Transudative Effusion Research Articles

Frequency and Causes of Fluid Accumulation in the Pleural Space in the Patients Admitted to Teaching Hospitals in Hamedan City during 5 Years

Introduction: Occurrence of pleural effusion occurs in both hospitalized and outpatients. Recognizing the most important and common causes of pleural effusion in each region and in different communities can be a useful step in early and timely diagnosis of the causes and, consequently, timely treatment and thus reducing the time and burden of diagnostic and therapeutic costs imposed on patients. Methods: In this descriptive cross-sectional study, 407 patients admitted to Sina and Shahid Beheshti hospitals in Hamadan were studied by census. Data were analyzed with SPSS software (ver. 16). Results: From 407 patients with pleural effusion in this study, 262 persons (64.4%) were men and 145 (35.6%) women. There were 244 persons (60%) with exudative pleural effusion, 110 persons (27%) with transudate effusion and 53 persons (13%) with empyema. Out of 244 exudative effusion cases, in 135 cases (55.3%) were recorded pneumonia, 50 cases (20.5%) lung malignancy, 33 cases (13.5%) other malignancies, 13 cases (5.3%) tuberculosis, 7 cases (2.9%) pulmonary thromboemboli and 6 remained cases (2.5%) were other causes. Pneumonia was the most common cause of empyema. Conclusion: According to results of this study, exudative pleural effusion was the most common type of effusions. In all types of pleural effusions, the most common site of involvement was right hemithorax. Identifying common causes of pleural effusions in each region facilitates the initial treatment of pleural effusions until reaching a definitive diagnosis.

Effusion-Serum Chloride Gradient in Heart Failure-Associated Pleural Effusion - Pathophysiologic Implications.

Background: There is scant clinical data of electrolyte analyses in the pleural fluid under heart failure (HF) pathophysiology.Methods and Results: This study retrospectively analyzed data from 17 consecutive patients who presented with pleural effusion and underwent thoracentesis. A diagnosis of worsening HF was established by clinical criteria (presentation, echocardiography, serum B-type natriuretic peptide, and response to therapy). Samples of non-heparinized pleural fluid and peripheral venous blood, obtained within 2 h of each other, were subjected to biochemical analysis. The source of pleural effusion was determined as transudate or exudate according to Light’s criteria. Fifteen patients (53% men; mean [±SD] age 85±11 years) had HF-associated pleural effusion, 10 of whom had transudative effusion and 5 who had exudative effusion (fulfilling only 1 [n=4] or both [n=1] lactate dehydrogenase criteria). The effusion-serum gradient (calculated by subtracting the serum electrolyte concentration from the effusion electrolyte concentration) was significantly higher for chloride (mean [±SD] 7.4±2.6 mEq/L; range 4–14 mEq/L) than sodium (0.9±1.4 mEq/L; ranging from −1 to 4 mEq/L) and potassium (−0.1±0.3 mEq/L; ranging from −0.8 to 0.2 mEq/L; P<0.001 for each).Conclusions: In HF-associated pleural effusion, the chloride concentration is higher in the pleural effusion than the serum, indicating that chloride may have an important role in the formation and retention of body fluid in the pleural space.

Diagnostic Accuracy of Thoracic Ultrasonography to Differentiate Transudative From Exudative Pleural Effusion

There are limited data examining the diagnostic accuracy of thoracic ultrasonography (TUS) in distinguishing transudative from exudative pleural effusions. What is the diagnostic accuracy of TUS in distinguishing transudative from exudative effusions in consecutive patients with pleural effusion? Consecutive patients who underwent TUS and subsequently a diagnostic thoracentesis with a pleural fluid analysis were identified. TUS images of the pleural effusions were interpreted by previously published criteria. We evaluated the diagnostic performance of TUS findings in predicting a transudative vsexudative pleural effusions and specific pleural diagnoses. We evaluated 300 consecutive pleural effusions in 285 patients. The pleural effusions were classified as exudative in 229 of 300 cases (76%). TUS showed anechoic effusions in 122 of 300 cases (40%) and complex effusions in 178 of 300 cases (60%). An anechoic appearance on TUS was associated with exudative effusions (68/122; 56%) as compared with transudative effusions (54/122; 44%). The presence of a complex-appearing effusion on TUS was highly predictive of an exudative effusion (positive predictive value of 90%). However, none of the four TUS characteristics were highly specific of a pleural diagnosis. Thoracic ultrasonography is inadequate to diagnose a transudative pleural effusion reliably. Although the TUS findings of a complex effusion may suggest an exudative pleural effusion, specific pleural diagnoses cannot be predicted confidently.

Review of interference indices in body fluid specimens submitted for clinical chemistry analyses

ObjectivesThe aims of this study were to retrospectively investigate interference indices in a wide range of body fluid specimens and compare these indices to those found in serum/plasma. Design and MethodsThis retrospective study evaluated interference indices for hemolysis, icterus, and lipemia in 2752 body fluid specimens submitted for clinical chemistry testing. ResultsThe distribution of interference indices for body fluid samples was generally similar to that of serum/plasma interference indices. Hemolysis of specimens submitted for lactate dehydrogenase (LD) represented the most common interference for body fluid chemistries. Body fluids collected from postsurgical drain sites had a higher proportion of tests exceeding both icterus and lipemic limits compared to serum/plasma specimens. ConclusionsOverall, degrees of hemolysis, icterus, and lipemia observed in body fluid specimens were in large part similar to serum/plasma specimens, with a few notable differences. Body fluids exhibited a higher proportion of samples with severe icterus or lipemia. Severely lipemic body fluid samples were significantly less likely to also be hemolyzed relative to severely lipemic serum/plasma specimens. LD was the test most commonly affected by interference across all body fluid types. False elevations in pleural fluid LD induced by hemolysis can lead to mis-classification of transudative effusions as exudative using Light’s criteria. The possible impact of interferences on clinical chemistry testing in body fluids is an important post-analytical consideration.

A comparative study of serum effusion albumin gradient and Light's criteria to differentiate exudative and transudative pleural effusion.

Context:The incidence of pleural effusion is approximately one million per year. For diagnosing and treatment plan, pleural effusions have to be classified into transudate and exudate. If the diagnosis is not appropriate, it may result in severe complications. The established criterion for differentiating exudates from transudates is Light's criteria. But there were some false positive results in case of transudative effusions when Light's criteria were used.Aims:This study was done to determine the accuracy of serum effusion albumin gradient (SEAG) when compared to Light's criteria in differentiating transudates and exudates.Settings and Design:It is a prospective observational study. In the present study, the sample size is 66 patients, in whom the SEAG was used for the classification of pleural effusions with a cut-off value of 1.2 g/dl.Methods and Materials:All the blood samples were collected and biochemical parameters like total protein, albumin, and LDH were analyzed in both serum and pleural fluid using XL 640 fully automated random access analyzer.Statistical Analysis Used:Results were analyzed using SPSS software version 20.Results:20 of 22 transudates and 41 of 44 exudates were classified correctly using SEAG. The diagnostic accuracy of SEAG (92.42%) is better than Light's criteria (87.87%) in differentiating both transudative and exudative effusions.Conclusions:The SEAG is superior to Light's criteria in identifying the transudative effusions. It is also observed that Light's criteria identified exudative effusions better than SEAG.

Cytological-energy analysis of pleural effusions with predominance of neutrophils.

Background:The predominance of neutrophils in pleural effusions of patients with different serious impairments of the pleural cavity organs is often found. The aim of this study was to identify the type of injury using the cytological-energy analysis of pleural effusions.Methods:We analysed 635 samples of pleural effusions with predominance of neutrophils. We compared the values of the coefficient of energy balance (KEB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) catalytic activities in the following subgroups of patients: with transudative effusions, purulent pneumonia, chest empyema and after chest surgery with and without purulent complications. Statistical analysis was performed using the ANOVA Kruskal–Wallis test (p < 0.05 was considered as significant).Results:We found the lowest KEB values in pleural effusions of patients with chest empyema and their gradual increases in patients with purulent pneumonia and with transudative effusions. We observed the highest LDH and AST enzymes activity in patients with chest empyema and their gradual decrease in patients with purulent pneumonia and with transudative effusions. LDH and AST enzymes activity was significantly higher in pleural effusions of patients after chest surgery with purulent complications compared with non-purulent cases.Conclusion:The most intensive inflammation and the most extensive tissue destruction in the pleural cavity were found in patients with chest empyema. Significantly better parameters were observed in patients with purulent pneumonia. The absence of serious inflammation and the absence of tissue destruction were typical for patients with transudative effusions. Finally, our results confirmed an anticipated higher tissue destruction in patients after chest surgery. Significantly worse injury was found in surgical patients with purulent complications compared with non-purulent ones. The reviews of this paper are available via the supplemental material section.

Role of Pleural Fluid C-Reactive Protein in the Aetiological Diagnosis of Exudative Pleural Effusion

Introduction: Pleural effusions, the result of the accumulation of fluid in the pleural space, are a major diagnostic problem due to its anatomical nature with no direct access. There is variation in management, depending on the pleural disease. The pleural effusion can either exhibit specific or nonspecific characteristics. Aim: To determine the clinical significance and diagnostic role of pleural fluid C-Reactive Protein (CRP) level in the aetiological diagnosis of exudative pleural effusion. Materials and Methods: This was a cross-sectional study performed during the study period of September 2013 to December 2014. A total of 53 Patients identified with pleural effusion were recruited in the study and pleural fluid was subjected for the measurement of CRP level. Pleural fluid CRP was assessed with CRP-Turbilatex-Quantitative turbidimetric immunoassay method which is based on the principle agglutination reaction. The data was subjected to statistical analysis using Epi info software version 3.4.3. The Receiver Operating Characteristic (ROC) curve was plotted to illustrate the diagnostic ability. The smallest cut-off value was the minimum observed test value minus 1, and the largest cut-off value was the maximum observed test value plus 1. All the other cut-off values were the averages of two consecutive ordered observed test values. Results: Among the 53 patients in the study, 42 had exudative effusions (79.20%) and 11 had transudative effusions (20.80%). The common cause of exudative effusion was tuberculosis 26 (61.90%), followed by 9 malignancy (21.40%) and 7 parapneumonic effusion (16.70%). In our study, the pleural fluid CRP was statistically significant (p&lt;0.001) marker to differentiate exudative effusions with CRP-value &lt;30 suggestive of malignancy, CRP-value 30-50 mg/L suggestive of tuberculosis and CRP-value &gt;70 mg/L suggestive of parapneumonic effusions. Conclusion: Determination of pleural fluid CRP is a useful diagnostic marker for differentiating exudative and transudative effusions. Also, Pleural fluid CRP is a statistically significant marker in differentiating tubercular effusions from nontubercular exudative effusions.

A Comparative Study of Liquid-Based Cytology and DNA Image Cytometry in the Diagnosis of Serous Effusion.

Background:Liquid-based cytology is one of the most useful methods to diagnose a patient with serous effusion, especially when malignancy is suspected. As an alternative to the use of liquid-based cytology only, the serous effusion can be further processed using the technique of DNA image cytometry, which may augment diagnostic utility. The aim of this study was to compare the diagnostic yields of liquid-based cytology, DNA image cytometry, and both in combination, regardless of serous-effusion etiology.Methods:We conducted a descriptive study on patients with serous effusions from July 2016 to June 2018. All samples were submitted for liquid-based cytology and DNA image cytometry techniques. We compared the results of cytopathological studies to the final diagnoses.Results:For a total of 798 samples, final diagnoses included 412 (51.6%) malignancies, 280 (35.1.%) inflammatory diseases, and 106 (13.3%) transudative serous effusions. Liquid-based cytology had a more sensitive diagnostic yield than DNA image cytometry did (38.8% vs 30.7%; P < .05), but the combination of both had a higher yield (43.7%; P < .05) compared with that of liquid-based cytology alone. For the 412 malignant serous effusions, diagnostic yields of liquid-based cytology and DNA image cytometry were 73.8% and 59.5%, respectively. The difference in sensitivity was significant (P < .05). Combined liquid-based cytology + DNA image cytometry improved diagnostic yield to 83.3% (P < .05). However, both liquid-based cytology and DNA image cytometry had low diagnostic yields for inflammatory diseases and transudative serous effusions.Conclusion:In serous effusion, liquid-based cytology’s diagnostic performance is better than that of DNA image cytometry. Application of both techniques can significantly increase diagnostic yield.

Expression of IL-1β, HMGB1, HO-1, and LDH in malignant and non-malignant pleural effusions

IL-1β, HMGB1, HO-1, and LDH in the pleural effusions (PE) of patients with transudative, infectious, and malignant etiologies were determined using ELISA and enzymatic assays. IL-1β, HMGB1, HO-1, and LDH showed significant differences between the three etiologies. Post-hoc analysis revealed higher levels of HO-1 and HMGB1 in infectious versus transudative effusion. Higher levels of IL-1β were found in infectious versus transudative or malignant effusion. The comparison of LDH levels showed significant differences. Positive correlations were found between IL-1β, HMGB1, and LDH in infectious effusions. The samples were then divided into cancerous and non-cancerous groups, and logistic regression revealed that increasing IL-1β levels were significantly associated with a decrease in cancer risk after adjusting for HMGB1, HO-1, and LDH. Our findings suggest that IL-1β, HMGB1, HO-1, and LDH are expressed differently, with positive correlations between HMGB1, IL-1β, and LDH in infectious effusions, and low IL-1β expression in malignant effusions.

Analysis of pleural fluid: Differentiating transudate from exudate

Introduction: Pleural fluid is defined as the fluid that is found between the two layers of pleura, (i.e. the parietal and visceral pleura) the membranes which line the cavity and surround the lungs. Normally, 10-20ml of pleural fluid, similar in composition to plasma but lower in protein ( over the layers of pleura, facilitating the movement between lungs and chest wall. The pleural fluid enters the systemic capillaries in the parietal pleura and exits via the parietal pleural stoma and lymphatics. (1) Pleural fluid accumulates when too much fluid enters or too little fluid exits the pleural cavity. Pleural fluid analysis is used to diagnose the cause of accumulation of pleural fluid in the chest cavity (Pleural effusion). Pleural effusion may be Transudative or Exudative. Analysis is done in three broad spectrums (1) Biochemical analysis (2) Microbiological analysis (3) Clinical pathology or cytology analysis. Materials and Methods: Pleural fluid is obtained by Thoracocentesis. Thoracocentesis or pleural tap is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. The fluid obtained is sent for analysis. Pleural fluid analysis is a group of tests used to diagnose the cause of fluid build-up such as CHF, Cirrhosis, Infection etc. Result: Study shows that pleural effusions are common among 40-60 years of age group with a slight male predominance. The present study suggests that exudative effusions are more common than transudative effusions with a percentage of 61%. Conclusion: Pleural fluid analysis helps in diagnosing the etiology of the effusion based on the appearance and biochemical parameters. The common etiology for pleural effusion reported in India is Tuberculosis. WHO statistics shows India accounted for 27% of the total new infections in 2017, which is the highest among the top 30 high TB burden countries in the world. Keywords: Exudative, Pleural fluid, Transudative, Thoracocentesis.

BLINDED BY THE LIGHT: A CASE OF MALIGNANT PLEURAL EFFUSION WITH TRANSUDATIVE PROPERTIES

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Light’s criteria is routinely used to help aid in the diagnosis and treatment of pleural effusions by categorizing them into transudates or exudates. Pleural effusions due to malignancy and infection are classically exudative, while effusions from heart failure, cirrhosis, and renal failure are examples of usual transudates (1). When exceptions to this pattern do occur, it is most often that a transudate is misclassified as an exudate (1). Presented is a case where a transudative effusion was later discovered to be malignant due to likely concurrent hepatic hydrothorax. CASE PRESENTATION: A 59 year-old male with a history of alcoholic cirrhosis presented with respiratory distress and right upper quadrant pain was found to have complete opacification of the left hemithorax on chest X-ray. Upon admission, the pulmonary service was consulted where bedside evaluation confirmed a large right pleural effusion anechoic by ultrasound. Diagnostic thoracentesis was consistent with a transudative effusion with pleural protein 1.1, serum protein 5.6, pleural lactate dehydrogenase 76, and serum lactate dehydrogenase 269. Hepatic hydrothorax was considered to be the likely etiology given presence of ascites and a history of cirrhosis. Medical cytology however later revealed atypical neoplastic cells. Abdominal imaging revealed a large mass in the right hepatic lobe. IR-guided biopsy revealed metastatic adenocarcinoma with a primary cholangiocarcinoma. Prior to oncologolical evaluation for chemotherapeutic options, the patient decompensated with worsening encephalopathy and respiratory distress from re-accumulation of pleural fluid and abdominal ascites. Given overall grave prognosis, goals of care discussions were held and comfort care was initiated with the patient passing comfortably shortly thereafter. DISCUSSION: Light’s criteria are routinely used to help aid in the diagnosis and treatment of pleural effusions by categorizing them into transudates or exudates. Certain etiologies of pleural effusions are classically transudative, while others are exudative (1). When pleural studies do not meet Light’s criteria for an exudative effusion, physicians will tend to consider that malignancy and infection are ruled out (2, 3). This can lead to a missed or incorrect diagnosis since malignant effusions have been described in the literature to be transudative in as much 10.6% (4) of cases. We describe a case where pleural studies did not meet criteria for an exudative effusion, so a malignant etiology was initially considered to be unlikely. However, medical cytology later showed malignant cells, leading to further work-up revealing the primary underlying cholangiocarcinoma. CONCLUSIONS: When an effusion is transudative, one cannot assume that malignancy is ruled out, otherwise a deadly diagnosis may be missed. Reference #1: Light RW. “The Light criteria. The beginning and why they are useful 40 years later.” Clinical Chest Medicine 2013; 34(1): 21-6. Reference #2: McGrath EE, Anderson PB. “Diagnosis of pleural effusion: a systematic approach.” American Journal of Critical Care 2011; 20(2): 119-27. Reference #3: Thomas R, Cheah HM, Creaney J, Turlach BA, Lee YCG. “Longitudinal measurement of pleural fluid biochemistry and cytokines in malignant pleural effusions.” Chest 2016; 149(6): 1494-500. DISCLOSURES: no disclosure on file for Alfredo Astua; No relevant relationships by Dawn Maldonado, source=Web Response No relevant relationships by Michael Megally, source=Web Response

CHRONIC LUNG DISEASE AND ITS PROGRESSION TO PULMONARY HYPERTENSION: THE NEED FOR EARLY SCREENING

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Despite the evolution of group 3 pulmonary hypertension (PH) management and treatment, reports suggest that over half of patients are diagnosed with PH at an advanced stage (1). Factors such as the presence of nonspecific symptoms, over-reliance on echocardiography, and decreased use of right-heart-catheterization (RHC) contribute to delayed diagnosis (2). We present this case to highlight the importance of early diagnosis of PH due to chronic lung disease. CASE PRESENTATION: A 60-year-old African-American female with a past-medical-history of chronic obstructive pulmonary disease on 3L home oxygen (GOLD stage 4), secondary erythrocytosis, and obstructive sleep apnea presented with bilateral leg pain and subjective fevers. Vitals were significant for hypotension (BP 96/51) and tachycardia (HR 106). Physical exam revealed an obese female in moderate distress with 2+bilateral lower extremity edema with diffuse, erythematous, and purulent rashes in the same areas. Labs were significant for elevations in lactic acid (2.7), bicarbonate (39), and hemoglobin/hematocrit (15.3/51.7). Chest x-ray (CXR) showed cardiomegaly. EKG showed normal sinus rhythm without any ischemic findings. The patient was started on broad spectrum antibiotics and IV fluid resuscitation for sepsis secondary to cellulitis. On hospital day 4, the patient developed acute respiratory distress with desaturation to 85%. Arterial blood gases showed pH 7.26, pO2, 69, pCO2 68, consistent with hypercarbic respiratory failure. Repeat CXR revealed interval development of a large right pleural effusion. Emergent thoracentesis was performed with 600cc of fluid with labs consistent for transudative effusion (serum/pleural: LDH 227/59, protein 5.5/2). Echocardiograph revealed normal ejection fraction and left ventricular function, but an elevated right ventricular systolic pressure (50-60mmhg) and a flattened septum. RHC was performed and revealed fixed severe pulmonary hypertension with negative vasoreactivity (PA:59mmhg, RA:33mmhg, PAVR:7) The patient was started on non-invasive ventilatory support in addition to aggressive diuresis given negative vasoreactivity on RHC. However, her respiratory status continued to deteriorate despite sepsis resolution. After further discussion with the patient, she decided to transition to comfort measures with subsequent transfer to a hospice facility DISCUSSION: PH associated with chronic lung diseases confers poor prognosis. Despite a high prevalence (62.4%) of PH in COPD patients (3), there are no PH screening guidelines in this high-risk patient population. CONCLUSIONS: The establishment of early screening methods prior to the progression of pulmonary vascular dysfunction to PH will ultimately decrease the disease progression, reduce mortality, and improve quality of life in this high-risk population. Reference #1: Ginoux M, Turquier S, Chebib N, et al. Impact of comorbidities and delay in diagnosis in elderly patients with pulmonary hypertension. ERJ Open Res. 2018;4(4):00100-2018. Published 2018 Nov 28. https://doi.org/10.1183/23120541.00100-2018 Reference #2: Maron BA, Galiè N. Diagnosis, Treatment, and Clinical Management of Pulmonary Arterial Hypertension in the Contemporary Era: A Review. JAMA Cardiol. 2016;1(9):1056–1065. https://doi.org/10.1001/jamacardio.2016.4471 Reference #3: Gupta KK, Roy B, Chaudhary SC, et al. Prevalence of pulmonary artery hypertension in patients of chronic obstructive pulmonary disease and its correlation with stages of chronic obstructive pulmonary disease, exercising capacity, and quality of life. J Family Med Prim Care. 2018;7(1):53-57. DISCLOSURES: No relevant relationships by Temidayo Abe, source=Web Response No relevant relationships by Philip Bene, source=Web Response No relevant relationships by Eric Chang, source=Web Response No relevant relationships by Gabrielle De Allie, source=Web Response No relevant relationships by Parris Tanksley, source=Web Response

A study of role of interleukin-8 in differentiating transudative and exudative pleural effusion

Background: Differentiation between transudative and exudative effusion is considered the initial step in the etiological diagnosis of any pleural effusion. The differentiation is essential, since the treatment of underlying systemic cause is enough in transudative pleural effusion, whereas extensive investigations and treatment is required in exudative effusion. Recent studies have demonstrated the existence of a novel neutrophil activating peptide first named NAP-l, but subsequently renamed IL-8. Interleukin-8 being the mediator of local inflammation may help in the differentiation of transudates and exudates. Methodology: This is a hospital based cross sectional study which included 70 patients with pleural effusion. After diagnosing pleural effusion, they were further divided into two categories, namely transudate and exudate based on Light’s criteria. The concentration of pleural fluid interleukin-8 was determined by an Enzyme Linked Immunosorbent Assay (ELISA) method by using commercially available assay kits. Statistical Analysis: All results are expressed as mean ± standard deviation (SD) for continuous variables and as frequencies for categorical variables. The difference in the age and gender between groups is disproved using independent student t-test and chi-square test, Mean pleural fluid Interleukin-8 level between the groups is analyzed using independent student t-test. Results: The parameters in Light’s criteria (pleural fluid protein and LDH) and Interleukin 8 were able to differentiate transudate from exudate and were found to be statistically significant with p value of Conclusions: It is clear from our study that IL-8 can be used to diagnose and differentiate exudates from transudative pleural effusions with a good sensitivity and specificity. Keywords: Pleural effusion, Interleukin 8, Exudative effusion, Transudative effusion, Empyema.

Hepatic Hydrothorax: An Updated Review on a Challenging Disease.

Hepatic hydrothorax is a challenging complication of cirrhosis related to portal hypertension with an incidence of 5-11% and occurs most commonly in patients with decompensated disease. Diagnosis is made through thoracentesis after excluding other causes of transudative effusions. It presents with dyspnea on exertion and it is most commonly right sided. Pathophysiology is mainly related to the direct passage of fluid from the peritoneal cavity through diaphragmatic defects. In this updated literature review, we summarize the diagnosis, clinical presentation, epidemiology and pathophysiology of hepatic hydrothorax, then we discuss a common complication of hepatic hydrothorax, spontaneous bacterial pleuritis, and how to diagnose and treat this condition. Finally, we elaborate all treatment options including chest tube drainage, pleurodesis, surgical intervention, Transjugular Intrahepatic Portosystemic Shunt and the most recent evidence on indwelling pleural catheters, discussing the available data and concluding with management recommendations.

CORRELATING BIOCHEMICAL, RADIOLOGICAL AND CYTOLOGICAL OUTCOMES OF PLEURAL EFFUSION

Introduction: The research emphasises on the association bond of correlation of biochemical radiological and cytological outcomes of pleural effusion&#x0D; Material and Methods: The samples for the study were collected from the diagnostic centre, out-patient department and in-patient department of Department of Biochemistry, Internal Medicine, Respiratory Medicine at Rabindranath Tagore Medical College, Udaipur, Rajasthan The research was carried out on a total of 100 patients .The observations took about a year’s time. The research was carried out on a total of 100 patients,&#x0D; Results: 100 patients with pleural effusion were studied of which 60.00% were cases of tuberculous effusion and 40.00% were cases of non tuberculous effusion. This was reflective of the high prevalence of tuberculosis in the area being studied. The remaining 40 cases were of malignant effusion (15 cases), Transudative effusion (13 cases), synpneumonic effusion (8 cases) and 4 cases of empyema.. In patients of age more than 40 years, malignant effusion was more common; It was found more common in lower socioeconomic class such people live in crowded, unhygienic conditions. The commonest symptoms were cough (81.32%) and breathlessness (78.76%), followed by fever 69.20%, weight loss 64.64%, chest pain 45.50%, loss of appetite 63.30% and hemoptysis 15.80%.&#x0D; Conclusion: Thus it can be concluded that ADA is elevated in tubercular pleural effusion. Exudatives had decreased glucose but increased protein, LDH and cholesterol compared to transudatives Pleural fluid cytology revealed elevated Lymphocytes in tubercular and polymorphs in acute infections&#x0D; Keywords: Lactate dehydrogenase, Adenosine Deaminase biochemical, radiological and cytological outcomes of pleural effusion

Is computed tomography scan able to replace laboratory tests to differentiate transudate effusions from exudate effusions? that is a question

BackgroundPleural effusion is considered an interesting clinical problem that is commonly faced by physicians and is caused by several diseases. The ability of computed tomography (CT) to differentiate transudate effusion from exudate effusion is still under research.ObjectiveThe aim of this study was to assess the accuracy of the CT in diagnosing the nature of the pleural effusion.Patients and methodsIn this prospective cross-sectional analytic study, laboratory biochemistry markers were used to classify pleural effusion into exudate or transudate based on Light’s criteria. Chest CT without contrast had been done for all patients, and CTs were diagnosed by the radiologist. Measurement of the pleural fluid density was done and shown using the CT attenuation values [Hounsfield unit (HU)].ResultsOf 79 patients with pleural effusion, 60 patients had exudate effusion and 19 patients had transudate. The mean attenuation values were significantly higher in exudate effusion (20.11±7.11 HU) versus transudate effusion (13.8 ±4.11 HU), with P value of 0.03. Receiver operating characteristic curve analysis showed that the cutoff for exudate effusion was optimal at greater than or equal to 15.33 versus less than 15.33 HU for transudate (area under the curve=0.57; 95% confidence interval: 0.45–0.68). This point had 85.71% sensitivity and 46.55% specificity.ConclusionWe reasoned the CT attenuation values of the pleural fluid may replace the laboratory tests in characterizing the pleural effusion, either exudate or transudate. However, there was an overlapping HU values in most effusions. So correlation of the CT results with the clinical findings is essential, and further CT studies are highly recommended to confirm and validate these findings.

Computed tomography attenuation value for the characterization of pleural effusions in dogs: A cross-sectional study in 58 dogs

CT attenuation value can help to differentiate exudate from transudate in people. The aim of this cross-sectional study was to assess the utility of CT in characterizing pleural effusions based on attenuation values in a population of dogs having CT and diagnostic thoracentesis within 48 h of each other. The CT attenuation values were determined using four circular, same size, regions of interest (ROIs) placed on the same CT slice with the greatest quantity of fluid. Values of each ROI were recorded and the mean of the four ROIs mean values (mean of the means) was calculated and considered as the CT attenuation value of that patient. The final population included 23 proper inflammatory exudates, 15 chylous effusions, 12 hemorrhagic effusions and 8 transudates.The median of ‘mean of the means’ values were: exudate 19.22 HU (8.23 to 37.66 HU); chylous effusion 10.26 HU (−0.90 to 15.37); hemorrhagic effusion 31.65 HU (18.10 to 54.97), and transudate 11.20 HU, (−2.52 to 16.59). CT accurately differentiated hemorrhagic from chylous effusion (AUC 1.0, P < 0.0001) and hemorrhagic effusion from transudate (AUC 1.0, P < 0.0001); CT-values allowed good accuracy in distinguishing exudates from transudates [AUC 0.87 (95%, CI: 0.74–1.0; P < 0.0001)]. HU attenuation values did not accurately differentiate between transudates and chylous effusion. A cutoff value of 34.68 HU (sensitivity of 96% and specificity of 95%) discriminated between exudates and hemorrhagic effusions. CT-value <12.15 HU had a sensitivity of 94% and specificity of 78% for identify transudate or chylous effusion.

Pleural transudate: pathophysiology during superior vena cava syndrome.

Pleural transudative effusion arises from imbalances between the hydrostatic and/or oncotic pressures. Temperature drop following talc poudrage through a spray may accentuate the pressure changes induced by superior vena cava syndrome. http://ow.ly/EpZm30nwVZj

Differentiation Between Transudative and Exudative Pleural Effusions by Diffusion Weighted Magnetic Resonance Imaging

Background: Pleural effusion could develop in very different pathological conditions. It is important to characterize pleural effusion and to identify its etiology. Different radiological methods, such as ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) are used for the diagnosis of pleural effusion. Objectives: To assess the ability of diffusion weighted imaging and apparent diffusion coefficient (ADC) maps to differentiate transudative effusions (TEs) from exudative effusions (EEs). Patients and Methods: This prospective observational, single center study was performed on 100 consecutive patients who had pleural fluid detected by chest X-ray, US, or CT and were referred for MRI. Afterwards diffusion-weighted MRI (DW-MRI) was obtained using a multislice, single shot, respiratory triggered spin echo, echo planar imaging sequence. Pleural effusions obtained with thoracentesis were classified into TEs or EEs according to the clinical criteria established by clinical, pathologic findings and Light's criteria. Analysis of MRI was interpreted by one radiologist specialist who was blinded to clinical findings and according to the clinical criteria established by Light. Results: The ADCs of EEs were significantly lower than those of the TEs. The difference between the mean ADC values of TEs and EEs was significant (P < 0.01). The optimum cutoff point for ADC values was 3.51 × 10-3 mm2/s, with a sensitivity of 90.4% and a specificity of 78%. Conclusion: We conclude that ADC value is a noninvasive, reliable, and reproducible imaging parameter that may help to assess and characterize pleural effusion.

Nodules and masses are associated with malignant pleural effusion in dogs and cats but many other intrathoracic CT features are poor predictors of the effusion type.

Thoracic CT may be used in the workup of patients with pleural effusion. In humans, certain pleural features on CT aid in diagnosing an underlying cause for pleural effusion, whereas this is not well studied in veterinary medicine. This retrospective cross-sectional analytical study assessed pleural and other intrathoracic abnormalities on CT in dogs and cats with pleural effusion and explored potential discriminatory features between effusion types. Eighty-nine dogs and 32 cats with pleural cytology and/or histopathology were categorized into malignant pleural disease (15 dogs and 11 cats), pyothorax (34 dogs and 7 cats), chylothorax (20 dogs and 11 cats), transudative (11 dogs and 2 cats), and hemorrhagic effusion (9 dogs and 1 cat). Multivariable logistic regression analysis comparing malignancy to other effusions found that older patient age (dogs: odds ratio 1.28, P=0.015; cats: odds ratio 1.53, P=0.005), nodular diaphragmatic pleural thickening (dogs: odds ratio 7.64, P=0.021; cats: odds ratio 13.67, P=0.031), costal pleural masses (dogs: odds ratio 21.50, P=0.018; cats: odds ratio 32.74, P=0.019), and pulmonary masses (dogs: odds ratio 44.67, P=0.002; cats: odds ratio 18.26, P=0.077) were associated with malignancy. In dogs, any costal pleural abnormality (odds ratio 47.55, P=0.002) and pulmonary masses (odds ratio 10.05, P=0.004) were associated with malignancy/pyothorax, whereas any costal pleural abnormality (odds ratio 0.14, P=0.006) and sternal lymphadenopathy (odds ratio 0.22, P=0.040) were inversely associated with transudates. There were, however, many overlapping abnormalities between effusion types, so further diagnostic testing remains important for diagnosis.