Recurrent Pleural Effusion Research Articles

Comparison between Intubated Video Assisted Thoracoscopic Surgery and Awake Video Assisted Thoracoscopic Surgery in Management of Recurrent Pleural Effusion in Suez Canal University Hospitals

Comparison between Intubated Video Assisted Thoracoscopic Surgery and Awake Video Assisted Thoracoscopic Surgery in Management of Recurrent Pleural Effusion in Suez Canal University Hospitals

The Diagnostic Challenges of Pleural Tuberculosis: A Case Report

Extra-pulmonary tuberculosis often presents atypically, resulting in a delay in diagnosis and treatment. We present a case of recurrent pleural effusion in an immunocompetent patient due to pleural tuberculosis. We also discuss the diagnostic challenges and the role of immunohistochemistry in the diagnosis of pleural tuberculosis.

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

Anesthetic Chalenges And Managment In Patient With Ataxia- Telangiectasia.

Louis-Bar Syndrome is a synonym for a very rare complex neurodegenerative disorder ataxia-telangiectasia (A-T). This is an autosomal recessive inherited disease that encompasses abnormalities in the cerebellum, multisystem degeneration, immunodeficiency, increased risk for malignancy and consecutive respiratory insufficiency. Most of the patients are radiosensitive and any exposing to ionization may lead to progression of the disease. Potential risks from anesthesia, mechanical ventilation, and postoperative complications in these patients have been insufficiently discussed in the literature. We present a successful anesthetic and respiratory management with one-lung ventilation in a patient with Louis-Bar Syndrome who underwent video assisted thoracoscopy (VATS) for recurrent pleural effusion.

Management strategies for recurrent pleural effusion: a clinical practice review

Management strategies for recurrent pleural effusion: a clinical practice review

Primary pericardial angiosarcoma with pleural metastasis: an unusual clinical presentation

Abstract Introduction/Objective Primary pericardial angiosarcoma is an uncommon, aggressive cardiac neoplasm that arises from the endothelial cells of blood vessels. It typically affects middle-aged men and has a poor prognosis due to early metastasis. Unfortunately, there are currently no established guidelines or effective treatments for this rare malignancy. The purpose of this case study is to emphasize the significance of recognizing the unspecific presentations of pericardial angiosarcoma and ensuring timely diagnosis and appropriate treatment. Methods/Case Report A 56-year-old male presented with recurrent pericardial effusion and exudative pleural effusion. The radiologic studies showed a thickened pericardium with right-sided pericardial effusion and a large right- sided pleural effusion. Resected partial pericardium and parietal pleura showed the presence of epithelioid to spindled cells that formed solid sheets and vascular structures filled with numerous red blood cells. The tumor cells were cytologically malignant, with angulated shapes and hyperchromatic nuclei, and showed extensive invasion into the surrounding connective tissue. Mitotic figures were variably visualized, and there was abundant hemorrhage. Immunohistochemical analysis of the lesional cells showed positivity for ERG, CD31, Factor VIII, and retention of Methylthioadenosine phosphorylase (MTAP) and BRCA1-associated protein 1 (BAP1), while they were negative for WT1, calretinin, claudin-4, and p40. Based on the morphology and immunoprofile, a diagnosis of high grade angiosarcoma was rendered, and the patient underwent chemotherapy. The overall survival of the patient was 8 months to date. Results (if a Case Study enter NA) NA Conclusion Prompt diagnosis of pericardial angiosarcoma is crucial, as nonspecific symptoms may lead to misdiagnosis, such as in this case where the patient was initially diagnosed with pericarditis. Video-assisted thoracic surgery and histologic analysis are necessary to reach a correct diagnosis, which ensures appropriate treatment, as a delayed diagnosis can worsen the prognosis and even lead to death.

Pleural clinic: where thoracic ultrasound meets respiratory medicine.

Thoracic ultrasound (TUS) has become an essential procedure in respiratory medicine. Due to its intrinsic safety and versatility, it has been applied in patients affected by several respiratory diseases both in intensive care and outpatient settings. TUS can complement and often exceed stethoscope and radiological findings, especially in managing pleural diseases. We hereby aimed to describe the establishment, development, and optimization in a large, tertiary care hospital of a pleural clinic, which is dedicated to the evaluation and monitoring of patients with pleural diseases, including, among others, pleural effusion and/or thickening, pneumothorax and subpleural consolidation. The clinic was initially meant to follow outpatients undergoing medical thoracoscopy. In this scenario, TUS allowed rapid and regular assessment of these patients, promptly diagnosing recurrence of pleural effusion and other complications that could be appropriately managed. Over time, our clinic has rapidly expanded its initial indications thus becoming the place to handle more complex respiratory patients in collaboration with, among others, thoracic surgeons and oncologists. In this article, we critically describe the strengths and pitfalls of our "pleural clinic" and propose an organizational model that results from a synergy between respiratory physicians and other professionals. This model can inspire other healthcare professionals to develop a similar organization based on their local setting.

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

A woman in her fifties with cirrhosis of the liver and postural dyspnoea.

A woman in her fifties with advanced cirrhosis of the liver was admitted multiple times with recurrent pleural effusion and ascites. She was accepted for liver transplantation, at which time she developed postural dyspnoea and a drop in oxygen saturation.

Risk factors for symptomatic malignant pleural effusion recurrence in patients with actionable mutations in advanced lung adenocarcinoma.

Malignant pleural effusion (MPE) comes generally with high mortality and poor prognosis. Recurrence of symptomatic MPE is always accompanied by poor survival quality. In lung adenocarcinoma, researchers speculate whether patients with actionable mutation or without are applicable to different management models for MPE. Under the background of the high mutation probability and the encouraging therapeutic response in Asians, researches on the risk factors of MPE are in need. This retrospective review included 343 metastatic lung adenocarcinoma patients with MPE. Recurrence was defined as recurrent symptomatic MPE requiring the second thoracentesis to relieve symptoms within 300 days after the first thoracentesis. Univariable and multivariable Cox regression analysis were utilized to investigate independent risk factors for MPE recurrence. Of the 343 patients involved, 139 experienced MPE recurrence within 300 days; 34.3% in 201 patients with actionable mutations and 51.2% in 129 patients without actionable mutations are in the recurrence. The median recurrence-free survival (RFS) of the group without mutations was 161 days. The median RFS of the other group with mutations was 300 days. Patients with actionable mutations showed a significantly lower hazard of MPE recurrence on univariate analysis. The multivariate analysis indicated that receiving targeted therapy after the first thoracentesis within 30 days, lower neutrophil-to-lymphocyte ratio (NLR) level, lower serum lactate dehydrogenase (s-LDH) level, and lower serum carcinoembryonic antigen (s-CEA) level were independent protective factors. In subgroup analysis, risk factors differed. Receiving targeted therapy after the first thoracentesis within 30 days remained an independent factor in the mutated patients. The findings herein indicated the characteristics of specific patients at high risk for MPE recurrence in lung adenocarcinoma. Patients with actionable mutations benefit more in MPE recurrence and could benefit from targeted therapy and active intrapleural management.

Case Series of Challenging Diagnosis for Recurrent Pleural and Pericardial Effusion

Three cases presented to our hospital with recurrent pleural and pericardial effusion. Detailed history of present and past illnesses were recorded. Thorough clinical examination done. All routine blood investigations were carried out. Pleural fluid, pericardial fluid peritoneal fluid were sent for analysis which revealed high ADA, exudative lymphocytic predominance, negative for malignancy and the patients were started on antitubercular therapy, but still patient didn’t show any response. thoracoscopic biopsy showed chronic inflammation. PET CT whole body and bone marrow biopsy revealed lymphoma.

A Case of Demons-Meigs Syndrome Observed at the Markala Reference Health Center

DEMONS-MEIGS syndrome is defined by a pathological triad associating ascites, hydrothorax (Both can sometimes be associated) and an ovarian tumor, most often solid and benign but possibly cystic. Objective: To describe a case of Demons-Meigs syndrome observed at the Health Center of Reference of Markala. Clinical observation: We report the medical file of a 64-year-old postmenopausal lady, G11P7V6A0D1, IIG=2 years old without surgical history but poorly monitored hypertension. She was conducted in our department on 08/25/2020 in a picture of paroxysmal abdominal-pelvic pain with gravity type associated with an alteration of the general condition. It is associated with a productive cough with dyspnea of effort and previous chest pains. After the physical examination, there was a voluminous rounded pelvic mass going from the epigastric region to the pubic hair, the ultrasound examination having objectified an ascites of medium abundance and a voluminous left pelvic mass of 191mm / 120 mm then the chest X-ray from the front showing a right basal pleural effusion, the diagnosis of Demons-Meigs syndrome was evoked. After a preoperative assessment and a pre-anesthetic consultation, an exploratory laparotomy was performed. At the celiotomy, a serohematic ascites of 1.5 l is discovered, a large ovoid and pediculated ovarian tumor of the left ovary, not bumpy, overhanging the uterus, not twisted and not adhered but easily mobilizable. Conclusion: The Demons-Meigs syndrome which essentially comprises a benign ovarian tumor, ascites and a recurrent pleural effusion, characterized by healing without sequelae with drying of the effusions (Ascites and pleurisy) after removal of the ovarian tumor still retains a rather obscure etiology and pathophysiology.

Treatment Outcome with Talc or Povidone Iodine in Recurrent Pneumothorax or Recurrent Pleural Effusion

Abstract Background: The present study assessed the treatment outcome of pleurodesis with talc or povidone iodine in recurrent pneumothorax or recurrent pleural effusion and the efficacy and safety of talc or povidone iodine in the same. Materials and Methods: A total of 23 patients with recurrent pneumothorax (15) and recurrent pleural effusion (8) were enrolled. Pleurodesis with either talc or povidone iodine was performed via intercostal drainage tube. Treatment outcome along with complications was studied by routine follow up of patients for 6 months. Results: A total of 23 patients (19 males and 4 females) were included in the study. 16 patients were subjected to povidone iodine pleurodesis while 7 patients underwent talc pleurodesis. Mean age of patients was 38.68+19.6 for the povidone iodine group and 43.85+16.32 for the talc group. Eight (34.78%) patients had recurrent pleural effusion whereas 15 (65.21%) patients had recurrent pneumothorax. Post procedure pain was experienced by 5 (31.25%) patients in the povidone iodine group and 4 (57.14%) patients in the talc group. Two (12.5%) and one (14.28%) patient had fever following povidone iodine and talc pleurodesis respectively. Pleurodesis was successful in 13 (81.25%) patients in the povidone iodine group and 7 (100%) patients in the talc group, during the follow up period of 6 months. Conclusion: Both talc and povidone iodine are effective pleurodesis agents and povidone iodine can be considered a good alternative to talc as a pleurodesis agent in recurrent cases of pneumothorax or pleural effusion, irrespective of the underlying cause, as it is safe, easily available and cost effective. Keywords: Recurrent pneumothorax, Recurrent pleural effusion, Pleurodesis, Talc, Povidone Iodine

June 2023 Medical Image of the Month: Solitary Fibrous Tumor of the Pleura

No abstract available. Article truncated after 150 words. An 85-year-old man presented to our institution for a second opinion and for management of a recurrent left-sided pleural effusion. The patient has a history of CLL, which was diagnosed with a chest wall biopsy 4 years prior to presentation. Since that time, he has undergone chemotherapy and had a good response. In the past 18 months, the patient has had their left-sided pleural effusion drained 24 times. The patient also has a history of hypothyroidism and has had a cholecystectomy. The patient brought multiple outside imaging studies with him for review. An image capture from a recent ultrasound-guided left thoracentesis (Figure 1A) demonstrated, in retrospect, a pedunculated left lower lobe mass. An outside PET-CT (Figure 1B) was also available, confirming the presence of this mass, which had relatively uniform, low level FDG uptake such that it evade notice on first interpretation. A CT angiogram (Figure 2) demonstrated a large …

Comparison of the Effectiveness between Povidone-Iodine and Bleomycin as Pleurodesis Agents in Patients with Malignant Pleural Effusion at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

Background: Malignant pleural effusion (MPE) is a clinical problem in which fluid accumulates in the pleural cavity. This condition is generally caused by malignancy. Pleurodesis is a medical procedure in the form of fusion of the visceral and parietal pleura in order to prevent the recurrence of pleural effusion. Pleurodesis has the risk of causing chronic inflammation, which will trigger excessive attachment between the visceral and parietal pleura. Of course, an intervention is needed to reduce the risk of inflammation, one of which is by using a pleurodesis agent, which has an anti-inflammatory effect. This study aimed to compare the efficacy of povidone-iodine compared to bleomycin as a pleurodesis agent in malignant pleural effusion patients at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
 Methods: Prospective cohort study, where as many as 46 research subjects participated in this study and were grouped into groups that received povidone-iodine and bleomycin. The success of pleurodesis agents was assessed by the production of WSD. Data analysis was carried out using SPSS univariate and bivariate.
 Results: The results of the study showed that there was no statistical difference between the 10% povidone-iodine agent and the bleomycin agent, where p>0.05. However, in the 10% povidone-iodine group, the success rate was 100%, while in the bleomycin group, the success rate was 82.6%.
 Conclusion: There was no significant difference in the efficacy of povidone-iodine as a pleurodesis agent compared to bleomycin in patients with malignant pleural effusion at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.

Diffuse intrapulmonary mesothelioma mimicking pulmonary lepidic adenocarcinoma: a rare case report and review of the literature

Mesothelioma, with various clinical manifestations, radiological features, and histomorphological types, can be divided into epithelioid, sarcomatoid, and biphasic types, according to their histomorphological characteristics. There is a rare growth pattern of pleural mesothelioma: diffuse intrapulmonary mesothelioma (DIM), with a distinctive pattern of predominantly intrapulmonary growth, has no or minimal pleural involvement, and simulates interstitial lung disease(ILD) clinically and radiologically. A 59-year-old man presented to the hospital with recurrent pleural effusions for 4 years and a history of asbestos exposure. Computed tomography (CT) showed bilateral pure ground-glass opacity lesions, and the tumor cells showed a lepidic growth pattern pathologically. Immunohistochemical staining was positive for CK, WT-1, calretinin, D2-40, CK5/6, and Claudin4, while TTF-1, CEA, EMA, CK7, CK20, and other epithelial markers were negative. BAP1 loss its expression, and MTAP was positive in cytoplasm. CDKN2A was negative tested by Fluorescence in situ hybridization (FISH). The final diagnosis was DIM. In conclusion, we should recognize this rare disease to avoid misdiagnosis and delayed treatment.

Indwelling pleural catheters for persistent pleural effusions secondary to post lung resection for malignancies.

Malignant and nonmalignant pleural effusions (NMPEs) such as those due to hepatic hydrothorax have been successfully treated with an indwelling pleural catheter (IPC) with a low complication rate. There is no literature on the utility or safety of this treatment modality for NMPE post lung resection. We aimed to assess the utility of IPC for recurrent symptomatic NMPE secondary to post lung resection in lung cancer patients over a period of 4 years. Patients who underwent lobectomy or segmentectomy as part of the treatment plan for lung cancer between January 2019 and June 2022 were identified, these patients were screened for post-surgical pleural effusion. A total of 422 underwent lung resection, of which 12 had recurrent symptomatic pleural effusions requiring IPC placement and were selected for final analysis. The primary end points were improved symptomatology and successful pleurodesis. Mean time to IPC placement was 78.4 days post-surgery. The mean length of IPC catheter was 77.7 days standard deviation (SD) 23.8. All 12 patients achieved spontaneous pleurodesis (SP), there was no second pleural intervention or re-accumulation of fluid on follow up imaging in any of the subjects after IPC removal. Two patients (16.7%) had skin infection related to catheter placement that was managed with oral antibiotics, there were no cases of pleural infections that required catheter removal. IPC is a safe and effective alternative in managing recurrent NMPE post lung cancer surgery with high rate of pleurodesis and acceptable complication rates.

Assessing Factors That May Impact Physician-based Decisions for Placing Indwelling Pleural Catheters.

Malignant pleural effusion is a common finding in patients with advanced cancer and is a frequent cause of dyspnea. Current guidelines indicate thoracentesis for symptomatic patients, while indwelling pleural catheters (IPC) are recommended for patients who develop pleural fluid re-accumulation. IPC maintenance, however, requires a significant level of financial and social support. This study aims to analyze potential influencing factors that may play a role in the decision for placing IPCs in patients with recurrent malignant pleural effusions. This study retrospectively collected baseline sociodemographic and laboratory data in patients who underwent thoracentesis for malignant pleural effusion from August 2016 to October 2021, and selected patients who presented with re-accumulation of pleural fluid within 30 days or had a pulmonary physician's note documenting that IPC is a potential management option. Of these selected patients (IPC candidates), we stratified patients who underwent IPC placement and those who did not, and performed statistical analysis between these 2 groups. One hundred seventy-six patients who underwent thoracentesis were regarded as IPC candidates. Almost all baseline sociodemographic characteristics, including ethnicity ( P =0.637), sex ( P =0.655), and marital status ( P =0.773) were similar between the 2 groups, but significantly higher ECOG scores ( P =0.049) were noted in the IPC group. No statistically significant differences were noted in age, body mass index, platelet, PTT, international normalized ratio, creatinine, white blood cell, red blood cells, fluid protein, or fluid lactate dehydrogenase. Fluid albumin ( P =0.057) and serum neutrophil:lymphocyte ratio ( P =0.003) were significantly higher in patients without IPC placement. This study did not recognize any baseline sociodemographic factors that may contribute to the decision to place IPCs.

Milky fluid from where? You are about to find out…

Traumatic chylothorax most commonly occurs after thoracic surgeries with a few cases reported in patients after abdominal surgery. Effusions usually are caused by a pleural reaction during the postoperative period. However, this can also occur from disruption of the thoracic duct during the surgical procedure. The initial approach is conservative with supportive measures, including drainage by ultrasound-guided thoracentesis and diet modification, and surgery is rarely needed. Having a medical history preceding abdominal surgery is always important to consider the possibility of a pancreatic pleural fistula, which can be excluded by an abdominal computed tomography. Lymphangiography is considered the gold standard diagnostic tool, but its use is limited to cases unresponsive to conservative measures. In this patient, a lymphangiography or surgical intervention was not performed since the patient improved after initial management with no recurrent pleural effusion. A new pleural effusion after abdominal surgery must include chylothorax in the differential diagnosis.Keywords: Traumatic chylothorax, hiatal hernia repair, thoracic duct, lymphangiography, abdominal computed tomography

Bruton Tyrosine Kinase Inhibitor Associated Cryptococcal Meningitis Manifesting as Stroke (P1-10.002)

<h3>Objective:</h3> To highlight the appearance of fungal-related stroke on MRI and to increase awareness of opportunistic CNS infection as an etiology of cryptogenic stroke in patients receiving immunomodulatory therapies <h3>Background:</h3> Over a third of strokes are cryptogenic. Identifying the etiology of stroke is a crucial step in reducing the incidence and associated morbidity and mortality of recurrent stroke. Opportunistic CNS infection is a well-documented cause of stroke. The development and increasingly widespread use of high-efficacy immunomodulatory drugs requires vigilance for opportunistic infection and associated complications in patients receiving these drugs. <h3>Design/Methods:</h3> A case report <h3>Results:</h3> A 65-year-old gentleman with Waldenstrom’s macroglobulinemia on zanubrutinib complicated by biopsy-confirmed AHL amyloidosis, which was further complicated by cardiomyopathy, nephropathy, and recurrent pleural effusions presented with encephalopathy and was found to have multifocal acute, symmetric, subcortical strokes. There was no evidence of prior strokes or chronic small vessel disease on MRI. A comprehensive stroke work-up was unremarkable, including typical vascular risk factors within goal, negative blood cultures, normal d-dimer, normal serum viscosity, no radiographic evidence of large vessel disease, and no arrhythmia on telemetry. Echocardiogram showed bi-atrial enlargement related to cardiac amyloid, but no evidence of atrial, ventricular, or perivalvular thrombus. Lumbar puncture was performed and revealed WBC 10, RBC 9, glucose 16, and protein 154. Cryptococcal antigen was positive at a titer of 1:64. Amphotericin B and flucytosine were initiated with clinical improvement over two weeks and he was transitioned to fluconazole for maintenance therapy and prophylaxis. <h3>Conclusions:</h3> This case describes a patient treated with zanubrutinib who developed cryptococcal meningitis causing multifocal acute, symmetric, subcortical strokes. Small molecule tyrosine kinase inhibitors are associated with increased relative risk of opportunistic infection, including CNS fungal infections. Opportunistic CNS infection should be considered as a potential cause of cryptogenic stroke in patient’s receiving these drugs. <b>Disclosure:</b> Dr. Perez has nothing to disclose. Mr. Morrison has nothing to disclose. The institution of Dr. Sloane has received research support from National Center for Advancing Translational Sciences of the National Institutes of Health: KL2TR001879.