Transudative Effusion Research Articles

Diagnostic role of different biochemical parameters in pleural effusion

A pleural effusion, an excessive accumulation of fluid in the pleural space, indicates an imbalance between pleural fluid formation and removal. For diagnosing and treatment plan, pleural effusions have to be classified into transudate and exudate. The aim of present study was to analyze various biochemical parameters (LDH, pH, Glucose, Triglycerides, Cholesterol, Creatinine, Amylase and ADA) in pleural fluid and to correlate these Biochemical parameters with diagnosis of the patients. The study was a hospital based descriptive study. The study was conducted over a period of one year on 100 samples. Total 100 samples were enrolled in the study. Both serum and pleural fluid samples were collected and quantitatively analyzed using semi-automated analyzer. The results of the present study shows thatThe Mean±SD of concentration of glucose in pleural fluid was 65.69±14.13 mg/dl, total protein 3.53±1.53g/dl, albumin 1.64±0.85g/dl, cholesterol 58.9±13.05mg/dl, triglycerides 68.7±10.47mg/dl, creatinine 1.73±0.96mg/dl, amylase 49.56±17.78IU/L, LDH 299.82±65.46 U/L and ADA was 49.56±17.78U/L.It was concluded that Biochemical parameters play important role in diagnosing Pleural effusions. These markers when used collectively their diagnostic efficacy is greatly increased. 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.

A novel biomarker for pleural effusion diagnosis: Interleukin‐36γ in pleural fluid

Numerous studies have described the critical importance of interleukin (IL) -36γ in host defense against lung infections, but it is unknown whether it plays a role in infectious pleural effusion (IPE). This study aimed to examine the levels of IL-36γ in pleural effusions of different etiologies and evaluate the diagnostic accuracy of IL-36γ in the differential diagnosis of IPE. A total of 112 individuals was enrolled in this research. IL-36γ levels in pleural fluids of all 112 patients were measured by enzyme-linked immunosorbent assay (ELISA). We also characterized these markers' diagnostic values across various groups. Patients with tuberculous pleural effusion (TPE) and parapneumonic effusion (PPE) had exhibited markedly higher IL-36γ levels in their pleural fluid than the malignant pleural effusion (MPE) and transudative effusion patients. Furthermore, the IL-36γ concentrations in TPE patients were evidently higher than in uncomplicated parapneumonic effusion (UPPE) patients but significantly lower than in complicated parapneumonic effusion (CPPE)/empyema patients. Pleural fluid IL-36γ is a useful marker to differentiate TPE from UPPE, at a cut-off value for 657.5pg/ml (area under the curve=0.904, p < 0.0001) with 70.0% sensitivity and 95.7% specificity. The elevated IL-36γ in pleural effusion may be used as a novel biomarker for infectious pleural effusion diagnosis, particularly in patients with CPPE/empyema, and is a potentially promising biomarker to differentiate between TPE and UPPE.

BIOPROSTHETIC AORTIC VALVE FAILURE IN END-STAGE RENAL DISEASE AND REINTERVENTION

BIOPROSTHETIC AORTIC VALVE FAILURE IN END-STAGE RENAL DISEASE AND REINTERVENTION

Characteristics of patients with transudative efusion followed in an university hospital

Aim: To determine the etiological causes, radiological and laboratory features of transudative pleural effusions and to observe the clinical course after therapeutic thoracentesis. Material and Method: The files of patients with transudative effusion who underwent therapeutic thoracentesis by the Interventional Radiology Department between 01.01.2012 and 30.11.2012 were retrospectively reviewed. Pleural effusion (PE) anatomical features were evaluated with Postero anterior (PA) chest X-ray and Thorax Ultrasonography (USG). Demographic and clinical features, pleural effusion analysis results, presence and rates of complications were analyzed. Results: As a result of pleural fluid analysis, our study group consisted of 60 transudative pleural effusion cases, 36 (60%) women. The mean age was 71.23±2.36 years. Patients using diuretic therapy in cases with pleural effusion were statistically significantly higher than patients who did not (p&amp;lt;0.05). The most common etiologic causes were Congestive heart failure (CHF) and the accompanying disease hypertension (HT). Fifty (83.3%) of the pleural effusions were unilateral and 39 (65%) of them were right-sided (p&amp;lt;0.05). Diagnostic and therapeutic thoracentesis of our cases was performed by the radiologist under the guidance of thorax USG, and pneumothorax was observed in only one case (1.7%). In our 2-month clinical follow-up, the presence of recurrent pleural effusion was not detected in any of the cases. Conclusion: In cases with persistent transudative pleural effusion, therapeutic thoracentesis can be considered in cases where fluid resorption is not at the desired level despite effective treatment.

Diagnostic value of pleural cholesterol in differentiating exudative and transudative pleural effusion

BackgroundPleural effusions are most commonly classified as transudative or exudative based on Light's criteria which has shown misclassification in 10%–20% of cases. Studies have demonstrated lesser misclassification with pleural fluid cholesterol criteria. Thus, this study aimed to find the diagnostic properties of pleural fluid cholesterol in differentiating the type of effusion. Materials and methodsThis cross-sectional study involving 72 patients was undertaken in a tertiary center in Nepal for a duration of 2 years. On the basis of Light's, Heffner's, etiological, and pleural fluid cholesterol criteria, pleural effusion was classified as exudative or transudative. The findings were then evaluated to determine the diagnostic value of each approach in identifying the effusion type and comparing them on the basis of sensitivity, specificity, positive predictive value and negative predictive value. ResultPleural fluid cholesterol detected effusion as exudative with sensitivity of 91.94% and specificity of 80.00% against Light's criteria; with a sensitivity of 98.28% and specificity of 85.71% against the etiological diagnosis. Additionally, against the etiological diagnosis, sensitivity of both Light's and Heffner's criteria was 100%; however, specificity was 71.43% and 64.29% respectively, which is far less than that of pleural fluid cholesterol (85.71%). Furthermore, pleural fluid cholesterol was also found to have better results than protein ratio, LDH ratio and pleural fluid protein ratio in determining the type of effusion. ConclusionWhen considering the avoidance of confusing outcomes in equivocal instances and cost effectiveness in developing nations, pleural fluid cholesterol can be one of the most useful alternative diagnostic methods for differentiating between exudative or transudative effusions.

Descriptive study of clinical profile of malignant pleural effusions in a tertiary care centre

Introduction: Pleural effusion (PE) refers to the excessive or abnormal accumulation of fluid in the pleural space. PE is commonly encountered medical problem and caused by a variety of underlying pathological conditions.1 They are classified broadly in to exudative and transudative effusion based on Light's criteria.2 Common causes of transudative effusions are congestive cardiac failure, cirrhosis, nephrotic syndrome, superior venacava obstruction, peritoneal dialysis, glomerulonephritis, myxoedema, pulmonary emboli and sarcoidosis whereas exudative PE is caused by neoplastic diseases, infections, pulmonary embolism, gastrointestinal diseases, collagen vascular diseases, drug induced, iatrogenic, hemothorax and chylothorax. Materials and Methods: A total of 178 consecutive cases ≥ 18 years having pleural effusion with proven underlying malignancy were included in the study. Detailed clinical history, general and systemic examination was done in all patients. A chest radiograph was done and the size of effusion was estimated in all cases. If the size of effusion was more than 2/3rd, it was considered large/ massive effusion. After preliminary examination and investigations, an informed consent was taken from all the patients regarding diagnostic thoracentesis. Further, every study participant was subjected to following investigations: pleural fluid cytology, pleural fluid LDH, pleural fluid proteins, S. proteins and S. LDH.

Assessment of the value of mesothelin in differentiating between different pleural malignancies by different interventional modalities

Abstract Context Malignant mesothelioma is an insidious neoplasm, with malignant pleural mesothelioma as the most common type, which is characterized by poor prognosis in most patients owing to late presentation. The use of noninvasive markers for early diagnosis of malignant pleural mesothelioma is of great importance in decreasing the incidence of associated morbidity and mortality. Aims To evaluate the value of soluble mesothelin level in serum and pleural fluid as a diagnostic marker in patients with pleural malignancies and in differentiation of different causes of pleural effusion. Patients and methods We included 48 patients who were classified into three groups: group A (mesothelioma), group B (metastatic malignancy), and group C (transudative effusion). History taking, clinical examination, and laboratory assessment were performed in all groups, in addition to measuring mesothelin level in serum and pleural fluid. Histopathological examination of pleural biopsies was performed in groups A and B. Results Mesothelin levels in serum and pleural fluid demonstrated a statistically significant increase in group A as compared with the cases in groups B and C (P&lt;0.001). Moreover, mesothelin levels in serum and pleural fluid demonstrated a statistically significant increase in the samples taken from the cases in group B as compared with the cases in group C (P&lt;0.001). Conclusion Soluble mesothelin-related peptides (SMRP) could be used as a valuable marker in diagnosis of different causes of pleural effusion. The diagnostic accuracy of pleural fluid SMRP was higher as compared with the serum SMRP.

A Clinical Study of Pleural Effusion and its Radiological, Biochemical, Bacteriological, and Cytological Correlation

Background: Pleural effusion refers to excessive or abnormal accumulation of fluid in the pleural space. It is a commonly encountered medical problem caused by a variety of underlying pathological conditions. Collection of fluid in the pleural cavity has varied etiological factors. Because of the various etiologies that can cause pleural effusion, it often presents a diagnostic problem, even after extensive investigations. Materials and Methods: A prospective study was carried out with the aim was to arrive at the etiological diagnosis by analysis of history, clinical presentation, biochemical, radiological, cytological, and bacteriological methods. The inclusion criteria were total 100 patients of adult age and either sex were taken, with age &gt;18 years, and chest X-ray showing evidence of pleural effusion. Already diagnosed with pleural effusion were excluded from the study. Diagnosis was made on clinical examination, radiological examination, and analysis of laboratory data. Results: A total of 106 patients were enrolled with a mean age of 42.8 years and standard deviation of ± 15.1, respectively. Out of 106, the maximum number of cases of pleural effusion were tuberculosis 59 (55.7%) among them more than three-fourth of them were affected on the right side and only 13 (12.2%) were affected on the left side. After tuberculosis, malignancy 17 (16.0%) and congestive heart failure 10 (9.4%) respectively. Most of the cases were affected on the right side 57 (53.7%), followed by 35 (33.1%) and only 14 (13.2%) were affected bilaterally. The most common presenting symptoms are 99 (93.3%) and had shortness of breath, 87 (86.0%). Among the plural effusion cases, majority 90 (84.9%) of them had diagnosed with thoracocentesis. Almost 89 (83.9%) exudative effusions are more common and only 17 (16.1%) transudative effusion. Conclusion: A maximum number of cases of pleural effusion were tuberculosis followed by malignancy. Thoracentesis and pleural fluid analysis were the most common diagnostic technique. Thoracoscopy was required in few cases which are difficult to diagnose cases.

Diagnostic accuracy of CT Hounsfield unit in distinguishing Exudative and Transudative Pleural Effusion

Background: Differentiation of exudative and transudative types of pleural effusion is crucial for management of patients. Currently, this differentiation is done with the help of biochemical analysis of the aspirated fluid after thoracentesis, which is an invasive procedure. Objective: To evaluate the utility of CT attenuation values in pleural effusion and define a threshold value to differentiate between exudative and transudative pleural effusion. Materials &amp; Methods: A cross sectional study was done on 130 patients showing pleural effusion on CT thorax, mean attenuation was calculated using nine regions of interest on three slices. Within 48 hours of imaging, biochemical assessment was done to decide exudative or transudative nature of fluid as per Light’s criteria. A Receiver operating characteristic curve was drawn to assess the cut off CT attenuation value for distinguishing between exudative and transudative effusion and evaluate its accuracy. Result: Mean CT attenuation value of 57 exudative effusion cases was 5.9 + 6.48 HU, which was higher than 73 cases with transudative pleural effusion (2.97 + 2.69 HU). The difference was statistically significant (p value &lt; 0.0001). The ROC curve revealed a cut off value of 7.5 HU. When the mean CT attenuation value was &gt; 7.5 HU, the specificity and sensitivity of CT scan for diagnosing exudative effusion was 98.6 % and 59.6% respectively. Area under the curve was 0.79, which revealed moderate accuracy of this threshold value. Conclusion: CT attenuation values have moderate accuracy in differentiating between exudative and transudative pleural effusion.

Treating Recurrent Pleural Disease: A Review of Indications and Technique for Chemical Pleurodesis for the Interventional Radiologist.

Pleural space diseases such as recurrent pleural effusion and pneumothorax inflict a significant symptomatic burden on patients. Guidelines and studies are available to guide best practices in the setting of refractory effusions, mostly in the setting of malignancy, and recurrent pneumothorax. Less data is available to guide management of refractory transudative effusions. Recurrent pleural effusions can be treated with tunneled pleural catheters or catheter-based pleurodesis. While refractory transudative effusions can benefit from tunneled pleural catheter, this is an area of ongoing research. Regarding recurrent pneumothorax, video-assisted thoracoscopic surgery (VATS) pleurodesis using mechanical or laser/argon beam coagulation is the most effective means of preventing recurrence. Catheter based pleurodesis, a less invasive means of administering chemical sclerosant via percutaneous thoracostomy tube, is only used when surgery is not an option. However, both approaches induce inflammation of the pleural space, resulting in adherence of the parietal and visceral pleura to prevent fluid or air re-accumulation. This article will discuss catheter based chemical pleurodesis geared toward the interventional radiologist, including a review of disease processes and indications, technique, and strategies to mitigate complications as well as a literature review comparing percutaneous chemical pleurodesis to other therapies.

Lipoprotein profile of pleural and peritoneal transudates in dogs and cats.

BackgroundCurrent diagnostic evaluation of transudative effusions rarely aids in identifying an underlying etiology. Lipoproteins in the fluid might reflect the site or nature of vessel involvement.ObjectivesImprove the classification and diagnostic utility of pleural and peritoneal transudates in dogs and cats by investigating lipoprotein patterns in effusions. Compare these patterns with other peritonaeal and pleural fluid variables and underlying diseases.AnimalsSamples of transudates and serum from 18 cats and 37 dogs with transudative effusion (total nucleated cell count [TNCC] <5000 cells/μL) were analyzed.MethodsLipoprotein fractions, triglyceride, and cholesterol (CHO) concentrations were prospectively determined in paired fluid and serum samples. Standard fluid measurements were retrospectively collected.ResultsTwo distinct fluid lipoprotein patterns were noted. Fluids rich in VLDL+IDL were associated with chronic kidney disease, acquired portosystemic shunts or protein‐losing enteropathy (group I). Fluids rich in denser lipoproteins were associated with underlying heart disease, caudal vena cava syndrome or intracavitary neoplasia (group II). Group I and group II also had significant differences between fluid concentrations of CHO (x̄ = 8 vs 110 mg/dL) and TP (x̄ = 0.6 vs 3.8 g/dL), respectively. Five peritoneal transudates were triglyceride‐rich (>100 mg/dL) and associated with pancreatitis.Conclusions and Clinical ImportanceProtein‐poor (TP <1.5 g/dL) and protein‐rich (TP >2.5 g/dL) transudates were associated with distinct lipoprotein patterns and specific groups of disease. Effusions secondary to pancreatitis might be transudative and rich in triglycerides.

POS-679 SWEET HYDROTHORAX: A PERITONEAL DIALYSIS DILEMMA

Hydrothorax is a rare and serious complication in the patient treated with peritoneal dialysis (PD). It consists of pleuro peritoneal communication through the porous diaphragmatic leak. Its diagnosis is challenging as it may be wrongly considered as fluid overload. It may lead to vicious circle because hypertonic glucose peritoneal solutions may be used thus aggravating surcharge. case report A 45-year-old male with end stage chronic kidney disease secondary to IgA nephropathy, 4 years after starting automated peritoneal dialysis (APD) contacted our institution’s PD unit with complaints of cough and dyspnoea. He has past medical history of hypertension, 2 episodes of peritonitis successfully treated.Clinical examination revealed oedema of the lower extremities and reduced auscultation sounds in the right lower lung. Residual diuresis was absent. Chest radiography confirmed right pleural effusion.Thorax computed tomography showed a massive pleural effusion with right lower-lobe atelectasis and evidence of multiple defects in the diaphragmatic dome with a diaphragm that is shriveled at the right cardiophrenic angle. The thoracentesis drained 1.7L of pleural fluid during the following days.Laboratory findings demonstrated a transudative effusion with the chemical component of pleural fluid similar to PD fluid.We did not find any sign of peritonitis, hypoalbuminaemia, infectious or neoplastic diseases. However, echocardiography revealed cardiac failure. Patient was switched to hemodialysis and intensive ultrafiltration was performed. This case describes an unusual presentation of hydrothorax in the context of peritoneal dialysis. Switchto hemodialysis is frequently necessary temporarily or definitively. All clinicians prescribing peritoneal dialysis should be aware of this complication to avoid delayed diagnosis.

Pleural Fluid Bilirubin to Serum Bilirubin Ratio, comparison with Light’s Criteria.

Introduction: Pleural fluid bilirubin and pleural fluid bilirubin to serum bilirubin ratio evaluation had been reported by several in distinguishing exudative from transudative pleural effusions along with Light’s Criteria. The aim of this study was to assess whether pleural fluid bilirubin to serum bilirubin ratio, was a sensitive marker in classifying the pleural effusion as exudative and transudative and its correlation with Light’s criteria.&#x0D; Methods: A cross-sectional, observational study of Pleural fluid bilirubin to serum bilirubin ratio ≥ 0.6 for exudates was taken and compared with Light’s criteria overall and its individual parameters to classify exudative and transudative along with the diagnosis. Statistical analysis was done using SPSS 16, Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV) and diagnostic accuracy of each tests were calculated.&#x0D; Results: By diagnosis on discharge out of 86 samples of pleural effusion, 78(90.69%) were exudative and 8(9.3%) were transudative effusion. Among transudative effusion, 72 were classified correctly and 6 were misclassified by pleural fluid Lactate dehydrogenase (LDH) &gt; 2/3rd of serum LDH criteria and out of 8 transudative, 4 were misclassified as exudative. When the pleural fluid to serum bilirubin ratio ≥0.6 was used to differentiate , it categorized 67 as exudative effusion by pleural fluid LDH &gt; 2/3rd of serum LDH criteria and 11 were misclassified as transudative. This criterion had a sensitivity, specificity, PPV and NPV of 85.53%, 50%, 92.88% and 27.78 % respectively with a significant p value of &lt;0.01. &#x0D; Conclusion: The pleural fluid to serum bilirubin ratio can serve as an alternative easy and cost-effective diagnostic tool in differentiating between exudative and transudative pleural effusion. Though, it misclassified 11 exudative pleural fluids as transudative and 4 transudative as exudative. By taking Light’s criteria as a standard, pleural fluid bilirubin to serum bilirubin ratio ≥0.6 was found to be inferior to the Light’s criteria also in terms of sensitivity, specificity, PPV and NPV. Still the pleural fluid to serum bilirubin ratio can serve as an alternative easy and cost-effective diagnostic tool in differentiating between exudative and transudative pleural effusion in low resource settings.

Nicotinamide phosphoribosyltransferase as a biomarker for the diagnosis of infectious pleural effusions

Nicotinamide phosphoribosyltransferase (NAMPT) has been reported to be involved in infectious diseases, but it is unknown whether it plays a role in infectious pleural effusions (IPEs). We observed the levels of NAMPT in pleural effusions of different etiologies and investigated the clinical value of NAMPT in the differential diagnosis of infectious pleural effusions. A total of 111 patients with pleural effusion were enrolled in the study, including 25 parapneumonic effusions (PPEs) (17 uncomplicated PPEs, 3 complicated PPEs, and 5 empyemas), 30 tuberculous pleural effusions (TPEs), 36 malignant pleural effusions (MPEs), and 20 transudative effusions. Pleural fluid NAMPT levels were highest in the patients with empyemas [575.4 (457.7, 649.3) ng/ml], followed by those with complicated PPEs [113.5 (103.5, 155.29) ng/ml], uncomplicated PPEs [24.9 (20.2, 46.7) ng/ml] and TPEs [88 (19.4, 182.6) ng/ml], and lower in patients with MPEs [11.5 (6.5, 18.4) ng/ml] and transudative effusions [4.3 (2.6, 5.1) ng/ml]. Pleural fluid NAMPT levels were significantly higher in PPEs (P < 0.001) or TPEs (P < 0.001) than in MPEs. Moreover, Pleural fluid NAMPT levels were positively correlated with the neutrophil percentage and lactate dehydrogenase (LDH) levels and inversely correlated with glucose levels in both PPEs and TPEs, indicating that NAMPT was implicated in the neutrophil-associated inflammatory response in infectious pleural effusion. Further, multivariate logistic regression analysis showed pleural fluid NAMPT was a significant predictor distinguishing PPEs from MPEs [odds ratio (OR) 1.180, 95% confidence interval (CI) 1.052–1.324, P = 0.005]. Receiver-operating characteristic (ROC) analysis demonstrated that NAMPT was a promising diagnostic factor for the diagnosis of infectious effusions, with the areas under the curve for pleural fluid NAMPT distinguishing PPEs from MPEs, TPEs from MPEs, and IPEs (PPEs and TPEs) from NIPEs were 0.92, 0.85, and 0.88, respectively. In conclusion, pleural fluid NAMPT could be used as a biomarker for the diagnosis of infectious pleural effusions.

Randomised trial of indwelling pleural catheters for refractory transudative pleural effusions.

Refractory symptomatic transudative pleural effusions are an indication for pleural drainage. There has been supportive observational evidence for the use of indwelling pleural catheters (IPCs) for transudative effusions, but no randomised trials. We aimed to investigate the effect of IPCs on breathlessness in patients with transudative pleural effusions when compared with standard care. A multicentre randomised controlled trial, in which patients with transudative pleural effusions were randomly assigned to either an IPC (intervention) or therapeutic thoracentesis (TT; standard care). The primary outcome was mean daily breathlessness score over 12 weeks from randomisation. 220 patients were screened from April 2015 to August 2019 across 13 centres, with 33 randomised to intervention (IPC) and 35 to standard care (TT). Underlying aetiology was heart failure in 46 patients, liver failure in 16 and renal failure in six. In primary outcome analysis, the mean±sd breathlessness score over the 12-week study period was 39.7±29.4 mm in the IPC group and 45.0±26.1 mm in the TT group (p=0.67). Secondary outcomes analysis demonstrated that mean±sd drainage was 17 412±17 936 mL and 2901±2416 mL in the IPC and TT groups, respectively. A greater proportion of patients had at least one adverse event in the IPC group (p=0.04). We found no significant difference in breathlessness over 12 weeks between IPCs or TT. TT is associated with fewer complications and IPCs reduced the number of invasive pleural procedures required. Patient preference and circumstances should be considered in selecting the intervention in this cohort.

Assessment of the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions

Pleural effusion is divided into exudative and transudative effusion, and the distinction between exudate and transudate requires multiple investigations of biochemical parameters and their comparison in pleural fluid and serum. This study aimed to assess the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions. This epidemiological and cross-sectional study was performed on 50 patients aged between 18 to 90 years with the diagnosis of exudative pleural effusion referred to Imam Khomeini Hospital in Ahvaz in 2018 and 2019. Demographic and clinical information of patients were collected. The pleural effusion was diagnosed based on physical examination and chest radiography. Pleural effusion was confirmed by thoracentesis. A pleural fluid sample was taken from all patients, and the levels of CEA, CA125, and CRP markers were measured in the pleural fluid. Differentiation of transudate and exudate pleural effusions was performed using Light criteria. The mean CEA and CA125 level of pleural fluid were significantly higher, and the mean CRP level of pleural fluid was significantly lower in patients with malignant diagnoses (P &lt;0.05). Cut-off value with highest sensitivity and specificity in differentiating types of exudative pleural effusions was obtained for CEA tumor marker (greater than 49.8), CA125 tumor marker (greater than 814.02), and CRP marker (less than 7.56). Also, in differentiating types of exudative pleural effusions, CEA tumor marker had sensitivity (89.03%) and specificity (78.42%); CA125 tumor marker had sensitivity (53.18%) and specificity (62.44%), and CRP marker had sensitivity (82.16%), and specificity (89.05%) were. Although the tumor markers had high specificity in the present study, the low sensitivity of some of these tumor markers reduced their diagnostic value. On the other hand, given the numerous advantages of tumor markers, such as low cost and non-invasive, combining them with another can increase the diagnostic value and accuracy.

Non-invasive characterization of pleural and pericardial effusions using T1 mapping by magnetic resonance imaging.

Differentiating exudative from transudative effusions is clinically important and is currently performed via biochemical analysis of invasively obtained samples using Light's criteria. Diagnostic performance is however limited. Biochemical composition can be measured with T1 mapping using cardiovascular magnetic resonance (CMR) and hence may offer diagnostic utility for assessment of effusions. A phantom consisting of serially diluted human albumin solutions (25-200 g/L) was constructed and scanned at 1.5 T to derive the relationship between fluid T1 values and fluid albumin concentration. Native T1 values of pleural and pericardial effusions from 86 patients undergoing clinical CMR studies retrospectively analysed at four tertiary centres. Effusions were classified using Light's criteria where biochemical data was available (n = 55) or clinically in decompensated heart failure patients with presumed transudative effusions (n = 31). Fluid T1 and protein values were inversely correlated both in the phantom (r = -0.992) and clinical samples (r = -0.663, P < 0.0001). T1 values were lower in exudative compared to transudative pleural (3252 ± 207 ms vs. 3596 ± 213 ms, P < 0.0001) and pericardial (2749 ± 373 ms vs. 3337 ± 245 ms, P < 0.0001) effusions. The diagnostic accuracy of T1 mapping for detecting transudates was very good for pleural and excellent for pericardial effusions, respectively [area under the curve 0.88, (95% CI 0.764-0.996), P = 0.001, 79% sensitivity, 89% specificity, and 0.93, (95% CI 0.855-1.000), P < 0.0001, 95% sensitivity; 81% specificity]. Native T1 values of effusions measured using CMR correlate well with protein concentrations and may be helpful for discriminating between transudates and exudates. This may help focus the requirement for invasive diagnostic sampling, avoiding unnecessary intervention in patients with unequivocal transudative effusions.

Accurate and Rapid Diagnosis of Exudative Pleural Effusion.

Background: Accurate diagnosis of exudate pleural effusion is definitely important. Few studies have been published on this topic. The current work present evidence for the importance of the pleural fluid markers like high sensitivity-C reactive protein [hsCRP]; tumor necrosis factor alpha [TNFα]; and cholesterol levels measurement in differentiating types of exudative from transudative pleural effusion. Aim: The current study was to determine and evaluate the diagnostic importance of measured levels of pleural fluid cholesterol, high sensitivity-CRP and tumor necrosis factorα in diagnosing and differentiating transudate from exudate pleural effusion. Methods: This study was carried out on 100 patients suffering from pleural effusion who subjected to diagnostic evaluation at Al Sahel Teaching Hospital. The full biochemical analysis of the pleural fluid, pleural fluid culture, and cytology examination were also performed. TNFα, hs CRP, and cholesterol level were assessed in the samples of pleural fluid. Results: One hundred patients were initially evaluated, in accordance to Light's criteria, of 100 patients suffering from pleural effusion, 67 had exudative effusions while 33 patients had transudative pleural effusion. The concentrations of pleural fluid hs CRP and TNFα, found to be significantly elevated in the exudative nature group of pleural fluid than the transudative pleural effusion group (p < 0.05). Also, pleural fluid cholesterol level was elevated in the exudative pleural effusion than transudative pleural effusion (P< 0.001). Conclusion: Patients presented with pleural effusion, simple markers of elevated pleural fluid hsCRP, TNFα, and cholesterol levels may be helpful in discrimination between exudates and transudates effusion.

Evaluation of Light's criteria in cytologically proved malignant pleural effusions.

Malignant pleural effusions are usually described as exudates. However, several studies have determined a high incidence of cytologically proved malignant effusions in transudates. The study aims to determine the compliance of cytologically proved malignant pleural effusions with Light's Criteria and to assess when it is necessary to perform more studies in transudates. We have retrospectively reviewed all the cytologically positive effusions at our institution over six years. Biochemical characteristics were recorded, and Light's criteria were determined for each effusion. We analyzed the effusions' compliance with the criteria and determined whether its primary tumor or the presence of cirrhosis, acute kidney injury or congestive heart failure could interfere in the criteria being met. Overall, 224 patients presented malignant pleural effusions with biochemical pleural fluid analysis. Two (0.9%) were transudative effusions and two hundred and twenty-two (99.1%) were exudative effusions. Lung carcinoma, breast carcinoma and ovarian carcinoma were the most frequent primary tumors. One hundred and two (45.94%) patients met three Light criteria, 77 (34.68%) patients met two criteria and 43 (19.36%) met one criterion. Both patients with transudative malignant pleural effusions presented concomitant malignant ascites. Malignant transudative pleural effusions were 0.9% of our patients. We found no relation between transudative malignant effusions and the presence of cirrhosis, acute kidney injury or congestive heart failure, or the type of tumor. We found no difference between the tumor type and the distribution of Light's criteria met.

Trace element levels in pleural effusions.

Trace element levels in pleural effusions.