Tuberculous Effusion Research Articles

A novel interleukin 36 gamma for diagnosing and differentiating malignant from infectious pleural effusion

Background Pleural effusions can be caused by various diseases, making their diagnosis challenging. Light’s criteria are often used to distinguish transudative and exudative effusions. Exudative effusions have a more complex etiology, including parapneumonic, tuberculous, and malignant effusion. Objectives The main objective of this study was to evaluate the effectiveness and sensitivity of Interleukin 36 gamma (IL-36γ) as a diagnostic marker for differentiating between malignant and infectious pleural effusions. Methods The study involved 100 patients with pleural effusion. Patients were categorized into five groups based on their final diagnosis. An ELISA technique was used to quantitatively measure the levels of pleural fluid IL-36γ. Results The results showed that pleural IL-36γ levels were higher in tuberculous pleural effusion compared with malignant, transudative, and uncomplicated pleural effusion. In contrast, pleural IL-36γ levels were higher in complicated pleural effusion compared with tuberculous, malignant, transudative, and uncomplicated pleural effusion. Conclusion Based on the study’s findings, it was concluded that pleural IL-36γ is a novel biomarker that can be used to diagnose and differentiate malignant pleural effusion from infectious pleural effusion.

The levels of soluble CD137 are increased in tuberculosis patients and associated with disease severity and prognosis.

Tuberculosis (TB) was the leading cause of death from a single infectious agent before the coronavirus pandemic. Therefore, it is important to search for severity biomarkers and devise appropriate therapies. A total of 139 pulmonary TB (PTB) patients and 80 healthy controls (HCs) were recruited for plasma soluble CD137 (sCD137) detection through ELISA. Moreover, pleural effusion sCD137 levels were measured in 85 TB patients and 36 untreated lung cancer patients. The plasma cytokine levels in 64 patients with PTB and blood immune cell subpopulations in 68 patients with PTB were analysed via flow cytometry. Blood sCD137 levels were higher in PTB patients (p=0.012) and correlated with disease severity (p=0.0056). The level of sCD137 in tuberculous pleurisy effusion (TPE) was markedly higher than that in malignant pleurisy effusion (p=0.018). Several blood cytokines, such as IL-6 (p=0.0147), IL-8 (p=0.0477), IP-10 (p ≤0.0001) and MCP-1 (p=0.0057), and some laboratory indices were significantly elevated in severe PTB (SE) patients, but the percentages of total lymphocytes (p=0.002) and cytotoxic T cells (p=0.036) were significantly lower in SE patients than in non-SE patients. In addition, the sCD137 level was negatively correlated with the percentage of total lymphocytes (p=0.0008) and cytotoxic T cells (p=0.0021), and PTB patients with higher plasma sCD137 levels had significantly shorter survival times (p=0.0041). An increase in sCD137 is a potential biomarker for severe TB and indicates a poor prognosis.

Tuberculous pericardial effusion causing tamponade in a healthy young male:  A diagnostic and therapeutic challenge of a rare manifestation of a fairly frequent disease in Sri Lanka: A Case Report  

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Indications for Tube Thoracostomies and Factors Associated with Complications among Patients Admitted to Bugando Medical Centre, Mwanza, Tanzania

Introduction: Tube thoracostomy is the procedure used in management of traumatic and atraumatic chest conditions. Despite its relative safety, it can still lead to potentially severe complications during or post its insertion.  Objective: To determine the common indications and complications for tube thoracostomies with their associated factors.  Patients and methods: This was a prospective longitudinal study for a total duration of 6 months involving patients who underwent tube thoracostomy during the study period. Recruitment of the patients was done under Convenience sampling technique from all hospital wards and units. A standardized structured questionnaire with TT Complication Reporting Tool incorporated into it was used and all data were entered into an Excel sheet then transferred to STATA version 15.0 software for analysis.  Results: Tuberculous and malignant effusion were the commonest indication by 36.9% followed by thoracic empyema (10.81%) in atraumatic category. In trauma; 16.22% had hemo-pneumothorax followed by pneumothorax (13.5%). 15.3% underwent tube thoracostomy as a post thoracotomy requirement. The observed 33.3% complications rate was significantly associated with age and tube duration where by tube size and urgency showed significant association with the depicted individual complications.  Conclusions: The usefulness of tube thoracostomy cuts across both atraumatic and traumatic indications. Despite its usefulness, it is not without complications as factors like age and tube duration are highly associated with its occurrence. We therefore emphasize on the utilization of proper measures towards complication rates reduction whilst accommodating its desired management outcome.

Management and follow-up of abundant tuberculous pericardial effusions experience of a Moroccan care unit

Management and follow-up of abundant tuberculous pericardial effusions experience of a Moroccan care unit

Pleural fluid residue as a diagnostic tool for cytology-negative malignant pleural effusion: A proof-of-concept study.

Pleural fluid residue, or macroscopic tissue, circulating freely in the pleural fluid obtained through direct filtration, may carry diagnostic histopathological information. We aimed to determine the histopathological concordance of pleural fluid residue in diagnosing TPE and MPE, compared with conventional pleural biopsy. This was a prospective cohort study of consecutive inpatients with cytology-negative exudative effusion who underwent pleuroscopy and had their initial suctioned pleural fluid filtered for residue samples. Pleural fluid residue demonstrated malignant cells in four out of seven cases of pleural biopsy-confirmed malignancy. Pleural fluid residue has comparable cytomorphology but reduced cellularity compared with pleural biopsy. No tuberculous histological features were present in the pleural fluid residue samples. In this preliminary study pleural fluid residue provided histopathological information for malignant pleural effusion, but no incremental diagnostic information for tuberculous effusion. However larger and more definitive studies are required to clarify these findings, and to explore the utility and suitability of pleural fluid residue for mutational analysis. This study demonstrates the potential of pleural fluid residue as a non-invasive diagnostic method for confirming malignancy in cytology-negative exudative effusion. In resource-limited settings or patients contraindicated for pleural biopsy, pleural fluid residue may provide a viable diagnostic alternative; however, this observation needs further validation.

Evaluation of Adenosine Deaminase as a Diagnostic Marker in Tuberculous Pleural Effusion

Abstract: Tuberculous pleural effusion (TPE) is a common medical condition more frequently encountered in poor countries. It is the second most common form of extra-pulmonary tuberculosis. The diagnosis of TPE is problematic because the clinical features are non-specific, and most laboratory tests are not diagnostic. An accurate diagnosis requires the detection of TB bacilli in the pleural fluid or tissue sample from the pleura, which is not an easy task due to the scarcity of bacilli in the pleural fluid and the need for invasive maneuvers to get pleural tissue for histopathological, bacteriological or molecular confirmation for the TB bacilli. : Different markers in pleural fluid have been evaluated to aid in diagnosing TPE. Among those biomarkers, Adenosine deaminase (ADA) was the most studied marker. It is an enzyme predominantly produced by T-lymphocytes and catalyzes the conversion of adenosine to inosine and deoxyadenosine. It is a hallmark of active cellular immunity. A high level of ADA can be found in exudative effusion of different etiologies such as parapneumonic, tuberculous and malignant effusions. : Although there is still a debate over the diagnostic accuracy of ADA as a marker for TPE, many studies recommend its use. A correct diagnosis is crucial for the start of treatment for TPE. Therefore, it is crucial to assess the diagnostic value of adenosine deaminase in diagnosing tuberculous pleural effusion. The ADA optimal cutoff value is still under investigation.

Conditional diagnostic accuracy according to inflammation status and age for diagnosing tuberculous effusion

BackgroundTuberculous effusion varies from lymphocyte-dominant to neutrophilic effusion according to inflammation status. The criteria of adenosine deaminase (ADA) and lymphocyte/neutrophil (L/N) ratio have yet not been evaluated across different disease conditions.MethodsPatients who conducted pleural fluid analysis from 2009 to 2019 at Asan Medical Center were included. Criteria (ADA of 50 and L/N ratio of 0.75) were evaluated by quantile subgroups according to age, C-reactive protein (CRP), white blood cell (WBC), and lactate dehydrogenase (LD) by the Monte Carlo simulation method to diagnose tuberculosis. The model for the ADA and L/N ratio was evaluated by AUROC.ResultsAmong the 2,918 reviewed cases, 2034 were included with 229 (11.26%) tuberculosis cases. The mean baseline ADA AUROC was 0.88 across all patients. Increased CRP and WBC showed high proportions of neutrophilic tuberculous effusion, with low sensitivity of approximately 45% and 33% in the fifth WBC and CRP groups, respectively. The AUROC of the models decreased with the increase in WBC and CRP groups (ADA model: 0.69 [the top quantile WBC group], 0.74 [the top quantile CRP group]). The AUROC of the models did not show a trend according to the increase in LD and age.ConclusionInflammatory status affects the diagnostic metrics for tuberculous effusion due to the progression of tuberculous effusion. Clinicians should consider the low accuracy of tuberculous effusion criteria in high-inflammatory conditions when diagnosing tuberculosis.

Diagnostic Accuracy of Lactate Dehydrogenase/Adenosine Deaminase Ratio in Differentiating Tuberculous and Parapneumonic Effusions: A Systematic Review.

Tuberculous pleural effusion (TPE) and parapneumonic effusion (PPE) are often difficult to differentiate owing to the overlapping clinical features. Observational studies demonstrate that the ratio of lactate dehydrogenase to adenosine deaminase (LDH/ADA) is lower in TPE compared to PPE, but integrated analysis is warranted. We conducted a systematic review to evaluate the diagnostic accuracy of the LDH/ADA ratio in differentiating TPE and PPE. We explored the PubMed and Scopus databases for studies evaluating the LDH/ADA ratio in differentiating TPE and PPE. From a yield of 110 studies, five were included for systematic review. The cutoff value for the LDH/ADA ratio in TPE ranged from <14.2 to <25. The studies demonstrated high heterogeneity, precluding meta-analysis. Quality Assessment of Diagnostic Accuracy Studies Tool 2 assessment revealed a high risk of bias in terms of patient selection and index test. LDH/ADA ratio is a potentially useful parameter to differentiate between TPE and PPE. Based on the limited data, we recommend an LDH/ADA ratio cutoff value of <15 in differentiating TPE and PPE. However, more rigorous studies are needed to further validate this recommendation.

DIAGNOSTIC YIELD OF ADA IN TUBERCULAR PLEURAL EFFUSION

Objective: Tuberculosis (TB) is one of the most common causes of pleural effusion in developing countries like India encountered by medical professionals globally. The present study was carried out to evaluate the diagnostic yield of pleural fluid adenosine deaminase (ADA) in tubercular pleural effusion. Methods: This descriptive study was conducted in the Department of Medicine and Pulmonary Medicine, Saheed Laxman Naik Medical College and Hospital from January 1, 2019, to March 31, 2020. All patients >15 years of age with lymphocytic exudative pleural effusion and pleural effusion associated with smear/CBNAAT-positive pulmonary TB patients, who attended the department during the study period, were included in the study. A case was taken as tuberculous employing defined criteria. Patients with transudative effusions, post-traumatic effusions, pregnant and lactating women, and persons on drugs that affect ADA activity like interferon alpha, deoxycoformycin, ribavirin, and viramidine were excluded from the study. Results: The mean ADA value was 93.93±44.63 IU/L among the cases with tuberculous effusion and 56.36±62.81 IU/L in the non-tuberculous effusion group. At a cutoff value of 50.7 IU/L, pleural fluid ADA showed a sensitivity of 87% and a specificity of 74% in diagnosing TB etiology. Conclusion: The mean ADA values were significantly higher in tuberculous pleural effusions when compared to the non-tuberculous group. When this was combined with pleural fluid lymphocyte dominancy, the specificity increased to 96%. Pleural fluid ADA values have a strong association with age. ADA estimation is a simple, cost-efficient, and diagnostically helpful investigation with high reliability.

Detection of drug-resistant Mycobacterium tuberculosis in pericardial fluid culture and its correlation with cartridge based nucleic acid amplification test and adenosine deaminase activity

BackgroundPericardial effusion is the accumulation of fluid in the pericardial cavity. In nations with high tuberculosis (TB) load, TB is the most common cause of pericardial effusion. 1–2% of patients with pulmonary TB develop Pericardial TB worldwide. Multi-drug-resistant (MDR) TB, including extrapulmonary TB (EPTB) cases, are rising in number. Adenosine Deaminase (ADA) is an enzyme in lymphocytes and myeloid cells, which has certain immune functions in the body. ADA levels are increased in inflammatory conditions, like pleural, pericardial, or joint effusions, of bacterial etiology, granulomatous conditions, neoplasms, and autoimmune pathologies. TB is the only lymphocytosis involving disease with increased ADA levels. MDR EPTB is rare, but cases are on the rise, and tuberculous pericardial effusion is one such example. Hence, it is important to know the percentage of cases detected by a culture that can be identified by cartridge-based nucleic acid amplification test (CBNAAT), their resistance patterns, and to identify potential markers like ADA, which can help in early identification of cases. The objectives of this study were to identify the Mycobacterium tuberculosis (MTB) bacilli in culture, and correlate them with cartridge-based nucleic acid amplification test (CBNAAT) results and their drug-resistance, in the Pericardial tubercular effusion, and to find if Adenosine Deaminase (ADA) levels can be used as a predictor of the presence of MTB in pericardial fluid. MethodologyWe enrolled 52 patients with moderate to large tuberculous pericardial effusion, based on pericardial fluid analysis, CBNAAT, and culture methods, between January 2021 and December 2021. ResultsThe mean age of the patients was 41.85 + 17.88 years, with a median of 38 years. Males made up 57.7% of the total patients. MTB was detected in 16 (30.8%) patients in the CBNAAT evaluations. 14 (87.5%) of the CBNAAT-positive TB patients were sensitive to Rifampicin, whereas the remaining 2 (12.5%) were resistant to Rifampicin on CBNAAT. MTB was found to be growing in 8 (15.38%) drug sensitivity test cultures. Out of these 8, 6 were sensitive to first-line drugs, whereas 2 were resistant to both Isoniazid and Rifampicin. The presence of cough was found to have a significant difference between CBNAAT-detected MTB positive and negative patients (p = 0.020), whereas an insignificant difference was found for the presence of hypertension, diabetes mellitus, obesity, dyspnea, or fever. There was also an insignificant difference between the number of patients positive for the Tuberculin skin test, between the two groups. ADA was significantly higher in the MTB-detected CBNAAT group (85.91 + 37.60U/L vs 39.78 + 24.31U/L, p = 0.005), whereas the total leukocyte count, lymphocytes, neutrophils, random blood sugar levels, and serum protein levels had no significant difference. The area under the Receiver Operator Curve (CBNAAT positive: dependent variable; ADA: test result variable) was 0.854 (null hypothesis rejected), with a standard error of 0.078. ConclusionsCulture is the gold standard method to diagnose tuberculosis. Detection of MTB on pericardial fluid culture is very uncommon, though in our study, culture came out positive in 16% of patients, and 4% were resistant to rifampicin and isoniazid. Higher ADA levels in pericardial fluid are an indicator of tuberculous pericardial effusion.

Study on etiological profile of pleural effusion in tertiary care centre in Dakshin Kannada

Background: Pleural effusion (PE) is a pathological state that often develops in patients with thoracic or systemic diseases and if not diagnosed and treated early, heralds a serious prognosis. Aim of the study was to determine the etiological profile of PE from exudative and transudative pleural fluid. Methods: This cross-sectional study was conducted in participants admitted with PE in the general medicine ward of Yenepoya medical college hospital between the period of January 2021 and December 2021. The patients were analyzed for the socio-demographic characteristics; examination was done with focus on general physical examination, respiratory system, cardiovascular system and gastrointestinal system. SPSS was used for analysis. Results: A total of 80 participants fulfilling inclusion criteria were included in the study. The mean age of participants was 50.28±15.85 years. Among the participants, 36.3% were female and 63.8% were male, with male preponderance in the study. PE, according to Light’s criteria, was differentiated into exudative effusion which accounted for 63.8% and the rest 36.3% were transudative. The most common cause of PE was TB followed by malignancy. The most common malignancy causing effusion was carcinoma of the lung. All the etiologies of PE showed a male preponderance and it was statistically significant (p<0.05). Conclusions: In males, PE was more frequently observed. The main causes of PE were TB and cancer. One of the Clinical indicators including pallor demonstrated a strong correlation with malignant and tuberculous effusions. Malignancy and empyema were substantially correlated with clubbing.

Bacillary Positive Tuberculous Body Fluid Smears: A Perspective on How Fast to Use Acid Fast.

Background Tuberculous effusions are common. Classically, they are described as bacteria poor and lymphocyte rich. Our experience, however, has been more varied. We compiled this rare group of bacteria-positive tuberculous fluids to document their cytologic spectrum and to look for possible predictors of bacillary positivity. Methods Fifty-one cases of bacillary positive fluids were identified and their clinicopathological details were noted. Per case, the smear background was assigned as either clear, caseous, suppurative, granular proteinaceous or frankly hemorrhagic. Fine, punched-out vacuoles in the smear background were also noted. The bacillary load in each case was classified from scanty to 3+. Eventually, the clinicopathologic variables were tabulated for frequency and studied for any association with bacillary presence. Results Only 19 of the 51 patients had a history of tuberculosis. Retropositive patients comprised a small proportion (9.8%) and did not always indicate strong (3+) bacillary positivity. The granular proteinaceous background was the most frequent (35%) pattern. Only a suppurative background was associated with strong bacillary positivity. Fine vacuoles were seen almost always with caseous and granular proteinaceous backgrounds but without statistical significance. Conclusion Tuberculous effusions can have diverse smear backgrounds, not necessarily one rich in caseous material. When tuberculosis is known or clinically suspected, non-classical findings such as abundant neutrophils or suppurative background should not dissuade one from requisitioning mycobacterial stains. In fact, acid-fast stains should probably routinely accompany Giemsa slides of clinically idiopathic effusions in endemic areas since it is still the cheapest and fastest method for a conclusive diagnosis.

The laboratory investigation of pleural fluids: An update based on the available evidence.

Selecting appropriate laboratory tests based on available evidence is central to improve clinical effectiveness and impacting on patient outcome. Although long studied, there is no mutual agreement upon pleural fluid (PF) management in the laboratory context. Given the experienced confusion about the real contribution of laboratory investigations to guide clinical interpretation, in this update, we tried to identify useful tests for the PF analysis, aiming to unravel critical points and to define a common line in requesting modalities and practical management. We performed a careful literature review and a deepened study on available guidelines to finalize an evidence-based test selection, intended for clinicians' use to streamline PF management. The following tests depicted the basic PF profile routinely needed: (1) abbreviated Light's criteria (PF/serum total protein ratio and PF/serum lactate dehydrogenase ratio) and (2) cell count with differential analysis of haematological cells. This profile fulfils the primary goal to determine the PF nature and discriminate between exudative and transudative effusions. In specific circumstances, clinicians may consider additional tests as follows: the albumin serum to PF gradient, which reduces exudate misclassification rate by Light's criteria in patients with cardiac failure assuming diuretics; PF triglycerides, in differentiating chylothorax from pseudochylothorax; PF glucose, for identification of parapneumonic effusions and other causes of effusion, such as rheumatoid arthritis and malignancy; PF pH, in suspected infectious pleuritis and to give indications for pleural drainage; and PF adenosine deaminase, for a rapid detection of tuberculous effusion.

Cardiac tamponade in a multiracial population- epidemiology, clinical characteristics and survival outcomes - a single centre experience

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac tamponade is a medical emergency which requires prompt medical intervention via pericardiocentesis. Diverse etiologies has been attributed, with malignancy and Tuberculous effusions being the leading causes. The aim of this study is to compare clinical characteristics and survival outcome in a multiethnic Asian centre. Methods We performed a single centre retrospective analysis in a hospital in Malaysia. All patients who are acutely presenting with echocardiographic cardiac tamponade between January 2013 to July 2022 were included in this study. Demographic details, clinical presentations, echographic findings, fluid analysis procedural details, and complications were obtained via electronic medical records. Data were analysed using Statistical Package for the Social Sciences version 26 Software. Results Of the 6015 patients admitted to our CCU over 9 years, we identified 46 patients fulfilling criteria of tamponade, representing about 0.8% of total admission. Mean age of our cases are 44.59 (±16.48).Males represent 60.9%( n=28) of our cases with Malay race forming nearly 54.3% ( n=25), followed by Chinese, 28.3% ( n= 13). Orthopnea was the commonest clinical manifestation representing 89.1%,followed by tachypnoea ( 69.6% ),fever (69.6%, cough ( 63%,) , and pleuritic chest pain (26.1%.) Malignancy forms the bulk of our cases (60.9%, n= 28), with lung malignancy being the commonest ( 42%, n= 12), followed by breast ( 25%, n= 7), and lymphoma (17.9%, n= 5). Other aetiologies includes infective cause (15.2% , n= 7), with Tuberculosis being the predominant cause, Uremic effusion (10.86 %, n= 5) and rheumatological effusion ( 6.5%, n= 3). Complications occurred in 34.8 % ( n=16) of our cases, with mortality reaching up to 43.8% ( n=7). No significant association seen between Race, tamponade size, amount drained and drainage duration among the oncology vs non oncologic groups ( P value >0.005). The median survival time is 28 days (SE=1.23) for oncology patients and 52 days (0.0) for non-oncology patients at 1 year. Log-rank test indicated that survival experience is significantly different (p< 0.048) between groups in one year outcome. Lymphoma patients have better median survival rate than breast cancer patients (P=0.014) Conclusion Malignancy is the commonest cause of Cardiac Tamponade at our centre. Lymphoma patients with tamponade fare better compared to other forms of malignancy, with breast cancer patient faring the worst.

Performance verification of a biochemical detection system for hydrothorax and ascites and clinical diagnostic accuracy evaluation of exudate and tuberculous effusion.

Lactate dehydrogenase (LDH), total protein (TP) and glucose (Glu) in pleural hydrothorax and ascites can be used in the diagnosis of exudate, and adenosine deaminase (ADA) can be used in the diagnosis of tuberculous effusion. However, the manufacturers do not claim that their biochemical reagents can be used to detect hydrothorax and ascites samples. Therefore, medical laboratories must conduct suitability studies on biochemical reagents for hydrothorax and ascites samples to comply with regulatory requirements for humor detection. This study aimed to verify the analytical performance and clinical diagnostic accuracy of the Mindray biochemical reagents, including LDH, TP, Glu and ADA, for hydrothorax and ascites. The repeatability, detection limits and reference intervals of Mindray biochemical reagents (LDH, TP, Glu, ADA) in detecting hydrothorax and ascites were determined. The comparison of different measurement procedures was performed. Meanwhile, the diagnostic accuracy of LDH, TP, Glu and ADA were assessed. The quality control results of LDH, TP, Glu, and ADA were all under control. The repeatability coefficient of variation (%) of LDH, TP, Glu, and ADA were all less than 1%. The limits of blank of LDH, TP, Glu, and ADA were 0.33 U/L, 0.45 g/L, 0.00 mmol/L, and 0.04 U/L, respectively; the limits of detection were 1.57 U/L, 1.85 g/L, 0.05 mmol/L, and 0.12 U/L, respectively. Compared with the reference measurement program, the correlation coefficients of LDH, TP, Glu and ADA were 0.9931, 0.9983, 0.9996 and 0.9966, respectively; the regression equations were y=1.0082x-10.06, y=0.9965x-0.4732, y=0.9903x+0.0522 and y=1.0051x-0.0232, respectively. The reference intervals of LDH, TP, Glu, and ADA in hydrothorax and ascites were ≤198.39 U/L, ≤32.97 g/L, ≥5.03 mmol/L. and ≤11.00 U/L respectively. For differentiating between exudates and transudates, the area under the curve (AUC) of LDH, TP, and Glu were 0.913, 0.875, and 0.767, respectively; the AUC of ADA for the differential diagnosis of tuberculous and nontuberculous effusions was 0.876. The LDH, TP, Glu, and ADA assays were validated for use with the Mindray BS-2800 analyzer for hydrothorax and ascites evaluation. LDH, TP, and Glu in hydrothorax and ascites are applicable to the differential diagnosis of exudates and transudates; ADA in hydrothorax and ascites can be employed to differentiate and diagnose tuberculous and nontuberculous effusions.

PS-R02-3: MASSIVE TUBERCULOUS PERICARDIAL EFFUSION WITHOUT CARDIAC TAMPONADE OR MEDIASTINAL LYMPHADENOPATHY IN AN 88 YEAR OLD MALE: A CASE REPORT

Tuberculosis, although endemic in Asia does not commonly affect the heart and would usually present as constrictive pericarditis. Pericardial involvement heralds an unfavorable prognosis and remains a challenge to clinicians. Cardiac tamponade is common in patients with massive pericardial effusions. In the Philippines, it is the second most common cause of cardiac tamponade as documented in the five-year CAPTIVE Heart Study. Mediastinal lymphadenopathy occurs in all cases and denotes lymphatic spread to the pericardium. We present a rare case of an elderly patient presenting with two month history of dyspnea without fever, weight loss, or chest pain. Echocardiography revealed thickened pericardium with fibrinous strands and massive pericardial effusion of 91 mm without tamponade physiology. CT scan revealed absence of mediastinal or hilar lymphadenopathy. Sputum gene xpert was positive. Anti-tuberculosis regimen was started. Patient also then underwent anterolateral thoracotomy, pleuropericardial window with biopsy. Histopathology revealed chronic inflammatory cells, peripherally located granulomas composed of epitheloid cells and Langhans giant cells confirming tuberculosis as the cause of the pericardial effusion. Large pericardial effusion of more than 20 mm is a predictor to the development of hemodynamic instability and subsequent tamponade. In comparison to 2D Echocardiography findings of the patient with a pericardial effusion measurement of 91 mm, still no tamponade physiology was noted even if the effusion existed for more than a month. Mortality is high even in the absence of cardiac tamponade. Mediastinal lymphadenopathy does not occur in all cases of tuberculous pericardial effusion but is still a possibility as seen in the case. The threshold of chronic massive pericardial effusion in developing into tamponade may be higher than previously noted as documented in the case.

Pericardial Disease in Patients with Cancer

Pericardial effusion can develop in patients with acute pericarditis or in association with a wide variety of systemic diseases and is characterized as transudative, exudative, pyopericardium, or hemopericardium. Large effusions are usually related to tuberculous or neoplastic effusions. Primary pericardial tumors are rare, with the vast majority of cases resulting from secondary tumors. Pericardial effusion may be present in 7% to 53% of patients with cancer and is correlated with an advanced stage of the disease. The main types [...]

Development and validation a simple scoring system to identify malignant pericardial effusion.

Malignant pericardial effusion (MPE) is a serious complication in patients with advanced malignant tumors, which indicates a poor prognosis. However, its clinical manifestations lack specificity, making it challenging to distinguish MPE from benign pericardial effusion (BPE). The aim of this study was to develop and validate a scoring system based on a nomogram to discriminate MPE from BPE through easy-to-obtain clinical parameters. In this study, the patients with pericardial effusion who underwent diagnostic pericardiocentesis in Taizhou Hospital of Zhejiang Province from February 2013 to December 2021 were retrospectively analyzed. The eligible patients were divided into a training group (n = 161) and a validation group (n = 66) according to the admission time. The nomogram model was established using the meaningful indicators screened by the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression. Then, a new scoring system was constructed based on this nomogram model. The new scoring system included loss of weight (3 points), no fever (4 points), mediastinal lymph node enlargement (2 points), pleural effusion (6 points), effusion adenosine deaminase (ADA≦18U/L) (5 points), effusion lactate dehydrogenase (LDH>1033U/L) (7 points), and effusion carcinoembryonic antigen (CEA>4.9g/mL) (10 points). With the optimal cut-off value was 16 points, the area under the curve (AUC), specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) for identifying MPE were 0.974, 95.1%, 91.0%, 85.6%, 96.8%, 10.56 and 0.05, respectively, in the training set and 0.950, 83.3%, 95.2%, 90.9%, 90.9%, 17.50, and 0.18, respectively, in the validation set. The scoring system also showed good diagnostic accuracy in differentiating MPE caused by lung cancer from tuberculous pericardial effusion (TPE) and MPE including atypical cell from BPE. The new scoring system based on seven easily available variables has good diagnostic value in distinguishing MPE from BPE.

A rare case of adolescent tuberculous pericardial effusion: a case report

Tuberculous pericarditis (TBP) is a rare case of extrapulmonary TB (EPTB) especially in the developed countries. This may cause serious and deadly impact if not diagnosed and treated properly. A-15-year-old girl was admitted with tightness of breath, weight loss, a productive cough and fatigue. Severe malnutrition, bronchial rales and anemia are present in patient. Chest x-ray showed pleural effusion with cardiomegaly. On three days later, Thoracic multi-slice spiral (MSCT) confirmed pericardial effusion, following pericardiocentesis on the fifth day. Tuberculous was confirmed by analysis of pericardial fluid. This patient was diagnosed as tuberculosis pericardial effusion showed complete recovery after pericardiocentesis and anti-tuberculosis drugs administration. Tuberculous is an endemic disease and its extrapulmonary forms should be included as a differential diagnosis. Early and adequate treatment decreases the risk of developing into a potentially fatal disease.