Recurrent Bilateral Pleural Effusions Research Articles

Recurrent Bilateral Pleural Effusion Secondary to Idiopathic Pleuritis in a Young Female Patient

Recurrent Bilateral Pleural Effusion Secondary to Idiopathic Pleuritis in a Young Female Patient

S1978 A Rare Case of a Pancreaticopleural Fistula Presenting as Recurrent Bilateral Pleural Effusions

S1978 A Rare Case of a Pancreaticopleural Fistula Presenting as Recurrent Bilateral Pleural Effusions

P53-5 Severe hypercalcemia in renal cell carcinoma: The diverse manifestations of genitourinary malignancies

Hypercalcemia of malignancy is a common paraneoplastic syndrome among patients with renal cell carcinoma (RCC), affecting up to 20% of patients. We report a case of metastatic RCC in a man presenting with severe hypercalcemia. A 76-year-old gentleman presented with 2 weeks of lethargy and dyspnea. He had a 50 pack-year smoking history. Examination revealed diminished breath sounds. Abdomen was soft with mild left flank tenderness. Blood tests revealed severe hypercalcemia (corrected calcium 4.09 mmol/L, range: 2.10-2.60 mmol/L), with a concurrent suppressed parathyroid hormone (PTH) level (0.5 pmol/L, range: 1.3-7.6 pmol/L), consistent with non-PTH mediated hypercalcemia. Chest X-ray showed bilateral pleural effusions with nodular opacities. A CT demonstrated an 8cm mass arising from the superior pole of the left kidney suspicious for a renal cell carcinoma, with innumerable pulmonary nodules, large bilateral pleural effusions, as well as mediastinal, hilar and para-aortic lymphadenopathy. Iatrogenic hypercalcemia and multiple myeloma were excluded. 1,25-dihydroxyvitamin D level was normal. Measurement of parathyroid hormone-related peptide was not feasible. Following treatment with intravenous fluid and zoledronic acid, his calcium level normalized twelve days later. He underwent a therapeutic and diagnostic thoracentesis. His radiological findings and pleural fluid cytology result were in keeping with metastatic renal cell carcinoma. He was commenced on pazopanib. He required bilateral long-term indwelling pleural catheter insertion for recurrent bilateral pleural effusions. He was discharged home after 4 weeks of hospitalization but was readmitted to hospital 6 weeks later with worsening dyspnea. CT showed progression of pulmonary metastases. He died 12 weeks after his initial presentation. RCC has protean manifestations and hypercalcemia is the most common paraneoplastic complication of RCC.

Pleural amyloidosis presenting as recurrent bilateral pleural effusions

Amyloidosis is a disease of insoluble protein deposition. It can affect many organ systems but less commonly found in the lung. Pleural effusions secondary to amyloidosis are rare and sparsely reported in the literature. The incidence ranges from 9 to 14 per million person-years. We present a case report of a 77-year-old female with respiratory distress and recurrent bilateral pleural effusions and known intra-abdominal amyloidosis. Initially, we attempted conservative non-operative management using tube thoracostomy drainage with lytic medications. But ultimately, she required decortication with the hope of promoting symphysis of her lung and chest wall to prevent recurrent effusions. Further investigation is warranted in this disease process, as the exact mechanism remains elusive. The same holds true regarding a standardized treatment approach due to the rarity of the disease.

Pancreatico-Pleural Fistula Presenting as Recurrent Bilateral Pleural Effusion: A Rare Complication of Chronic Pancreatitis

Pancreatico-Pleural Fistula (PPF) is a rare complication of chronic pancreatitis associated with significant morbidity and mortality. Diagnosis requires a high level of suspicion and management can be very challenging. We present an unusual presentation of recurrent bilateral pleural effusion secondary to PPF. 62 year old female presented to the hospital with worsening shortness of breath. History of multiple admissions in the last 6 months for recurrent left sided pleural effusions. Thoracentesis done at each visit revealed exudative nature of fluid but failed to identify the underlying etiology. Past history significant for an episode of pancreatitis in 2014 secondary to gall stones for which she underwent cholecystectomy. Chest X-ray revealed bilateral pleural effusions and patient eventually underwent bilateral chest tube placement. CT scan of the chest and abdomen revealed massive bilateral pleural effusion along with calcification of the pancreatic head and dilated pancreatic duct. Also noted were a 4 cm pseudocyst in the body and 7 cm pseudocyst in the tail of the pancreas with connection to the pleural space (Image 1,2). Pleural fluid amylase was elevated at 6915 U/L & lipase >3000 U/L. Patient subsequently underwent ERCP and a pancreatogram revealed a high grade stricture in the neck of the pancreas with extravasation of dye at the tail consistent with an internal pancreatic fistula. A 10 cm 7 fr plastic stent was successfully placed and patient was started on octreotide. Patient was subsequently discharged with bilateral pleurex catheters and daily octreotide injections. Day 60 follow up noted the pleural fluids secretions to be minimal with continued use of octreotide. Pancreatico-Pleural Fistula presenting as recurrent bilateral pleural effusions is an extremely rare complication of chronic pancreatitis. Pleural effusion due to PPF accounts for less than 1% of cases, while pleural effusion can be seen in 3—7% of patients with pancreatitis .Diagnosis requires a high degree of suspicion with supporting laboratory and radiological studies. Conservative treatment with pancreatic duct stenting and/or octreotide has been successful in 31—45% of cases, while surgery is curative in 80—90% of cases but with a high rate of mortality upto 10%. Combination of medical management and interventional endoscopy successfully reduced the pleural drainage in our patient.1400_A.tif Figure 1: CT scan of the chest and abdomen showing massive bilateral pleural effusion along with calcification of the pancreatic head with dilated pancreatic duct.1400_B.tif Figure 2: CT scan chest and abdomen showing a 4 cm pseudocyst in the body and 7 cm pseudocyst in the tail of the pancreas with connection to the pleural space

Unusual Cause of Bilateral Pleural Effusion.

Unusual Cause of Bilateral Pleural Effusion.

A Very Rare Cause of Pleuritic Chest Pain: Bilateral Pleuritis as a First Sign of Familial Mediterranean Fever

The familial Mediterranean fever (FMF), also called recurrent polyserositis, is characterized by reccurrent episodes of serositis at pleura, peritoneum, and synovial membrane and fever. We present a patient with recurrent bilateral pleural effusion due to serositis attacks as a first sign of FMF. A 59-year-old Turkish man suffered from recurrent pleuritic chest pain due to pleural effusion and atelectasis. The etiology was not found, and his symptoms were spontaneously recovered during several weeks. The pleuritic chest pain was associated with abdominal pain in the last attack. The gene mutation analysis revealed the homozygosity of FMF (F479L) gene mutation in both our patient and his grandchild. After the colchicine treatment, the attack has not developed. In conclusion, recurrent pleural effusion and pleuritic chest pain may be the first signs of the FMF.

Yellow Nail Syndrome: Treatment of Lymphedema Using Low Pressure Compression

The present report describes a case with the triad of yellow nail syndrome (YNS) and the use of low-pressure compression pump as treatment of lymphedema in YNS. A 71-year-old woman presented with bilateral lower extremity lymphedema, yellow nails, and recurrent bilateral pleural effusion. In this case, we specifically focused on lymphedema treatment of the legs besides other recommendations for YNS.

Low-molecular-weight heparin treatment failure in prevention of prosthetic mitral valve thrombosis.

Background Prosthetic heart valve thrombosis (PHVT) represents a dangerous postoperative complication following prosthetic heart valve replacement. Incidence varies according to different data from 0.5–4 % per year following mitral or aortic valve replacement in spite of adequate oral anticoagulation with coumarins. Case report We are presenting a case of prosthetic mitral valve thrombosis as a result of 6-month lowmolecular-weight heparin (LMWH) (nadroparine) treatment failure. Our patient presented with clinical picture of massive and recurrent bilateral pleural effusions and sub sequent development of acute left-sided heart failure. Diagnosis was made with transesophageal ultrasound examination. The patient underwent surgical thrombectomy and recovered completely. He died a month later because of pneumonia with septic complications and multiorgan failure. Conclusions Our case raises suspicion that the use of LMWHs as an alternative anticoagulant for long-term antithrombotic prophylaxis in patients with prosthetic heart valves carries an increased risk of PHVT. There is a lack of larger randomised trials comparing the safety of LMWH and coumarin anticoagulation in patients with prosthetic heart valves.

Surgical treatment of bilateral chylothorax due to benign lymphangioma of the thoracic duct

We present a female patient in whom after an 8-year history of recurrent bilateral pleural effusions, a benign lymphangioma of the thoracic duct was diagnosed and successfully treated by ligation of the duct, resection of the tumour and simultaneous decortication of the right pleural space and lung. This observation supports surgical intervention in this condition even in patients of advanced age.

Combined occurrence of chyloperitoneum and chylothorax after surgery and chemotherapy for Wilms' tumor

Chyloperitoneum is an extremely rare complication of abdominal surgery in children and a combined occurrence of chylothorax and chyloperitoneum after abdominal surgery has never been reported in children. Chylous ascites usually occurs as a result of operative trauma to the thoracic duct, cisterna chyli, or its tributaries. About one third of all patients with chylous ascites after retroperitoneal lymph node dissection also develop secondary chylothorax. Diaphragmatic defects have been shown to be responsible for the occurrence of chylothorax secondary to chyloperitoneum. Congenital diaphragmatic weakness may result in evagination of the peritoneum causing diaphragmatic blebs, the rupture of which results in the movement of the peritoneal fluid into the pleural cavity. In the authors' patient, the rent in the diaphragm that occurred during surgery was probably responsible for the chylothorax. The role of chemotherapy, if any, in the pathophysiology of this complication is unknown. Total parenteral nutrition (TPN) is a simple and effective treatment for postoperative chylous effusions. Surgical treatments such as abdominal exploration for the repair of leaking lymphatics and peritoneovenous shunt should be reserved for patients who fail TPN.

Recurrent Bilateral Pleural Effusions Secondary to Superior Vena Cava Obstruction as a Complication of Central Venous Catheterization

Five babies (birth weight 730 to 1,120 g) who developed bilateral pleural effusions as a complication of the use of central venous catheters are described. The effusions occurred seven to 19 days after initial placement or change of a central venous catheter. All required repeated thoracenteses to remove fluid accumulation of up to 200 mL/kg/d. The fluid was a clear transudate, but it became chylous when feedings were given. Venograms and autopsies demonstrated obstruction of the superior vena cava with drainage occurring through collaterals to the azygous vein and inferior vena cava. Silastic gas-sterilized catheters implanted in animals for four and 24 hours showed fibrin deposition when scanned by electron microscopy. No deposition occurred on autoclaved catheters after four hours and there was minimal deposition after 24 hours. It may be concluded that the pleural effusions resulted from obstruction of thoracic lymph flow into the venous system. Vena caval thrombosis may have been enhanced by 2-chloroethanol or ethylene oxide residues from gas sterilization of Silastic catheters.

Recurrent Pleural Effusion Associated with Dysgammaglobulinemia

A 45-year-old man presented with recurrent bilateral pleural effusions of undetermined etiology. This was associated with absence of IgM and a decreased IgA fraction. Possible associations are discussed.

Atypical presentations of diffuse fibrosing alveolitis

Two cases of diffuse fibrosing alveolitis with atypical radiological features are described. One case presented as an apparent anterior mediastinal mass in a young woman with radiologically normal lung fields; the other patient, an elderly man, had recurrent bilateral pleural effusions and pneumothorax.