Pleural Research Articles

Current Situation and Management of Pleural Effusion in PHI Clinical Hospital Tetovo

Introduction: Pleural effusion is a disturbance in the balance between fluid production and elimination in the pleural space, resulting in abnormal fluid accumulation. It can result from various medical conditions related to the lungs and pleura or systemic diseases. Identifying the etiology of pleural effusion is essential for effective treatment. According to Light's criteria, pleural effusions are transudative and exudative. Material and Methods: For this research, we collected data from the existing documentation in the Department of Pulmonology and Respiratory Allergology at PHI Clinical Hospital Tetovo from June 2022 to June 2023. This study included 133 patients with dyspnea, persistent chest pain, fatigue, hemoptysis, cough, a history of past illnesses, and other comorbid conditions. The data collection process was rigorous, and we followed ethical guidelines to ensure the reliability of our findings. Results: The patients included in our study were between 36 to 84 years old. Of them, 72,9% were males, and 27,1% were females. 85,7% were smokers, and 14,3% were non-smokers. 75,0% of patients complained of dyspnea, and 24,8% had hemoptysis. From the ultrasonography findings, 15,0% had an alteration in the left lung, 11,3% in the right lung, 20,3% of patients were punctuated to the left side, and 24,8% were punctuated to the right lung. In comparison, 1,5% were punctuated to both sides. In 2,3% of the subjects, computed tomography described an effusion in the left lung. Conclusion: The results suggest that pleural effusion is associated with various diseases, especially heart failure and malignant diseases. Our study underscores the importance of early detection of the cause of pleural effusion and the underlying disease for successfully managing and treating the disease. The insights from our research can guide healthcare professionals in developing effective treatment strategies and improving patient outcomes.

Antimicrobial resistance pattern and species distribution profile of aerobic bacteria causing sterile body fluid infection from a tertiary care hospital

Objectives: Body fluids such as pleural fluid, ascitic fluid, and cerebrospinal fluid are sterile but they can get infected by different microorganisms leading to life-threatening infections. We conducted this study to evaluate the distribution profile of various aerobic bacteria and their antimicrobial resistance pattern isolated from sterile body fluids from the patients attending a tertiary care hospital in North India. Materials and Methods: This hospital-based cross-sectional observational study was conducted in the Department of Microbiology of a tertiary care hospital. A total of 495 sterile body fluid samples were processed for species-level identification of aerobic bacteria by conventional methods following standard laboratory procedures. The antimicrobial susceptibility testing was performed by Kirby–Bauer disc diffusion method according to clinical and laboratory standards institute guidelines 2020. Results: Out of a total of 495 sterile body fluid samples, 48 were found positive on culture for bacterial pathogens. The predominant organisms isolated from sterile body fluids were Acinetobacter species (35%), followed by Klebsiella species (23%), Escherichia coli (13%), Pseudomonas species (12%), Staphylococcus aureus (13%), and Streptococcus species (4%). All of the Gram-negative isolates were 100% sensitive to Colistin followed by amikacin (67.50%) and gentamicin (60%). The Gram-positive isolates were 100% sensitive to vancomycin and linezolid followed by gentamicin (50%). Conclusion: Infections of sterile body fluids can lead to high morbidity and mortality. The knowledge of the bacteriological and antimicrobial resistance profile of bacteria causing sterile body fluid infections is vital in determining appropriate antimicrobial therapy.

Isogenic Transplantation of Hybrid Artificial Pleural Tissue Consisting of Rat Cells and Polyglycolic Acid Nanofiber Sheet Induces Restoration of Mesothelial Defects in Rat Model.

Impairment of the visceral pleura following thoracic surgery often leads to air leaks and intrathoracic adhesions. For preventing such complications, mesothelial cell proliferation at the pleural defects can be effective. To develop new materials for pleural defects restoration, we constructed a hybrid artificial pleural tissue (H-APLT) combining polyglycolic acid (PGA) nanofiber sheets with a three-dimensional culture of mesothelial cells and fibroblasts and evaluated its therapeutic efficacy in a rat pleural defect model. After rat lungs were harvested, pleural mesothelial cells and lung fibroblasts were cultured separately. To construct H-APLT, the cells were then coated with multiple layers of fibronectin and gelatin, followed by a single layer of mesothelial cells on top of multiple layers of fibroblasts accumulated onto a collagen-coated PGA nanofiber sheet. Left lateral thoracotomy was performed, and H-APLTs were transplanted into a rat model with pleural defects (N = 8). After 2-12 weeks of transplantation, lung resection and histological analyses were performed. H-APLTs exhibited a pleural structure with a highly integrated mesothelial layer invitro. After transplantation, all eight rats survived until sacrifice. At 12 weeks post-transplantation, the mesothelial layer on the lung surface was observed to be without defects with no intrathoracic adhesions detected. Successful isogenic engraftment of H-APLTs was achieved in a rat model of pleural defects. The combination of accumulated fibroblasts and collagen-coated PGA nanofiber sheets contributed to the maintenance of the mesothelial layer's structure and function, potentially preventing air leaks and intrathoracic adhesions.

Accuracy of Fully Automated and Human-assisted AI-based CT Quantification of Pleural Effusion Changes after Thoracentesis.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Quantifying pleural effusion change on chest CT is important for evaluating disease severity and treatment response. The purpose of this study was to assess the accuracy of artificial intelligence (AI)-based volume quantification of pleural effusion change on CT images, using the volume of drained fluid as the reference standard. Seventy-nine participants (mean age, 65 ± [SD] 13 years; 47 male) undergoing thoracentesis were prospectively enrolled from October 2021 to September 2023. Chest CTs were obtained just before and after thoracentesis. The volume of pleural fluid on each CT scan, with the difference representing the drained fluid volume, was measured by automated segmentation (fully-automated measurement). An expert thoracic radiologist then manually corrected these automated volume measurements (human-assisted measurement). Both fully-automated (median percentage error, 13.1%; maximum estimated 95% error range, 708 mL) and human-assisted measurements (median percentage error, 10.9%; maximum estimated 95% error range, 312 mL) systematically underestimated the volume of drained fluid, beyond the equivalence margin. The magnitude of underestimation increased proportionally to the drainage volume. Agreement between fully-automated and human-assisted measurements (intraclass correlation coefficient [ICC], 0.99), and the test-retest reliability of fully-automated (ICC, 0.995) and human-assisted (ICC, 0.997) measurements were excellent. These results highlight a potential systematic discrepancy between AI segmentation- based CT quantification of pleural effusion volume change and actual volume change. ©RSNA, 2025.

Coil Embolization for Pulmonary Artery Rupture into the Pleural Cavity during Balloon Pulmonary Angioplasty.

Coil Embolization for Pulmonary Artery Rupture into the Pleural Cavity during Balloon Pulmonary Angioplasty.

Pleural Fluid Calprotectin Levels in Benign and Malignant Pleural Effusions and Its Significance in Predicting Success of Pleurodesis in Malignant Pleural Effusions

Pleural Fluid Calprotectin Levels in Benign and Malignant Pleural Effusions and Its Significance in Predicting Success of Pleurodesis in Malignant Pleural Effusions

Blind nasoenteric tube placement risks: A case report of misplacement into the pleural cavity.

Enteral nutrition is a critical component of care for critically ill patients. However, the blind insertion of a nasoenteric tube, despite being a simple procedure, carries inherent risks that necessitate a reevaluation of the technique. A case of a 60-year-old female experienced the rare yet critical complication of a misplaced nasoenteric tube entering the thoracic cavity during a blind insertion procedure for enteral nutrition following a liver transplant. Following liver transplantation, the patient was diagnosed with severe pneumonia, a right-sided hydropneumothorax, and severe malnutrition. After the misplacement of the nasoenteric tube into the pleural cavity was detected from the chest X-ray, the tube was immediately removed, and the pneumothorax was actively managed. Subsequently, with the support of contrast radiography, the nasoenteric tube was successfully reinserted to provide the patient with nutritional support and promote rehabilitation. The patient responded well to the intervention and was discharged in stable condition following complete recovery. The case prompts a reevaluation of blind placement techniques and calls for the adoption of more reliable technologies to prevent similar incidents and ensure patient safety, such as electromagnetic and visualized guided placement technique.

Point-of-Care Lung Ultrasound in Small Animal Emergency and Critical Care Medicine: A Clinical Review

Thoracic point-of-care ultrasound (T-POCUS) has grown in popularity and usage in small animal emergencies and critical care settings due to its non-invasive nature, mobility, and ability to acquire images in real time. This review summarizes current understanding about T-POCUS in dogs and cats with respiratory illnesses, including normal thoracic ultrasonography appearance and numerous pathological situations. The basics of T-POCUS are covered, including equipment, scanning procedures, and picture settings. Practical applications in patients with respiratory distress are discussed, with an emphasis on pleural space abnormalities and lung diseases. Ultrasound results define pulmonary disorders such as pneumonia, atelectasis, cardiogenic and non-cardiogenic pulmonary edema, lung lobe torsion, pulmonary fibrosis, pulmonary thromboembolism, pulmonary neoplasms, and pulmonary bleeding. The evaluation focuses on T-POCUS diagnostic skills in a variety of clinical settings. Limitations and the need for more study to standardize techniques, establish agreed terminology, and create specialized educational routes are highlighted.

The Impact of Hepatic Hydrothorax on the Outcome of Liver Cirrhosis: A Comparative Study.

Introduction: Hepatic hydrothorax (HH) is a severe cirrhosis complication requiring early diagnosis and appropriate management. This study aimed to assess the impact of HH on the disease severity and mortality of cirrhotic patients and compare their clinical and biological profiles with those of patients without HH. Materials and Methods: This retrospective study involved 155 patients diagnosed with cirrhosis, of whom 31 had HH. The diagnosis of HH was based on imaging techniques such as X-ray, ultrasound, and thoracic CT scans. The severity of cirrhosis was evaluated using the Child-Pugh, MELD, MELD-Na, and MELD 3.0 scoring systems. Results: Of the included patients, 83.87% (n = 26) were men, with a 20% incidence of HH. The main etiology was chronic alcohol use. The pleural fluid localization revealed similar numbers of patients with bilateral and right pleural distribution. Patients with HH were predominantly classified in Child-Pugh-Turcotte class C. The MELD, MELD-Na, and MELD 3.0 scores had higher median values in the group of patients with hepatic hydrothorax. Still, death occurred at lower MELD scores when compared with cirrhotic patients without HH (MELD score > 22.5 for patients with HH vs. MELD > 32.5 for patients without HH). (The cirrhotic patients with HH presented lower serum albumin, cholesterol, and triglyceride levels and higher bilirubin, INR, and creatinine values. The mortality rate was higher in the group with HH-58,06% versus 20.97% in the control group (cirrhotics without HH). Conclusions: Hepatic hydrothorax is a serious complication of cirrhosis that requires early recognition and proper management, supported by using biomarkers and scoring systems.

Comparison of Pleural Fluid Adenosine Deaminase with the Lactate Dehydrogenase/Adenosine Deaminase Ratio in Differentiating Tubercular Pleural Effusion from Non-tubercular Effusion

Abstract Background: Pleural effusions are caused by various conditions, including tuberculosis and malignancies. Accurate differentiation between tuberculous pleural effusion (TPE) and non-tuberculous pleural effusion (NTPE) is crucial for effective treatment outcomes. While adenosine deaminase (ADA) levels are commonly used in diagnosing TPE, the pleural fluid LDH-to-ADA ratio is a potentially more accurate diagnostic marker. Objective: To evaluate the effectiveness of the LDH-to-ADA ratio in distinguishing between TPE and NTPE, especially in cases of increased ADA levels. Materials and Methods: This retrospective study included 80 patients who underwent their first thoracentesis with a pleural fluid ADA level of 40 IU/L or higher. Patients were categorized into TPE (n = 40) and NTPE (n = 40) groups based on clinical, radiological, and laboratory findings. Pleural fluid parameters, including LDH and ADA levels, were analyzed. Receiver operating characteristic (ROC) curve analysis was conducted to determine the diagnostic accuracy of the LDH-to-ADA ratio, with cut-off values assessed for the sensitivity and specificity. Odds ratios were calculated to evaluate the association between the LDH-to-ADA ratio and pleural effusion types. Results: ROC analysis demonstrated that the pleural fluid LDH-to-ADA ratio in comparison to the ADA levels was superior in identifying TPE, with an AUC of 0.86 (sensitivity: 75%; specificity: 90.1%), and for NTPE, with an AUC of 0.90 (sensitivity: 80%; specificity: 77.9%). The LDH-to-ADA ratio provided a strong correlation with TPE and NTPE, confirmed by both crude and adjusted odds ratios, respectively. Conclusion: The pleural fluid LDH-to-ADA ratio is a highly effective diagnostic tool for distinguishing between TPE and NTPE. It offers superior diagnostic performance compared to ADA levels alone, with well-defined cut off values enhancing its utility in clinical practice for accurate diagnosis and management of pleural effusions.

Association of Light’s Criteria with Pleural Fluid Procalcitonin Levels and Ultrasound Thorax with its Impact on the Management of Pleural Effusion: A Cross-sectional Study

Introduction: Pleural effusion, the abnormal accumulation of fluid in the pleural space, affects around 1.5 million people every year. Light’s criteria is routinely employed to distinguish between transudative and exudative effusions based on the test results obtained after thoracentesis. However, this procedure cannot be preferred in certain conditions due to its invasiveness. Thoracic Ultrasound (TUS) is a crucial bedside non invasive tool for identifying and differentiating pleural effusion types and helps guide treatment decisions. Light’s criteria can misdiagnose transudates as exudates, necessitating specific biomarkers like Procalcitonin (PCT). Aim: To determine ultrasound thorax findings among patients with pleural effusion and to assess the impact of these findings on management. To associate Light’s criteria with ultrasound findings and pleural fluid PCT levels. Materials and Methods: A cross-sectional study involving 89 patients diagnosed with pleural effusion was conducted at the Department of Respiratory Medicine, Shri BM Patil Medical College, Vijayapura, Karnataka, India from 2022 to 2024. Ultrasound of the thorax was performed on each patient, Light’s criteria were calculated and pleural fluid PCT levels was measured via Enzyme-linked Immunusorbent Assay (ELISA). Categorical variables between the two groups (exudative group and transudative group) were compared using the Chi-square/ Mann-Whitney U test, with p<0.05 considered statistically significant. Results: The mean age of the study participants was 50.8±18.1 years. The study found that complex septate findings were the most common Ultrasonography (USG) feature, with thin septations being the most frequent, followed by anechoic findings. The majority of the cases, 49 out of 89, were unilateral, more often on the right-side. Management varied from simple effusions treated with aspiration to complex cases that required interventions like intercostal drainage tube insertion or decortication. A cut-off of 0.345 ng/mL of pleural fluid PCT level effectively distinguished transudative from exudative effusions. There was a statistically significant association (p<0.05) between ultrasound findings as well as pleural fluid PCT levels with Light’s criteria. Conclusion: In conclusion, USG findings such as complex septate and thickened pleura are highly supportive of exudative effusions in the present study, while the anechoic appearance is indicative of transudative effusions. TUS is crucial in characterising pleural effusion and guiding treatment. PCT measurement in pleural fluid further aids in distinguishing between transudative and exudative effusions and also in identifying infectious effusions from other types, optimising patient management.

Evaluation of pleural fluid B7-H4 as a diagnostic marker of malignant pleural effusion

Background B7-H4 represents a recently identified B7 family member of molecules that exhibits a crucial impact on the tumor microenvironment regulation since it is deemed to inhibit both innate immunity as well as T-cell responses. Aim This work was aimed at assessing B7-H4 as a diagnostic marker in malignant pleural effusion (MPE). Patients and methods Our prospective analytic controlled case study involved 50 patients aged above 12 years old with parapneumonic, tuberculous, and MPE. All participants went through an equal categorization into two groups: group I: malignant cases with MPE. Group II: benign cases having benign PE. B7-H4 was measured in pleural fluid (PF) and serum by enzyme-linked immunosorbent assay. Results B7-H4 PF, as well as serum levels, exhibited significantly higher values within group I, possessing a significant positive correlation between both. The cut-off point of the PF level of B7-H4 in the diagnosis of MPF was 42 ng/ml, with a sensitivity of 88%, specificity of 80%, positive predictive value of 81%, negative predictive value 87%, and area under the receiver operating characteristic curve 0.939. While the serum level of B7-H4 cut-off was 33 ng/ml, sensitivity 80%, specificity 72%, positive predictive value 74%, negative predictive value 78%, and area under the curve 0.916. Conclusion High sensitivity and specificity of B7-H4 were observed while detecting MPE. The PF level of B7-H4 is more sensitive, specific, and accurate in the diagnosis of MPF than the serum level of B7-H4.

Chronic right lung abscess with empyema thoracic presenting as continuous high-grade fever: A case report

ABSTRACT A lung abscess is a microbial infection of the lungs. An empyema is an accumulation of pus in the pleural space that increases after infection of either lung or pleura generally. The sign of empyema is similar to that of lung abscess in that the patient has complaints of high-grade fever, chest pain, and productive cough. Here, we present the report of a patient who was admitted with high-grade fever, which could not be treated despite aggressive medical treatment due to underlying lung pathology. A 30-year-old woman started having right-sided chest pain; subsequently, she developed fever, which was continuous and high grade in character, for which she visited a local doctor. Right-sided intercostal drainage was done in that hospital, but neither too much drain came out nor she experienced relief in symptoms. Then, she was referred to a tertiary care center in Delhi for further treatment. She got re-evaluated there. During hospitalization, despite treatment with intravenous (IV) paracetamol and third-generation IV antibiotics, the fever did not come down, and hence she was planned for emergency posterior lateral thoracotomy to deal with the underlying pathology causing persistent high-grade fever. High-risk consent was taken for right side thoracotomy and patient was operated in a febrile condition. She was discharged on the third postoperative day with the chest tube in situ. The fever could not be treated for last 3 months despite aggressive medical treatment. Evacuation of pus from the pleural cavity was mandatory here because it was the primary focus to reduce the high-grade fever of patient.

Correlation of Pleural Fluid Analysis with Thoracoscopy Guided Biopsy in Undiagnosed Exudative Pleural Effusion

Abstract Background: Despite having a high burden of tuberculosis (TB) and thus pleural effusions, there is very little data or studies available based in India on pleural fluid analysis and thoracoscopic-guided biopsy, and their correlation with each other. The aim of this study was to compare and correlate various parameters of pleural fluid analysis with thoracoscopic-guided biopsy especially in undiagnosed pleural effusions in Indian setting. Patients and Methods: This prospective observational study was carried out in a total of 40 patients above 18 years of age after obtaining institutional ethics committee clearance and written informed consent who were admitted in the Department of Pulmonary Medicine, Sarvodaya Hospital and Research Centre, from August 2022 to January 2024 covering a total duration of 18 months. The data were entered into MS excel and analyzed by SPSS statistical software. Descriptive statistics such as frequency, standard deviation, and t-test was used to determine level of statistical significance which was set at 0.05. Results: The mean age of the study participants was found to be 53.23 ± 19.95 years, male-to-female sex ratio was 1.6:1. The most common cause of exudative pleural effusion was tuberculous pleuritis (40%) followed by malignancy (22.5%). Shortness of breath (67.5%) and chest pain (50%) were the predominant clinical symptoms. Malignant pleural effusions showed a polymorphic predominant cytology while lymphocytic predominant cytology was present in chronic inflammatory effusions predominantly tubercular. Parapneumonic effusions exhibited elevated adenosine deaminase (ADA) levels and more neutrophils in pleural fluid, whereas tubercular effusions demonstrated increased ADA levels with abundance of lymphocytes. Metastatic adenocarcinoma was the most common type of malignancy found on histopathology. Necrotizing granulomatous inflammation and granulomas were the predominant findings on histopathological examination and imprint cytology, observed in 40% and 35% of the study participants, respectively. Pleural biopsy has a significantly higher diagnostic yield for TB as well as malignancy (P < 0.05). Conclusion: Medical thoracoscopy serves as an effective, safe, and well tolerate diagnostic tool for pulmonologists in assessing undiagnosed pleural effusions postthoracentesis.

Characterizing Risk Factors Associated With Recurrent Pleural Effusions in the Lung Transplant Recipients.

Pleural effusions remain a common postoperative complication following lung transplantation, occurring in 10% to 26% of cases. We aimed to explore potential clinical or radiographic features associated with clinically significant post-lung transplant pleural effusions requiring repeat interventions for their management. Lung transplantation recipients who underwent thoracentesis at our institution between June 2012 and October 2022 were reviewed. In total, 77 patients were included. Data were collected via the electronic health record and adjudicated through direct chart review. Patients were stratified by the need for a single thoracentesis (control group) or additional interventions, including serial thoracentesis, pigtail placement, and surgery (composite group). The computed tomography (CT) of the chest before the first thoracentesis was reviewed by a thoracic radiologist who was blinded to patient outcome. Single thoracentesis was used to manage 25 (32.5%) patients, 4 (5.2%) required multiple thoracenteses, 42 (54.5%) required a pigtail catheter, and 6 (7.8%) required decortication for definitive management. In the composite group compared with the control group, who were managed by a single thoracentesis, there was an increased incidence of loculations (36.8% vs. 8%, P=0.01), rounded atelectasis (22.8% vs. 4%, P=0.05), and larger effusion size (P=0.01). The composite group had higher pleural fluid eosinophils (0.33% vs. 0% in control, P = <0.01) and monocytes (14.8% vs. 7.3%, P=0.04) levels. Baseline imaging, such as larger effusion size, loculations and rounded atelectasis, and pleural fluid cell profile with increased eosinophils and monocytes, can potentially identify clinically significant and refractory pleural effusions.

The diagnostic accuracy of HE4 in the differential diagnosis of pleural effusions

BackgroundPleural effusions are challenging to diagnose, with approximately 20–50% of malignant effusions not diagnosed by cytology. Human epididymal protein 4 (HE4) may be useful in the differential diagnosis of pleural effusions. In serum, this biomarker shows false-positive results in some benign diseases. The aim of this study was to evaluate the diagnostic utility of HE4 in this setting and to identify false positives. MethodsConcentrations of HE4, adenosine deaminase, % polynuclear cells, and C-reactive protein, were determined in 238 pleural fluid samples and the estimated glomerular filtration rate (eGFr) in serum. ResultsHE4 values ​​differed significantly (p < 0.01) between malignant [median (IQR)] [1065 (2085)] pmol/L and benign effusions [699 (589)] pmol/L. HE4 concentrations in gynecological and pulmonary tumors were significantly higher than in other tumors.For a cut-off point of 3050 pmol/L, 22 % sensitivity and 100 % specificity were obtained.In patients with benign disease, significant increases in HE4 were identified only in those with eGFr < 30 mL/min/1.73 m2 [1050(596)] pmol/L, and not in those with eGFr > 30 mL/min/1.73 m2 [597(532)] pmol/L).Two cut-offs were established for maximum specificity, depending on the eGFr: 3050 pmol/L for eGFr < 30 mL/min/1.73 m2 and 1992 pmol/L for eGFr > 30 mL/min/1.73 m2. A sensitivity of 28.5 % was obtained for patients with eGFr > 30 mL/min/1.73 m2 and 36.3 % for patients with eGFr < 30 mL/min/1.73 m2. The sensitivity using a specific cut-off point was 29.7 %. ConclusionsThe determination of HE4 in pleural fluids demonstrates high specificity and low sensitivity. The use of specific cutoff points that are clinically adjusted improves sensitivity while maintaining maximum specificity.

Utility of pleural fluid-derived extracellular vesicles as a source of Mycobacterium tuberculosis antigens MPT51 and MPT64 for pleural TB diagnosis: a proof-of-concept study.

Extracellular vesicles (EVs) have recently emerged as a source of microbe-specific biomarkers for disease diagnosis. In the present study, we evaluated the utility of pleural fluid-derived extracellular vesicles (pEVs) as a source of Mycobacterium tuberculosis (M. tb.) antigens for pleural TB (pTB) diagnosis. EVs were isolated from pleural fluid (PF) samples and were characterized by scanning electron microscopy and immunoblotting targeting CD63 and LAMP2 markers. Antigen-detection ELISAs were developed for 2 M. tb.-specific antigens, MPT51 and MPT64 in pEVs (pEV-ELISA) and direct PF samples (PF-ELISA), and evaluated on n=86 samples in a blinded manner. Cut-off values were calculated by ROC-curve analysis to achieve 90% (95%CI:73.47-97.89) and 86.67% (95%CI:69.28-96.24) specificity for MPT51 and MPT64 pEV-ELISA respectively. The sensitivity of pEV-ELISA was 71.43% (95%CI;29.04-96.33) for MPT51 and 57.14% (95%CI;18.41-90.1) for MPT64 antigens in the ‘Definite’ pTB group, while in the ‘Definite and Probable’ pTB group, the sensitivity was 62.86% (95%CI:44.92-78.53) for MPT51 and 65.71% (95%CI:47.79-80.87) for MPT64. Performance of PF-ELISA was sub-optimal, with 28.57% (95%CI:3.67-70.96) and 14.29% (95%CI:0.36-57.87) sensitivity for MPT51 and MPT64 in ‘Definite’ pTB group respectively. We conclude that M. tb.-antigens are concentrated in the EV-fraction of PF samples and EVs can be utilized for antigen-detection assays for pTB diagnosis. (200 words)

Tunneled Pleural Catheters: An Effective Nonsurgical Alternative for Nonexpandable Lung in Chronic Pleural Infection.

Open window thoracostomy (OTW) is the standard of care for debilitated patients with chronic pleural infection and nonexpandable lungs (NEL) who are not candidates for major surgical intervention. Tunneled pleural catheters (TPC) offer tremendous treatment potential in this setting based on their efficacy in malignant pleural effusion and NEL. We aim to assess the efficacy, safety, and health care utilization of TPC in this setting. We retrospectively evaluated patients who underwent TPC procedures for the long-term management of chronic pleural infection and NEL who were not candidates for major surgical intervention. Clinically, complete treatment success was defined as fever abatement, normalization of white cell count, and stoppage of antimicrobial therapy without requiring surgical intervention. It is deemed a partial success if chronic antimicrobial suppression is still needed. There were 20 patients who had TPC placed for chronic pleural infection with NEL. Clinical and partial treatment success was achieved in 9/17 and 8/17 patients, respectively, excluding 3 patients who were placed on comfort measures only. The median change in pleural volume was -218 mL. The median length of stay after TPC placement was 4.5 days. TPC was removed in 8 patients due to successful obliteration of pleural space in a median duration of 46.5 days. Four patients passed away with TPCs in place, 7 retained TPCs at the last health care system contact, and 1 patient had OTW due to TPC failure. This exploratory study suggests that TPC is an effective and safe intervention for the management of patients with chronic pleural infection and NEL lung who are not candidates for surgical intervention.

American Association of Bronchology and Interventional Pulmonology Essential Knowledge in Interventional Pulmonology Series: Selected Topics in Malignant Pleural Disease.

The goal of the American Association of Bronchology and Interventional Pulmonology Essential Knowledge in Interventional Pulmonology Series is to provide clinicians with concise, up-to-date reviews of important topics in the field of interventional pulmonology. This 3-year alternating rotation of primary topics will start with a focus on selected topics in malignant pleural disease. In this article, we update the reader on malignant pleural effusion in 3 parts: part 1-diagnosis, focusing on imaging and fluid biomarkers; part 2-management, with review of multimodal approaches, cost considerations, and evolving targeted therapies; and part 3-pleural mesothelioma. These reviews complement the Essential Knowledge in Interventional Pulmonology Lecture Series presented at the 2023 AABIP Annual Conference, available for viewing on the AABIP website (https://aabip.memberclicks.net/essential-knowledge-in-interventional-pulmonology-series).

RUPTURED PULMONARY HYDATID CYST PRESENTING AS PLEURAL EFFUSION IN A THIRD TRIMESTER PREGNANT WOMAN

Background: Hydatid disease is a zoonotic disease caused by infection with Echinococcus granulosus .Pulmonary hydatid cyst often becomes symptomatic after cyst rupture in the pleural cavity or bronchus.Pulmonary hydatid cyst may be misdiagnosed and therefore patients may receive inappropriate treatment.In this case, a 27-year-old full term pregnant female presented with sudden onset dyspnea and hypoxia. Upon further evaluation, it was found to be a ruptured hydatid. Case Report: A 27 year old full term(36 weeks) pregnant patient was admitted with sudden onset of dyspnea,fever and hypoxia(SpO2-84% (RA)).Patient was evaluated and obstetric parameters were found to be within normal limits. Chest X-Ray revealed a right homogenous opacity with CP angle blunting.Diagnostic thoracocentesis showed an exudative effusion which was pale in colour.Immunoglobin-G enzyme-linked immunosorbent assay for Echinococcus was positive.HRCT Thorax showed a right sided ruptured hydatid cyst.ICDT insertion was done,fluid drained and Abendazole was started.Patient showed progressive improvement and had a normal vaginal delivery. A seven months follow up found the patient to be healthy and free of symptoms. Discussion: Pulmonary hydatid cyst most commonly appears in the lower lobe of the right lung, and is usually solitary. These cysts may initially be asymptomatic.Pulmonary hydatid cysts rupture in about a third of patients,leads to secondary hydatid spread, asphyxia, anaphylactic shock, acute respiratory failure, massive hemoptysis, and circulatory collapse.Ruptured pulmonary hydatid cyst may be misdiagnosed as pneumonia, tuberculosis, lung abscess, tumor, or pneumothorax. Conclusion:Hydatid cyst rupture should be suspected in patients from areas where Echinococcus is endemic.In symptomatic cases surgical excision with Tab.Albendazole for minimum 3 to 6 months duration is the main stay of treatment.