Recurrent Pleural Effusion Research Articles

Treatment of Chylothorax complicating pulmonary resection with hypertonic glucose Pleurodesis

BackgroundTo retrospectively assess the efficacy of hypertonic glucose pleurodesis for treatment of chylothorax after pulmonary resection.MethodsOut of a total of 8252 patients who underwent pulmonary resection (at least lobectomy) at department of thoracic surgery, between June 2008 and December 2015, 58 patients (0.7%) developed postoperative chylothorax. All patients received conservative treatment, including thoracic closed drainage, oral fasting, and total parenteral nutrition.ResultsConservative treatment was successful in 50 (86.2%) patients, while eight patients [mean age: 58.0 years (range, 45–75)] were treated with hypertonic glucose pleurodesis. All eight patients had undergone operation for lung cancer (four squamous cell carcinomas and four adenocarcinomas). The bronchial stump was covered by pleural flap in three patients. After pleurodesis, three patients developed fever but without empyema; thoracentesis was performed in two patients. The mean time interval between pleurodesis and operation was 4.3 days (range,3–5) days. The average length of stay was 23.1 days (range, 18–31). No recurrent pleural effusion was observed over a mean follow-up duration of 28 months.ConclusionHypertonic glucose pleurodesis performed via the chest drainage tube is a viable treatment option for chylothorax after lung resection, prior to resorting to a thoracoscopic or thoracotomic ductus thoracicus ligation of the thoracic duct leak. It is a simple, safe and efficient modality associated with rapid recovery and less pain.

Multifocal pleural capillary hemangioma: a rare cause of hemorrhagic pleural effusion-case report

BackgroundCapillary hemangioma can be found in many organs, but rarely in pleura. Previously, only localized pleural capillary hemangioma cases have been reported. Corticosteroids are the most commonly recommended drugs in capillary hemangioma.Case presentationHere, we present a case of a young woman with recurrent hemorrhagic pleural effusion. Despite repeatedly thoracentesis, the routine examinations, including chest computed tomography (CT) scan, pleural effusion biochemical test, and cytology all failed to make a definite diagnosis. Thus, single port video-assisted thoracoscopy (VATS) was then performed. Numerous nodules arising from the parietal pleura were found, and biopsies showed multifocal pleural capillary. However, recurrent pleural effusion was successfully managed by oral azathioprine, after failure of dexamethasone treatment.ConclusionsTo our knowledge, this is the first case of a patient with recurrent hemorrhagic pleural effusion masquerading as malignant pleurisy, but in fact caused by multifocal pleural capillary hemangioma.

Surgical management of pleuro-peritoneal fistula in chronic renal failure patient-safety and effectiveness.

BackgroundPleuro-peritoneal fistula (PPF) is a known complication arising in patients receiving continuous ambulatory peritoneal dialysis (CAPD) as a form of renal replacement therapy with an incidence of approximately 2% (1). Previous literature has shown that the recurrence rate of non-operative management of PPF to be ~45%. Video-assisted thoracoscopic surgery (VATS) has been shown to be an effective and safe means of treating patients with PPF. However, to the author’s knowledge, there is currently no sizeable case series that discuss the various intra-operative findings, operative techniques employed, post-operative complications, duration of peritoneal dialysis suspension and fistula recurrence in this particular patient group.MethodsFrom January 2009 to January 2019, patients who underwent VATS for the repair of PPF at The Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, Hong Kong were retrieved from the Clinical Data Analysis and Reporting System (CDARS). Patient’s epidemiological data, comorbidities and surgical data were analyzedResultsThere were 35 patients who underwent VATS PPF repair in our series. The mean age was 60.8 years (44 to 82 years), the (54.3%), mean operative time was 60.8 minutes (15–224 minutes). There were 8 patients (25.8%) who suffered from recurrence of pleural effusion after re-initiation of CAPD. Concomitant use of mechanical and talc pleurodesis was statistically significant in preventing PPF recurrence with an odds ratio of 0.1201 when compared to non-operative techniques. One patient suffered from hemothorax requiring re-operation on post-operative day one. There were no 30-day mortalities.ConclusionsVATS appears to be a safe and effective surgical treatment to prevent recurrence of continuous peritoneal dialysis associated PPF. Concomitant mechanical and talc pleurodesis appears to have additional benefit.

Bilateral secondary pulmonary tuberculosis complicated with bilateral chylothorax: a case report

A 26-year-old female was admitted to the emergency department of thoracic surgery complaining of chest tightness, shortness of breath, and a history of bilateral tuberculosis. A chest Computed Tomography (CT) scan showed bilateral pleural effusion. After that, the patient was implanted with bilateral intercostal drainage tubes. Further analysis of the pleural effusion was conducted to confirm the diagnosis of bilateral chylothorax. We initiated conservative treatment consisting of fasting and total parenteral nutrition. After the failure of conservative treatment, the patient underwent ligation of the thoracic duct by right-sided thoracotomy combined with talc slurry. On the first day postoperatively, the right pleural effusion had decreased significantly, while the left pleural effusion had not. Subsequently, talc slurry was injected into the left thoracic drainage tube of the patient. Bilateral pleural effusion was significantly reduced. Re-examination chest X-ray showed the disappearance of pleural effusion, and the patient was discharged good healthy. Chest X-rays were reexamined one month postoperatively, and the patient's lung was well dilated, with no recurrence of pleural effusion. In this case, it was shown that conservative treatment is the first choice for chylothorax. However, if this proves to be ineffective, early surgical treatment should be considered. Early diagnosis and timely surgical intervention are the key factors to improve the prognosis of patients.

A rare case of thoracic Gorham-Stout disease presenting with recurrent pleural effusions

A rare case of thoracic Gorham-Stout disease presenting with recurrent pleural effusions

Long-Term Survival Following Inadvertent Transplant Lung Venous and Pleural Migration of Lipiodol after Attempted Embolization for Post-Lung Transplant (Ltx) Chylothorax

<h3>Introduction</h3> Chylothorax is a rare complication after LTx resolving in a minority of cases with non-surgical management, primarily tube drainage, low-fat or parenteral nutrition and somatostatin analogues. In refractory chylothorax, surgical ligation and thoracic duct embolization have been used.¹ Thoracic duct embolization has been effectively undertaken with varying combinations of alcohol, coiling, glue or lipiodol (iodinated poppy seed oil).^2-3 Lipiodol is theorised to cause intraluminal inflammation and duct closure. Previous cases have reported profound lung injury with pulmonary embolization.^2,4-5 <h3>Case Report</h3> A 67-year-old woman underwent a left single LTx for Chronic Obstructive Pulmonary Disease. Her post-LTx course was complicated by acute kidney injury and pulmonary venous congestion with high chest drain output. 7 days post-LTx, a persistent chyle leak was noted. Failing medical management, methylene guided lymphangiography deployed 30ml lipiodol and alcohol into the cisterna chyli. Unfortunately, on subsequent imaging lipiodol had accumulated in the pleural space and the interstitium of the LTx with spread to the retrocural space and thoracic inlet (Fig. 1A). The patient remained in ICU for 3-weeks, requiring slow wean of invasive ventilation via tracheostomy. Despite initial concerns of permanent lung fibrosis post-lipiodol, there was progressive resorption over the next month. The patient was decannulated and discharged home without supplemental oxygen (Fig. 1B). She achieved her peak lung function 1 year following LTx (FEV1 50%, FVC 42%). Complete radiological clearance of lipiodol was noted at 3 years (Fig. 1C). She remains alive with stable Chronic Lung Allograft Dysfunction (FEV1 20%) 11 years following LTx with no recurrent pleural effusions. <h3>Summary</h3> This case shows long-term single LTx survival despite lipiodol escape during attempted embolization without development of fibrosis.

Tunneled Pleural Catheter to Manage Recurrent Post-Transplant Effusion

<h3>Introduction</h3> Pleural effusions after lung transplant (LT) are common and use of chest tubes is routine. Chronic pleural effusion post-LT, can impede attainment of best pulmonary function. Therapeutic interventions may include tube thoracostomy, pleural decortication, and pleurodesis. Due to concerns related to immunosuppression and fears of infection, tunneled pleural catheters (TPC) are not typically considered post-LT. <h3>Case Report</h3> A 71-year-old female with IPF underwent an uncomplicated right LT and chest tubes were weaned in the usual fashion. As an outpatient, pulmonary function and physical recovery were below expectations and imaging demonstrated pleural effusion. Given multiple recurrences despite tube thoracostomy and impaired physical recovery, a TPC was considered. Following sterile TPC placement, the patient was able to drain her effusion at home, while increasing participation in rehabilitation, ultimately achieving functional independence. The catheter was removed when pleural output was minimal and spontaneous pleurodesis was assumed. The patient suffered no infectious complications and at one-year, pleural effusion has not recurred. <h3>Summary</h3> Prolonged or recurrent pleural effusions following LT may cause dyspnea and impede functional recovery. While TPCs are typically used to control malignant or benign effusions, they can provide several advantages in the LT population. Tunneling reduces infectious risk, low profile avoids accidental dislodgement, and they can be placed and managed as an outpatient, avoiding setbacks associated with a surgical procedure. With malignant pleural effusions, these catheters relieve symptoms and by 6 weeks, 45% may achieve spontaneous pleurodesis. Though shown to be safe in a case series of LT recipients, these catheters are rarely used post-LT. Infection is a feared complication, though occurs in only 5% of patients, with empyema seen in about 3% of cases. In appropriately selected patients, TPCs may be a viable alternative to manage recurrent pleural effusions.

Spindle cell sarcoma of the right atrium causing right atrial pseudoaneurysm: a case report and review of the literature

BackgroundSpindle cell sarcomas of the right atrium are extremely rare primary cardiac tumours, with very few cases reported in the medical literature. Pseudoaneurysms caused by cardiac spindle cell sarcoma have never been reported worldwide.Case presentationA 32-year-old woman was referred to our hospital for recurrent pericardial haemorrhagic effusion and pleural effusion. Three-dimensional transthoracic echocardiogram, contrast chest CT, and contrast MRI revealed a pseudoaneurysm on the right side of the right atrium with a thrombus. There was a defect between the pseudoaneurysm and the right atrium. PET-CT suggested that FDG metabolism inhomogeneity increased in the mass in the right atrium. Exfoliative cytology detection of massive pericardial effusion and pleural effusion revealed no tumour cells. Spindle cell sarcoma of the right atrium was not confirmed until the patient underwent right thoracic exploration and biopsy. Before a confirmed diagnosis, symptomatic treatment, such as chest effusion and pericardium effusion drainage, and transfusion of red blood cells were mainly used to relieve the patient’s symptoms. Unfortunately, the patient was lost to optimal treatments and passed away 20 days after the pathological diagnosis was made.ConclusionThe prognosis of spindle cell sarcomas remains poor due to delays in diagnosis, early metastasis and few available therapeutic options. Recurrent pericardial effusion and pleural effusion, especially in the nature of haemorrhagic effusion, and/or right atrial pseudoaneurysm shown on the transthoracic echocardiogram must be considered and highly suspected as malignancy by patients and physicians. If the diagnosis cannot be confirmed, histopathology should be performed as soon as possible to avoid losing the best treatment opportunity.

The Use of Intrapleural Thrombolytic or Fibrinolytic Therapy, or Both, via Indwelling Tunneled Pleural Catheters With or Without Concurrent Anticoagulation Use

Indwelling tunneled pleural catheters are commonly used for recurrent pleural effusion management. Catheter obstruction is not uncommon, often requiring intrapleural medications instillation (i.e., alteplase) to restore flow. The safety profile of intrapleural medications has been previously published, however most studies exclude anticoagulated patients. What is the safety profile of intrapleural alteplase and/or dornase alfa when utilized in indwelling tunneled pleural catheters, including patients that may be undergoing active anticoagulation? Retrospective review of previously placed indwelling tunneled pleural catheters from January 2009 - February 2020 undergoing intrapleural alteplase. Basic demographics, laboratory studies, anticoagulation medication usage, and complications were collected. Descriptive statistics were used to report demographics and outcomes. Univariate Firth's logistic regression analyses were used to identify factors associated with complications, followed by multivariable regression analyses. A total of 94 patients underwent indwelling tunneled pleural catheter placement and intrapleural instillation. The median age of patients was 66.1 (IQR - 57.6-74.9) years. Intrapleural medications were administered 71 times in 30 anticoagulated patients and 172 times in 64 not anticoagulated patients. A total of 20 complications were identified in 18 patients, and one experiencing more than one complication. There were 5 bleeding complications with no significant increased risk with anticoagulation usage (2 anticoagulated, 3 not anticoagulated; p=0.092). Multivariable Firth's logistic regression demonstrated that alteplase dose (p=0.04) and anticoagulation usage (p=0.05) were associated with any complication, but not associated with bleeding complications. We report a relatively low incidence of complications and in particular, bleeding complications in patients receiving intrapleural alteplase for non-draining IPCs. Bleeding episodes occurred in 5/94 (5.3%) patients with no apparent increased risk of bleeding complication, whether receiving anticoagulation or not. Additional study is warranted to identify risk factors for complications, in particular bleeding complications in this patient population.

Thoracoscopic practices in India-a survey by Indian chest society

BackgroundDiagnostic thoracentesis is the initial diagnostic investigation in the workup of an undiagnosed Pleural effusion. However, a significant percentage of pleural effusions remain undiagnosed after this step and after closed pleural biopsy. Medical thoracoscopy (MT) has a high diagnostic yield in these patients. MT is now widely practised in India. This survey endeavours to study the practice of this technique by respiratory physicians in India. MethodsAn electronic survey called ‘Indian Thoracoscopy survey’ was prepared and conducted under the aegis of Indian Chest Society. In all there were 63 Questions in English prepared and disseminated as a “Google Form” to conduct this survey. The subjects were recruited from the e-mail lists of the three major professional surgeries that serve the interests of the respiratory physicians. The participation in the survey was voluntary and no incentive of any sort was offered to the participants. The survey link was kept open for a 3-month period. ResultsThere were total 659 respondents, whose mean age was 41.5 years and majority of them were males (n = 564, 85.6%). The largest group of respondents practiced in corporate/private hospitals (n = 315, 47.8%). Only 311 (47.2%) respondents performed MT. Of these, 190 (61.1%) used flex-rigid/semi rigid thoracoscopes. Undiagnosed pleural effusions (N = 194; 62.4%) and recurrent pleural effusions (N = 117; 37.6%) were the most common indications for performing MT. Majority of the thoracoscopists (222, 71.4%) used conscious sedation and a combination of Midazolam and Fentanyl was the most preferred combination (n = 238; 76.5%). Most follow the manufacturer's recommendation for thoracoscope cleaning and disinfection and had safety check lists in place. ConclusionOur survey captures the practice of MT in India. MT seems to be increasing in popularity with significant numbers of respiratory physicians performing the procedure. Respondents felt that MT was a valuable investigation that was underused and more of them wanted to learn. It is safe to perform MT under conscious sedation and local anaesthesia and a boon to patients who required surgical procedures for evaluation of difficult to diagnose pleural diseases. The setup cost is significant and would not justify installation in all centres. The lack of opportunities for training is something that needs to be looked in to.

Role of genomics and histology diagnosis in recurrent malignant pleural effusion

Role of genomics and histology diagnosis in recurrent malignant pleural effusion

Abstract PO025: Development of patient derived organoid cultures of two advanced stage serous carcinomas of the uterus

Abstract Advanced stage serous carcinoma of the uterus typically portends a poor prognosis. There is an urgent need to augment clinical trial data with different methods of treatment evaluation before a patient is made to try and potentially fail a therapy. Patient derived organoids (PDOs) may represent such an opportunity. We describe the successful culture and drug sensitivity testing of two PDOs from patients with advanced stage serous carcinoma of the uterus who received neoadjuvant chemotherapy. Clinical response to treatment was compared with the organoid response to the same regimens. Drug sensitivity data are reported as percentage of residual cell viability 48 hours after one standard treatment dose, in which 100% viability indicates no response and 0% viability reflects complete cell death. We hypothesized that significant cell killing, i.e. a low cell viability in our assay, would be required to achieve clinical drug sensitivity in patients. Both patients were clinically platinum resistant. Patient 1 had a large burden of disease at the time of presentation, including skeletal and liver metastasis. Though she initially partially responded to triplet therapy of paclitaxel, carboplatin and bevacizumab, she ultimately had persistent unresectable disease after 6 cycles of therapy. The percent residual, post-drug cell viability for PDO-1 was 45% in response to paclitaxel, carboplatin and bevacizumab combinatorial treatment, 35% in response to paclitaxel and carboplatin, and 100% in response to single agent bevacizumab. Patient 2 received paclitaxel, carboplatin and trastuzumab because her tumor was positive for HER2neu. Though she also had an initial response to treatment, she experienced a recurrent malignant pleural effusion 3 months after completing platinum-containing triplet (trastuzumab was continued as a maintenance therapy). The percent residual cell viability for PDO-2 was 51% in response to the combination of paclitaxel and carboplatin. Previous investigators have identified PDOs as a potentially powerful functional model for treatment response. We confirm that it is feasible to establish organoids and to rapidly test agents for cell sensitivity even prior to the first post-surgical chemotherapeutic treatment cycle. For both patients, the PDO models were only moderately sensitive to the agents used for therapy, and the lack of long-term benefit achieved for these patients may have been suggested a priori by the PDO models. However, further studies are necessary to establish a threshold percent value of post-treatment cell viability that is predictive of clinical patient response. We hypothesize that such a threshold appears to be significantly below 50% from these two initial cases. Citation Format: Andreea M. Newtson, Jianling Bi, Yuping Zhang, Eric Devor, Kristina Thiel, Kimberly K. Leslie. Development of patient derived organoid cultures of two advanced stage serous carcinomas of the uterus [abstract]. In: Proceedings of the AACR Virtual Special Conference: Endometrial Cancer: New Biology Driving Research and Treatment; 2020 Nov 9-10. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(3_Suppl):Abstract nr PO025.

A NOVEL APPROACH TO THE ENDOSCOPIC REPAIR OF AN ENTEROCUTANEOUS FISTULA IN A PATIENT WITH CROHN’S DISEASE

Abstract Introduction Enterocutaneous fistula (ECF) is an abnormal connection that develops anywhere between the gastrointestinal tract and the skin. Fistulae most commonly occur in the context of inflammatory bowel disease. Standard definitive management involves surgery and biologic therapy. We present a case of an ECF treated with endoscopic and medical management. Case Presentation A 34-year-old man with Crohn’s disease with prior colectomy and ileorectal anastomosis presented with abdominal pain. CT enterography demonstrated a fistulous tract from the bowel to the anterior abdominal wall concerning for ECF. He subsequently underwent sigmoidoscopy with confirmation of ECF on the ileal side of his anastomosis. He was started on metronidazole 500 mg three times a day, azathioprine at 175 mg daily, and adalimumab 40 mg every other week in attempts to close the fistulous tract, however the patient reported continued drainage. Surgical correction was offered. However, in attempts to avoid surgical resection, he underwent sigmoidoscopy, where the tract was identified. A cytology brush was introduced into the fistula and used to irritate the epithelial layer to promote scarring. Next, doxycycline was injected through a scleroneedle into the track as a sclerosing agent. Argon plasma coagulation (APC) of the fistula internal os and surrounding tissue was performed, followed by deployment of 2 hemoclips to promote closure of the internal os. Initially there was closure but 2 months later there was recurrence of ECF. Sigmoidoscopy was repeated with administration of doxycycline to sclerose the tract, followed by APC to the tissue adjacent to the internal os, and the placement of a hemoclip to oppose the tissue around the internal os. Following endoscopic treatment, the patient’s ECF has remained healed. Since ECF closure, he has been in endoscopic and clinical remission for over 4 years. Discussion This approach was successful in the treatment of ECF. Doxycycline has been used for treatment of recurrent pleural effusions, lymphatic malformations and lymphoceles due to its sclerosing properties. Mechanism of action is unknown, but it is believed to be due to the induction of an inflammatory reaction that results in fibrosis and ablation of endothelial-lined cavities. APC has been used in the treatment of gastrointestinal conditions, including angiodysplasias and colonic polyps post polypectomy. There is limited evidence discussing its effectiveness of endoscopic fistulous repairs. Our experience reviews that the combination of biologic therapy and endoscopic therapeutic options are a successful option in the treatment of ECF. While surgical resection remains a treatment option, patient’s typically favor less invasive strategies. Further studies should investigate endoscopic closure of fistulous tracts in order to provide more treatment modalities to our patients.

Malignant pleural mesothelioma in young patient with recurrent pleural effusion

Background: Malignant pleural mesothelioma (MPM) is a rare, aggressive, and hard-to-treat tumor whose worldwide incidence has been rising since mid-20th century. It that has been etiologically associated to asbestos exposure. Prognosis is poor with an overall survival rate of less than 1 year in untreated patients. Although considered a disease of the elderly, a subset of patients with mesothelioma are young. MPM is a rare cause of pleural effusion in the clinical practice among younger adults. Therefore, a high index of suspicion is required for its diagnosis. Case presentation: We herein describe a 31-year-old male patient with a BRCA1-associated-protein-1 negative MPM who presented with recurrent pleural effusions. The patient had no history of asbestos exposure. Conclusion: MPM is a rare cause of pleural effusion in the clinical practice among younger adults. Therefore, a high index of suspicion is required for its diagnosis.

Non-Hodgkin Lymphoma Presenting with Recurrent Pleural Effusion: A Rare Case Report

Non-Hodgkin lymphoma (NHL) is a type of carcinoma which usually begins with lymph nodes. Pathogenesis of pleural fluid formation and reabsorption is also associated with pulmonary lymphatic system. Usually pleural effusions are encountered as complications due to infective aetiologies and non-infective causes. Pleural fluid formation and reabsorption in pulmonary lymphatic system are associated with pathogenesis. Authors present here a case report of a patient who presented with left sided severe chest pain investigated to have recurrent pleural effusion, and different clinico-radiological presentations. Computed Tomography (CT) scan showed a mediastinal mass from which CT guided biopsy was done and suggestive of Lymphoma. The patient responded to pleurodesis and chemotherapy.

Interventional management of recurrent malignant pleural effusion: state of the art in 2021.

This narrative review aims to describe and compare different interventional methods for the management of recurrent malignant pleural effusion and offers perspectives for the future era. Dyspnea as a result of the recurrent malignant pleural effusion is one of the main factors decreasing the quality of life in patients with oncologic diseases. To date, there is no strict guideline for the management of malignant pleural effusions. Several different techniques are available to prevent production of the effusion or to provide intermittent drainage, however, the principle of these methods remains palliative. The choice of treatment in any patient depends mainly on the preferences of the patient, speed of the fluid production, expandability of the lung, and predicted survival of the patients. The interventional methods of managing malignant pleural effusions are described in detail, including thoracocentesis, chemical pleurodesis, talc poudrage pleurodesis, slurry pleurodesis, thoracoscopic procedures, indwelling pleural catheters, implantable pleural ports, and pleuroperitoneal shunting. Pleurodesis and fully implantable devices such as pleural ports may become the most useful techniques in the future, mainly because of better comfort for the patients and no need for repeated pleural punctures (Ref. 55).

Rare case of recurrent chylothorax following irradiation for esophageal cancer

Introduction: Chylothorax is a rare cause of pleural effusion that results from damage of the thoracic duct and chyle leakage from the lymphatic system into the pleural space. Causes of chylothorax can be traumatic or non-traumatic. Chylothorax occurring due to damage to the thoracic duct by thoracic irradiation is rare, and infrequently described in the literature. Case Report: We present a case of a 74-year-old patient with a history of stage IV esophageal cancer who developed recurrent bilateral chylothoraces after palliative radiotherapy to her esophagus. She was treated conservatively with multiple modalities, including total parental nutrition leading to an oral low-fat medium-chain triglyceride diet, subcutaneous octreotide injection, and long-term insertions of bilateral chest drains. Conclusion: This case report and discussion highlight that chylothorax is a rare complication of radiotherapy. A suspicion of chylothorax should be raised in patients who present with recurrent pleural effusions after radiotherapy to the esophagus or mediastinum, as early intervention can improve outcomes in these patients.

Pleural Effusion and Ascites Associated with Endometriosis-Mimicking Tuberculosis

Objective: To report a case of Endometriosis associated with Pleural effusion. Design: Case report. Setting: Tertiary care center. Patient(s): A 30-year old woman presented with a right pleural effusion complicated with pneumothorax-mimicking TB. Intervention(s): Thoracentesis, pleural biopsy by a video-assisted thoracic surgery, pleurodesis, thoracic wedge resection, CT chest, CT Abdomen, and diagnostic Laparoscopy. Main Outcome Measure(s): After taking a GnRH analog, there was no recurrence of pleural effusion nor ascites. Result(s): Thoracentesis and wedge resection of lung ruled out malignancy. An omental mass biopsy obtained from diagnostic laparoscopy after the patient returned with drug-induced hepatitis, and ascites revealed endometriosis. Conclusion(s): Thoracic endometriosis is rare; however, it should be considered in the differential diagnosis by unknown causes of pleural effusion in reproductive age timeframe in women.

Pancreaticopleural Fistula: A Cause of Recurrent Pleural Effusions in Chronic Pancreatitis

AbstractPancreaticopleural fistula is a rare complication of chronic pancreatitis caused by disruption of the pancreatic duct and fistulous communication with the pleural cavity. It usually presents with respiratory symptoms from recurrent large volume pleural effusions. Paucity of abdominal symptoms makes it a diagnostic challenge, leading often to delayed diagnosis. Marked elevation of pleural fluid amylase, which is not a commonly performed test, is a sensitive marker in its detection. Imaging with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can help delineate the fistula. In this report, we present the clinical features, imaging, and management of a 59-year-old male patient with pancreaticopleural fistula, wherein the diagnosis was suspected only after repeated pleural fluid drainages were performed for re-accumulating pleural effusions and it was eventually successfully treated with pancreatic duct stenting. We review the literature with regards to the incidence, presentation, diagnosis, and management of this rare entity.

Efficacy and safety of autologous blood pleurodesis versus talc pleurodesis in symptomatic pleural effusions: A randomized trial

PURPOSE: This study aimed to compare the efficacy and safety of autologous blood pleurodesis with talc pleurodesis in patients with symptomatic pleural effusion.METHODS: This is a prospective, randomized, noninferiority trial. The smallest sample size was determined as 26 for each group by power analyses. For pleurodesis, 5 g of talc and 2 ml/kg blood were administered through the chest catheter. The success rate and complication were recorded in the 1st month after the procedures. The effect of the procedure on the successful pleurodesis was analyzed by univariate and then multivariate logistic regression analysis.RESULTS: A total of 60 patients were randomized. After randomization, 6 patients withdrew from the study. The overall success rate of pleurodesis was 72.0% in the autologous blood group and 69.0% in the talc group (P = 0.903). The most common complications were fever and pain, and both were higher in the talc group (P = 0.030 and P = 0.001, respectively). For successful pleurodesis, complete lung expansion and catheter duration (<7 days) were important factors in the talc group and in the autologous blood group, respectively (P = 0.001 and P = 0.034). The effect of the procedure on pleurodesis success was not significant (odds ratio [95% confidence interval): 1.51 [0.40–5.77]; P = 0.548) after adjustment for lung expansion and catheter duration.CONCLUSION: Autologous blood pleurodesis is a simple, inexpensive, effective procedure and no related to significant adverse events for patients with recurrent symptomatic pleural effusion. Especially, it can be preferred in patients with incomplete lung expansion. Further studies are required to confirm the results of this study.