Pleural infection results from bacterial entry and replication in the pleural space. Patients with pleural infection are a challenging subset, where appropriate antibiotic therapy, tube thoracostomy drainage, intrapleural enzymatic therapy (IET), and surgery are cornerstones of management. The factors influencing IET success remain unclear. A retrospective analysis of patients who received IET for pleural infection in our health system was conducted to identify factors associated with treatment outcomes. The electronic health record was queried for dispense and administration of intrapleural tPA and DNase between January 2018 and May 2024. Patients were included if they were over 18 years old with complicated parapneumonic effusion/empyema, had a CT chest within 1 day before thoracostomy tube insertion, received IET and had a follow-up CT chest within 7 days after the last IET dose. Volumetric analysis was performed for all patients. The clinical outcome was treatment success (clinical and radiologic improvement without need for surgical intervention). Of 185 patients included in the final analysis, 57 patients had treatment failure. The mean age was 56.8 years and were predominantly males. Pleural fluid biochemistry showed median pH and LDH were 7.00 and 1129U/L. Streptococcus species was the most common microbe in pleural cultures. Multivariable logistic regression analysis showed that a community source of infection was associated with treatment success, while a hospital source of infection was associated with a 71% risk of treatment failure [OR: 0.287 (95% CI: 0.115, 0.690); P = 0.006]. A community source of infection predicted treatment success with IET in our cohort.

The first case of Tritirachium oryzae isolated from pleural fluid of an Indian patient is reported. A 71 year old female patient who is a follow up case of carcinoma colon, presented with complaint of recurrent vomiting, pain abdomen and loss of appetite.

Umbilical venous catheters are frequently used when treating premature and sick newborns, to provide central access to medications, fluid, and nutrition. Pleural, pericardial, and intra-abdominal effusions are rare but can be fatal complications in newborns after umbilical catheterization. This is the first reported case of simultaneous pericardial, pleural, and intra-abdominal leakage of parenteral nutrition from a properly placed umbilical venous catheter. We present a case of a preterm infant of Northern European descent, born at gestational age of 29 weeks, with a birth weight of 890 g. She received a properly placed umbilical venous catheter shortly after delivery. On day 4 she became critically ill with respiratory failure and required ventilator support for 5 days. She was also hypotensive and received vasopressor treatment for 2 days. Owing to kidney failure and hyperkalemia, she required dialysis treatment for 6 days. She was diagnosed with pleural effusion on the right side, pericardial effusion, and intra-abdominal effusion. The drained effusions were biochemically analyzed and were found to be consistent with parenteral nutrition. After the effusions were drained, she remained hemodynamically stable and was discharged from hospital at 2 months of age. At discharge, her creatinine level was ~100 µmol/L, requiring outpatient follow-up. A cerebral ultrasound and neurological examination at term were normal. Although rare, clinicians should remain vigilant for effusions involving pleural, pericardial, and abdominal spaces, even when umbilical venous catheter placement appears correct. Early recognition and intervention are critical to improving neonatal outcomes.

Penetrating cardiac injuries are uncommon but carry a high mortality rate, particularly when involving the left ventricle. Survival is rare because of rapid blood loss or cardiac tamponade before medical intervention. This case describes the forensic examination of a 27-year-old man who sustained a single stab wound to the left anterior chest inflicted by an unknown assailant. External examination revealed pallor of the conjunctivae and an open wound on the left chest. Internal examination demonstrated blood infiltration of the left anterior thoracic wall extending to the fourth intercostal space. Approximately 1,000 mL of blood was present in the left pleural cavity and 250 mL within the pericardial sac. The stab wound penetrated the pericardium and left ventricle, causing fatal hemopericardium and cardiac tamponade. This case shows how a single deep chest wound can rapidly cause death and highlights the value of detailed autopsy in determining cause and manner of death.

INTRODUCTION. In surgical treatment of early peripheral lung cancer, accurate intraoperative visualization of the tumor and determination of tumor growth boundaries remain a problem.The OBJECTIVE was to develop a methodology and analyze the first results of intraoperative infrared fluorescence diagnosis of lung neoplasms.METHODS AND MATERIALS. The study included 27 operated patients with lung neoplasms of various histological types. Each patient immediately after performing access, as well as on the ex vivo, underwent an attempt at fluorescence imaging of the removed tumors in the near-infrared spectrum, as well as the presence of other foci of fluorescence. The fluorescence intensity was quantified. Indocyanine green lyophilizate with Human Albumin 20 % was used as a fluorescent agent, and the MMC SCOPE ICG system was used to visualize infrared fluorescence.RESULTS. Infrared fluorescence was used to visualize 21 out of 31 (68 %) neoplasms in 20 out of 27 (74 %) patients. When comparing fluorescent and non-fluorescent foci, there was no correlation between the presence of fluorescence and the histological structure, the size of the neoplasms and the presence of invasion of the visceral pleura. Fluorescence diagnostics also revealed in 3 patients (11 %) an additional 4 CT-negative foci ranging in size from 0.5 to 10 mm, all of which turned out to be malignant tumors.CONCLUSION. The method of fluorescent intraoperative diagnosis is safe and informative, it allows to visualize intrapulmonary neoplasms in 74 % of patients, as well as to identify Rg-negative tumor foci in 11 % of patients.

Pleural effusion is a common complication of lung diseases that requires rapid and accurate diagnosis. However, conventional diagnostic methods are often time-consuming and resource-intensive. Surface-enhanced Raman spectroscopy (SERS) offers a promising, label-free alternative for pleural fluid analysis but remains largely unexplored. In this pilot study, we developed a practical workflow for SERS-based pleural fluid analysis, incorporating preprocessing steps to convert noisy raw data into interpretable spectra, with protein depletion identified as a critical step. Using the optimized SERS protocol, pleural fluid spectra were compared with urine and protein-depleted serum profiles, revealing significant contributions from purine metabolites, particularly uric acid. Moreover, we identified distinct spectral signatures for transudative and exudative pleural fluids. Transudates exhibited sharper, more intense peaks and greater inter-sample variability, whereas exudates showed higher spectral reproducibility, as further supported by Principal Component Analysis. These findings highlight the potential of SERS, implemented with a portable Raman spectrometer, as a rapid, label-free, and cost-effective tool for pleural fluid assessment. Nevertheless, these results are preliminary, and further validation in larger and more diverse patient cohorts is required before integration into point-of-care diagnostic workflows.

Abstract Background Exudative pleural effusion (EPE) remains a diagnostic and therapeutic challenge. Inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR), have been proposed as non-invasive, cost-effective tools for diagnosis and prognosis. This study aimed to evaluate the diagnostic accuracy and prognostic significance of pleural fluid NLR and MLR in EPE. Methods This prospective cohort study included 60 patients with EPE at Alexandria Main University Hospital. Pleural fluid was analyzed for cell differentials, including neutrophils, monocytes, and lymphocytes. NLR and MLR were calculated. Diagnostic accuracy in differentiating malignant from non-malignant effusions and prognostic outcomes, including ICU admission, 30-day mortality, and recurrence, were evaluated. Results NLR and MLR were significantly lower in malignant pleural effusions (NLR: 1.21 ± 0.68; MLR: 0.19 ± 0.09) compared to benign effusions (NLR: 2.65 ± 1.24; MLR: 0.34 ± 0.13), with p < 0.001. A high NLR was significantly associated with ICU admission (30% vs. 10%, p = 0.03), higher 30-day mortality (20% vs. 3.3%, p = 0.04), and recurrence (36.7% vs. 13.3%, p = 0.02). Conclusion Pleural fluid neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios are practical, inexpensive, and non-invasive markers for differentiating between malignant and benign exudative pleural effusions. Moreover, high NLR values correlate with adverse clinical outcomes, making it a potential tool for prognostication. Incorporating these markers into routine pleural fluid analysis could enhance diagnostic accuracy and inform management strategies, especially in settings with limited resources.

Abstract Background Cryptococcus neoformans infection occurs more frequently in immunocompromised individuals, with pulmonary and cerebral forms being the most common. Among pulmonary manifestations, pleural effusion in cryptococcosis is an exceptional presentation. Methods We present a series of four cases of cryptococcosis with empyema caused by Cryptococcus neoformans diagnosed at a single centre and we conducted a systematic review of the literature on cases of cryptococcal pleural effusion. 32 were selected for data extraction and analysis. Results The median patient age was 59 years, with 72% over 50 years old. The infection was more common in males (72%). 62% cases were disseminated infection and 34% localized. Cryptococcus neoformans was the most frequent species (90%). Common predisposing factors included cirrhosis (22%), solid organ transplantation (12.5%), and malignancy (19%). HIV infection was infrequent (6%). Pleural effusions were unilateral in 67% of cases and bilateral in 32%. Radiological findings included consolidations (25%), ground-glass opacities, nodules and pleural thickening (15%). Cryptococcal serum antigen was positive in 64% of tested cases, and blood cultures were positive in 57% as well. Lumbar puncture detected Cryptococcus in 7 of 20 cases tested. Microbiological confirmation from pleural fluid was achieved in 75% of cases, with antigen testing aiding diagnosis when cultures were negative. Additional methods included pleural biopsy (positive in 8 cases), bronchoalveolar lavage, EBUS-TBNA, and lung tissue staining. Pleural fluid analysis revealed mostly exudates with lymphocytic predominance (67%). Adenosine deaminase levels were below 35 UI/L in 90% of the tested cases. Glucose and pH values were generally normal. Mortality was documented in 37% of cases. Conclusions Cryptococcal pleural infection is rare and mainly affects immunocompromised, older males, often with disseminated disease. Pleural effusions are typically lymphocyte-predominant and unilateral. Cryptococcal antigen detection in pleural fluid improves diagnosis, especially when cultures fail. Despite treatment, mortality rates remain notably high.

To evaluate the efficacy and safety of elemene pleural instillation in peritoneal dialysis (PD) patients with pleuroperitoneal communication (PPC). This single-center retrospective study enrolled PD patients with PPC who received elemene between October 2020 and January 2022. The diagnosis was confirmed by computed tomography peritoneography (CTP), demonstrating contrast medium in the pleural cavity. Patients received intrapleural elemene (200-400 mg/m2) once or twice weekly. Primary outcomes included treatment efficacy, changes in laboratory parameters, recurrence and safety. In this study 12 patients were included. After elemene instillation (median follow-up 14.1 months), 10patients (83.3%) successfully resumed continuous ambulatory peritoneal dialysis. Drug-related adverse events occurred in 9patients (75.0%): chest pain alone (5, 41.7%) and chest pain with fever (4, 33.3%). All events were CTCAE grade1 (7, 58.3%) or2 (2, 16.7%). No significant pretreatment to post-treatment changes were observed in renal function (eGFR), coagulation parameters (PLT, PT, TT, APTT) or dialysis adequacy (Kt/V, Ccr) (all P > 0.05). Elemene pleural instillation appears safe and effective for PD patients with PPC, facilitating resumption of continuous ambulatory peritoneal dialysis.

Disseminated primary multidrug resistant tuberculosis with concurrent pleural and oral cavity involvement: the first reported case

Solitary fibrous tumor of the pleura is an uncommon neoplasm that originates from the mesenchymal cells of the pleura (mainly the visceral pleura). It represents <5% of pleural tumors. It is generally slow-growing and benign in behavior, although 10–20% may exhibit malignant features. It affects adults without sex predilection and is often diagnosed incidentally during imaging studies. Clinically, most patients are asymptomatic, although some may present with chest pain, cough, dyspnea, or, in rare cases, paraneoplastic hypoglycemia. CT or MRI imaging typically shows a well-defined pleural mass, usually pedunculated, which may displace adjacent structures without invading them. Definitive diagnosis requires histopathological examination. The treatment of choice is complete surgical resection, which is usually curative. Prognosis is generally favorable; however, due to the risk of recurrence or malignant transformation, long-term follow-up with periodic imaging is recommended. We present the case of a 67-year-old man with respiratory symptoms whose chest CT revealed pulmonary masses in the left hemithorax; biopsy findings were consistent with a solitary fibrous tumor.

Fungal pleural effusion (FPE) is an uncommon cause of pleural infection, accounting for only 1%–3% of all cases. It usually occurs in immunocompromised individuals, such as those with malignancy, diabetes, human immunodeficiency virus (HIV), or chronic steroid use. We report a rare case of left-sided Candida-associated pleural effusion in an 85-year-old man with no known comorbidities or immunosuppressive condition. The patient presented with left-sided chest pain and weakness for two weeks. The pleural fluid analysis showed an exudative, lymphocyte-predominant effusion with low adenosine deaminase (ADA) levels. Medical thoracoscopy with pleural biopsy revealed fungal hyphae consistent with Candida species, confirming the diagnosis. The patient was treated with oral fluconazole 200 mg twice daily for eight weeks, showing marked clinical improvement and radiological resolution without the need for surgical intervention. This case highlights that FPE can occur even in immunocompetent individuals, emphasising the need for early pleural biopsy and timely antifungal therapy in undiagnosed exudative effusions

BackgroundCommunity-acquired pneumonia (CAP) remains a major cause of hospital admission and mortality, yet the causative pathogen is rarely identified. Conventional diagnostics, including sputum culture, blood culture and multiplex PCR, lack sensitivity, breadth, or speed. Consequently, most patients receive empirical antibiotics, with implications for antimicrobial stewardship and patient outcomes. Invasive sampling (e.g. bronchoalveolar lavage) improves diagnostic yield but is often impractical in routine care. Nanopore metagenomic sequencing offers unbiased, real-time pathogen detection, but its utility using non-invasive specimens such as swabs and sputum remains underexplored.MethodsWe performed Nanopore-based metagenomic sequencing on 60 respiratory samples (46 nasopharyngeal swabs, 12 sputa, 2 pleural fluids) from 38 adults hospitalized with CAP and 8 matched controls. The higher number of swabs reflects the practical challenges of sputum collection in hospitalized CAP patients, where non-production is common. We also performed a paired analysis on patients who had both swab and sputum collected, enabling direct comparison of sample types. Protocols incorporated host DNA depletion, microbial and viral workflows, and rigorous bioinformatics (taxonomic classification, genome breadth and read dispersion metrics) to distinguish true pathogens from commensals. Sequencing results were compared with routine microbiological diagnostics and reviewed in a multidisciplinary clinical context.ResultsHost depletion reduced human DNA contamination and enriched microbial reads. Sputum consistently provided higher bacterial read counts (median 192 426 versus 14 025 per sample), deeper genome coverage and more uniform read distribution. Clinically relevant pathogens identified in sputum included Streptococcus pneumoniae, Streptococcus pyogenes, Moraxella catarrhalis and Mycoplasmoides pneumoniae. Two samples (one sputum and one swab) from a patient were confirmed as M. pneumoniae positive by qPCR but missed by routine diagnostic tests. Within patient comparison with paired swab-sputum samples showed that swabs were dominated by upper airway commensals (e.g. Dolosigranulum pigrum), whereas sputum reliably reflected lower respiratory tract infections. Metagenomics additionally identified polymicrobial infections and potential resistance determinants in sputum and pleural fluid samples.ConclusionsOur study demonstrates that sputum-based Nanopore metagenomic sequencing is a powerful, non-invasive alternative to invasive lower respiratory tract sampling in CAP. It improves pathogen identification and expands coverage beyond culture and PCR assays. By bridging laboratory workflows with clinical decision-making, this approach could improve CAP management—particularly for patients able to provide sputum —by supporting rapid targeted therapy, optimizing antibiotic use and reducing diagnostic uncertainty in one of the most common serious infections worldwide.ImpactThis work highlights the tangible clinical–laboratory connection: how metagenomic sequencing, applied to a readily available specimen, can shift pneumonia diagnostics from empiricism toward precision. The findings position sputum metagenomics as a scalable tool for hospitals, especially in settings where invasive sampling is not feasible, with direct relevance to antimicrobial stewardship programmes and patient outcomes.

Streptococcus pneumoniae (Sp) is the leading bacterial pathogen causing complicated pneumonia, that is, with parapneumonic effusion/pleural empyema (PPE/PE). In 2022, there was a rise in group A Streptococcus (GAS)-complicated pneumonias in children. We reviewed the clinical characteristics of Sp- or GAS-complicated pneumonias admitted to 4 Portuguese tertiary hospitals, in 2018-2023. Of the 128 cases, 107 were by Sp and 21 by GAS, with a rise in PPE/PE in 2023. Pathogens were identified by molecular methods (89.8%) or culture (16.4%) from pleural fluid or blood. The mean age was 3.8 years (standard deviation 2.9) and 52.3% were male. Children with GAS PPE/PE were more likely to have rash (57.1% vs. 3.8%, P < 0.001), pharyngitis (52.4% vs. 19.8%, P = 0.004), septic shock (28.6% vs. 0.9%, p<0.001), higher procalcitonin (PCT) (80 vs. 2.13 ng/mL, P = 0.005), higher rates of admission to the intensive care unit (81.0% vs. 55.1%, P = 0.030) and of invasive mechanical ventilation (38.1% vs. 11.2%, P = 0.005). Fatality rate was similar in both groups (4.8% vs. 0%, P = 0.164). Among cases where genotyping was possible, 4/7 GAS were emm1 (3/4 M1UK sublineage, all in 2023) and 64/88 Sp were serotype 3. Sp serotype 3 remains the leading cause of PPE/PE in children in Portugal. The increase in GAS PPE/PE cases in 2023 followed an expansion of the M1UK sublineage in Portugal. GAS should be considered, especially in children presenting with rash, pharyngitis or higher PCT levels. Adequate antimicrobial and clinical management of GAS PPE/PE could be crucial to improve outcomes.

Liquid biopsies enable non-invasive monitoring and characterization of metastatic cancer, primarily through circulating tumor DNA (ctDNA) in blood. The representativeness of all metastatic sites in these liquid biopsies and the clinical relevance of other body fluids remain uncertain. We performed low-pass whole genome sequencing on 216 liquid and 745 metastatic tissue samples from 20 autopsied female patients with metastatic breast cancer to assess ctDNA detection, fraction, and site representativeness in seven body fluids (blood, ascites, cerebrospinal fluid, pericardial fluid, pleural fluid, saliva, and urine). Complementarily, whole exome sequencing on 86 liquid samples from 11 patients explored mutational information. ctDNA was detected in all fluids, but most frequently in blood, followed by ascites, pleural fluid, and cerebrospinal fluid. Phylogenetic reconstruction indicated that site representativeness varies by fluid type. Mutational and gene-level copy number analyses revealed clinically relevant information unique to non-blood fluids. These findings suggest a multi-fluid approach could enhance metastatic cancer monitoring and characterization.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus usually seen in asthmatic individuals, with pleural involvement being exceedingly uncommon. We describe a 23-year-old female with poorly controlled asthma who presented with progressive dyspnoea, chest pain, and left pyo-pneumothorax. Imaging demonstrated complete obstruction of the left main bronchus by a mucus plug with evidence of contralateral bronchiectasis. Laboratory evaluation revealed markedly elevated total IgE levels (6351.8 IU/mL) and raised specific IgE and IgG antibodies to A. fumigatus , fulfilling the modified ISHAM diagnostic criteria for ABPA. The patient was managed with systemic corticosteroids and itraconazole, leading to significant symptomatic and radiological improvement, with resolution of the air leak although minimal pleural thickening persisted as sequela. Pleural disease in ABPA is rarely reported, with published cases including effusion, hydropneumothorax, empyema, and pyo-pneumothorax, attributed to immune-mediated pleural inflammation, secondary infections related to therapy, or advanced fibrotic disease. Misdiagnosis as tuberculosis is frequent in endemic regions due to overlapping radiological features, often delaying appropriate therapy. Our case adds to the limited literature by highlighting pyo-pneumothorax as a potential presentation of ABPA, expanding its clinical spectrum beyond the conventional manifestations. The favorable outcome following combined corticosteroid-antifungal therapy reinforces the importance of early recognition and multidisciplinary management to prevent morbidity associated with such complications. Clinicians should remain vigilant when evaluating pleural involvement in asthmatics with elevated IgE and bronchiectasis, as timely diagnosis and targeted treatment can significantly improve outcomes.

T-cell lymphoblastic lymphoma (T-LBL) is a rare and aggressive form of Non-Hodgkin's lymphoma, comprising less than 1% of all adult NHL cases. The co-existence of peripheral eosinophilia with T-LBL is an exceptionally uncommon presentation with significant prognostic implications. We present a case of a 34-year-old male poultry farmer who presented with right-sided pleuritic chest pain, dyspnea on exertion, and dry cough. Clinical and radiological investigations revealed right-sided pleural effusion with anterior mediastinal mass encasing the superior vena cava and ascending thoracic aorta. Pleural fluid analysis demonstrated exudative features with elevated adenosine deaminase (ADA), while absolute eosinophil count was markedly elevated (&gt;1900/µL). Histopathological examination of CT-guided mediastinal biopsy confirmed T-cell lymphoblastic lymphoma with immunophenotyping showing positivity for TdT, CD3, CD4, CD5, CD7, CD8, CD10, and BCL2. The presence of concurrent peripheral eosinophilia associated with T-LBL is documented in only a few cases globally and carries poor prognostic implications with high risk of subsequent myeloid neoplasia. This case highlights the importance of comprehensive evaluation of unexplained hypereosinophilia and the diagnostic challenges in recognizing this rare clinicopathological entity. Keywords: T-cell lymphoblastic lymphoma, eosinophilia, mediastinal mass, non-Hodgkin's lymphoma, immunophenotyping

BackgroundMalignant pleural effusion (MPE) is common, affecting approximately 15% of patients with cancer. Over recent years, there have been significant changes in both the diagnostic and therapeutic strategies for the condition, and recent epidemiological studies have shown improvements in survival across most major cancer types. However, it is currently unclear whether there has been an increase in survival in patients with MPE.MethodsMedical records of patients diagnosed with MPE between 2015 and 2023 at Oxford University Hospitals were retrospectively reviewed. Patients were split into groups of equal size based on the date of MPE diagnosis and Kaplan-Meier survival analyses were performed. Subgroup analyses were conducted in patients with MPE by causative cancer type, performance status at diagnosis and treatment with systemic anti-cancer therapy. Cox regression analyses were carried out using the individual year of MPE diagnosis as an included variable.Results742 patients with MPE were included. There was no improvement in survival length in patients managed in more recent years. This was consistent across effusions secondary to any primary malignancy; effusion secondary to lung cancer, mesothelioma or breast cancer; in patients with better performance status; and in patients who received systemic anti-cancer therapy.ConclusionsDespite recent changes in the management of MPE and improving survival trends in cancer overall, survival time following the development of MPE appears to have remained stagnant over the 8-year time period under study. This suggests that MPE should potentially be considered as a discrete clinical entity, necessitating investigation of oncological therapies specifically targeted to the pleural space.

Haptoglobin response in serum and pleural fluid of tuberculin reactor cattle assessed by culture and gross pathology.

Pleural effusion is the abnormal accumulation of fluid in the pleural cavity, which may result from infection, trauma, neoplasia or systemic disease. This condition often leads to acute respiratory distress in cats and requires immediate intervention. Thoracocentesis is the primary diagnostic and therapeutic method to evaluate the type of fluid and identify possible causative pathogens. This report to describe the management of pleural effusion in a four-year-old female Persian cat who presented with complaints of dyspnea, weakness, and decreased appetite. Physical examination and thoracic radiographs revealed fluid accumulation in the pleural cavity. Thoracocentesis was performed at the 7th or 8th intercostal space after the area was shaved and sterilized. The cat was placed in lateral recumbency and anesthetized before fluid aspiration with a syringe. Hematological examination revealed anemia, while radiographs showed radiopaque areas on the thorax. The aspirated fluid was clear pale yellow in color. Bacterial culture on NA medium revealed microbial growth, indicating infection as one of the causes of the effusion. In conclusion, thoracocentesis plays an important role in the diagnosis and therapy of pleural effusion, and helps speed up the patient's recovery. The cat recovered and was discharged after six days of intensive care.