric population. There are methodological and practicality issues regarding diagnostic protocols (i.e. image views and their sequential order) and instrumentation (transducers and their setting) used in different studies. It also remains unclear which practitioner-the cardiologist, intensivist, pulmonologist or the radiologist, should perform the examination. Cost analysis pertaining to extensive clinical application of lung ultrasound in cardiac surgery has never been performed. Guidelines and recommendations are warranted for a systematic and extensive use of this technique in cardiac surgery at different ages, as it could serve as a useful, versatile tool that could potentially decrease time, radiation exposure and costs.

A "Sound" Approach.

A "Sound" Approach.

Cautious application of pleural N-terminal pro-B-type natriuretic peptide in diagnosis of congestive heart failure pleural effusions among critically ill patients.

Background and ObjectiveSeveral studies on diagnostic accuracy of pleural N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) for effusions from congestive heart failure (CHF) conclude that pleural NT-pro-BNP is a useful biomarker with high diagnostic accuracy for distinguishing CHF effusions. However, its applicability in critical care settings remains uncertain and requires further investigations.MethodsNT-proBNP was measured in pleural fluid samples of a prospective cohort of intensive care unit patients with pleural effusions. Receiver operating characteristic curve analysis was performed to determine diagnostic accuracy of pleural NT-proBNP for prediction of CHF effusions.ResultsOne hundred forty-seven critically ill patients were evaluated, 38 (26%) with CHF effusions and 109 (74%) with non-CHF effusions of various causes. Pleural NT-proBNP levels were significantly elevated in patients with CHF effusions. Pleural NT-pro-BNP demonstrated the area under the curve of 0.87 for diagnosing effusions due to CHF. With a cutoff of 2200 pg/mL, pleural NT-proBNP displayed high sensitivity (89%) but moderate specificity (73%). Notably, 29 (27%) of 109 patients with non-CHF effusions had pleural NT-proBNP levels >2200 pg/mL and these patients were more likely to experience septic shock (18/29 vs. 10/80, P<0.001) or acute kidney injury (19/29 vs. 9/80, P<0.001).ConclusionsAmong critically ill patients, pleural NT-proBNP measurements remain a useful diagnostic aid in evaluation of pleural effusions. However, patients with non-CHF effusions may exhibit high pleural NT-proBNP concentrations if they suffer from septic shock or acute kidney injury. Accordingly, it is suggested that clinical context should be taken into account when interpreting pleural NT-proBNP values in critical care settings.

Pleural ultrasonography. Pictorial essay.

Pleural ultrasonography (US) represents nowadays a useful diagnostic tool in the management of pleural diseases. Detection and evaluation of pleural effusions, pneumothorax and pleural-based lesions can be performed with US, which has the advantages of wide availability, low cost, absence of radiation exposure, and portability. It is the best method for guiding interventional procedures in the pleural space. It has also limitations, due to the interposition of bony parts of the thorax, subcutaneous emphysema and inability to visualize the mediastinal pleura. US of the thorax is an operator dependent technique demanding an experienced operator in order to obtain reliable results. This pictorial essay presents various ultrasound findings of the diseases which concern the pleura.

Diseases of the pleural space

Pleural effusion is defined as the abnormal collection of fluid in the pleural space secondary to changes in the transpleural pressure balance, increases in mesothelial and capillary endothelial permeability, or impairment of lymphatic drainage. The evaluation of pleural effusion is recommended in order to determine the definitive aetiology of the condition and for treatment planning. Clinically, pleural fluid is typically classified as transudate, serosanguineous, haemorrhagic, chylous, inflammatory or neoplastic.

Lung ultrasound in the evaluation of pleural effusion

In recent years, there has been an increasing interest in the use of ultrasound for the evaluation of chest diseases, especially for the study of bedridden, critically ill patients. In fact, the ultrasound method presents various advantages: it uses no radiation; it is inexpensive; it can be used at the bedside; it is noninvasive; and it can be repeated as necessary. In addition, ultrasound is starting to be a method used by professionals, other than radiologists, who have specific clinical questions,

Pleural fluid LDH-Cholesterol and ADA levels: Useful biochemical markers in comparision to Light and #8217;s criteria for more rapid and accurate evaluation of pleural effusion

Background: Early and decisive evidence of pleural effusion as transudative or exudative nature is of considerable importance for further diagnostic procedure and therapeutic implication. Aims & Objective: To evaluate the utility of PF LDH-Cholesterol including Triglycerides level and ADA levels and comparing it with Light’s criteria for rapid and accurate evaluation of Pleural effusion mainly exudates. Materials and Methods: Total of 100 cases of Pleural effusion studied from July 2011 to September 2012. All the cases were evaluated by clinical, biochemical, cytological analysis of pleural effusion to diagnose underlying cause and different methods were compared for its diagnostic value, its sensitivity and specificity. Results: Out of all the effusions, 94 were exudative and 6 were transudative in nature. The commonest cause of effusion was tuberculous (58 cases) followed by malignancy (24 cases). 62 patients showed ratio of pleural fluid and serum protein 60 mg/dl. 86.2% of patients with TB and 79.16% of malignancy patients had pleural fluid cholesterol levels > 60 mg/dl with pleural fluid to serum cholesterol ratio of >0.4. Pleural fluid triglyceride levels were >40 mg/dl in 50% of the patients. Pleural fluid LDH levels were 135 ± 37 in transudative effusion while it was 676 ± 414, 559 ± 225 and 678 ± 513 in exudative, tuberculous and malignant effusion respectively. Similarly ratio of pleural fluid to serum LDH was <0.6 in transudative while it was 2.68 ± 3.27, 1.93 ± 1.15 and 1.61 ± 1.13 in exudative, tuberculous and malignant effusion respectively. Pleural fluid ADA levels were 20 ± 17, 53.5 ± 43, 65.48 ± 39.9 and 24.29 ± 24.72 in transudative, exudative, tuberculous and malignant effusions respectively. It was found that the specificity of separating transudate and exudates and positive predictive value was 100% with light’s criteria, pleural fluid LDH levels and pleural fluid to serum LDH ratio. Sensitivity and specificity of ADA in tuberculous effusion is 79.31% and 76.16% respectively. Conclusion: In clinical setting Light’s criteria generally distinguish the exudative from transudative pleural effusion. Current study supports other studies in stating that the alternative criteria like PF LDH-Cholesterol and ADA levels must be considered as a good alternative.

AB 28. Evaluation of pleural effusion at first diagnosis of lung cancer

Background Pleural effusion is a common finding at first diagnosis of lung cancer and occurs in 7% to 30% of patients. 50-75% of those effusions are malignant.

Surface Marker Analysis in the Evaluation of Pleural Effusions: Unique Markers Can Assist in Distinguishing Malignant From Nonmalignant Effusions

PURPOSE: To evaluate and distinguish malignant and nonmalignant pleural effusions utilizing surface marker analysis by flow cytometry and assessing tumor forming efficiency by subcutaneous injection into SCID/NOD/IL2Rgamma-mice.