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PubMed2000

Pleural effusions and sera from patients with benign or malignant diseases.

In pleural effusions and sera from 66 patients copper and zinc were quantified by inductively coupled argon plasma-mass spectrometry after mineralizations in a closed-pressurized microwave unit with a mixture of concentrated nitric acid and 30% hydrogen peroxide. Total protein, pH, leukocyte count, lactate dehydrogenase, glucose, C-reactive protein, ceruloplasmin, and alpha1-antitrypsin were determined in many of the effusions. All but four effusions had concentrations of copper (range 58-1720 microg/kg) and zinc (range 27-1001 microg/kg) that were lower than the concentrations in the corresponding sera. Very high concentrations of zinc (1930-6470 microg/kg) were characteristic for thoracic empyemata. In the scatterplots of serum copper versus effusion copper, serum zinc versus effusion zinc, and serum copper/effusion copper versus serum zinc/effusion zinc no clearly delineated regions were noticeably useful for identifying malignant effusions. Similar plots of the concentrations of copper or zinc versus the eight clinical laboratory parameters or plots of clinical parameter versus clinical parameter failed to be of diagnostic value. Statistically highly significant correlations (p < or = 0.05, n > 45, r2 > 0.25) were observed for 9 of 28 pairs of the clinical parameters, for total protein and copper in the effusions and zinc in the effusions and for ceruloplasmin and copper in the effusions. Among the patients suffering from benign or malignant effusions, 52% had zinc concentrations in the sera below the low limit of the normal range (600 microg/kg). Supplementation of such patients with zinc should be considered.

Adolescent↗
PubMed1997

Diagnostic value of lactate dehydrogenase isoenzyme pattern in pleural effusions.

Lactate dehydrogenase isoenzymes have been used to classify the nature of pleural effusion. Nevertheless, studies have reported conflicting results. The objective of this study was to evaluate the diagnostic value of lactate dehydrogenase isoenzymes in the analysis of pleural effusions. Pleural fluid samples obtained from three respective diagnostic groups: group I transudate (n = 23), group II parapneumonic effusion (n = 29) and group III malignant effusion or pleuritis carcinomatosa (n = 41) were evaluated. Total lactate dehydrogenase activity and lactate dehydrogenase (LDH) isoenzyme pattern were significantly different between transudative (group I) and exudative (group II and III) effusions. Group II and III showed a low percentage of LDH1 (p < 0.001), whereas the percentages of LDH4 (p < 0.001) and LDH5 (p < 0.001) were higher compared to group I. Moreover, in exudative effusions the percentage of LDH1 (p < 0.005), LDH4 (p < 0.005), as well as LDH5 (p < 0.005) were significantly different between parapneumonic and malignant effusions. In contrast to relative lactate dehydrogenase isoenzyme values, the absolute values of lactate dehydrogenase isoenzymes did not differ between group II and group III. Logistic regression analysis yielded a strong discrimination between group I and II+III, simultaneously using lactate dehydrogenase, glucose and protein as explanatory variables. Logistic regression analysis yielded only a weak discrimination between group II and III, simultaneously using lactate dehydrogenase, glucose and the absolute values of LDH2 and LDH4 as explanatory variables. In conclusion, the lactate dehydrogenase isoenzyme pattern differed between pleural effusions of transudative and exudative origin. However, including lactate dehydrogenase isoenzyme activities in the biochemical work-up of pleural effusions did not reveal an additional discriminatory value in the assessment of the classification of these effusions.

Aged↗
PubMed1999

[Evaluation of atrial natriuretic peptide in differentiating benign and malignant pleural effusion].

OBJECTIVE: To discuss the value of atrial natriuretic peptide (ANP) in differentiating benign and malignant pleural effusion. METHODS: Direct radioimmunoassay was used to detect ANP of pleural effusion and serum in 30 tuberculous and 26 cancerous pleural effusion patients. RESULTS: The ANP in tuberculous and cancerous pleural effusion were (75 +/- 9) ng/L, (157 +/- 45) ng/L respectively, and significant difference was found (P < 0.001). The ANP of tuberculous pleural effusion was apparently lower [(75 +/- 9) ng/L] than serum [(170 +/- 37) ng/L], and significant difference was also found (P < 0.001). The ratio of ANP of pleural effusion to that of serum were 0.47 +/- 0.17, 0.99 +/- 0.46 respectively in tuberculous and cancerous pleural effusion patients. The sensitivity of ANP was 81% and specificity 100% in diagnosing malignant pleural effusion. CONCLUSIONS: Detecting ANP of pleural effusion is one of important methods for differentiating benign and malignant pleural effusion.

Adolescent↗
PubMed1994

Usefulness of soluble interleukin 2 receptor in differentiating tuberculous and carcinomatous pleural effusions.

OBJECTIVE: To evaluate the usefulness of soluble interleukin 2 receptor (sIL-2R) in differentiating tuberculous and carcinomatous pleural effusions. METHODS: Levels of sIL-2R were measured simultaneously in plasma and pleural fluid in 111 patients with pleural effusions of unknown causes. RESULTS: The causes of pleural effusions were tuberculosis in 42 cases, carcinoma in 41 cases, pneumonia in 18 cases, and heart failure in 10 cases. In all groups of patients, sIL-2R levels were significantly higher in pleural fluid than in plasma. Plasma and effusion levels of sIL-2R were highest in the patients with tuberculosis, followed by those with carcinoma, pneumonia, and heart failure. Levels were significantly higher in the tuberculous group than in the carcinomatous group. To differentiate tuberculous from carcinomatous effusions, the highest plasma and effusion sIL-2R values obtained from the carcinomatous group were chosen as cutoff points (test specificity, 100%). The sensitivities of plasma and effusion sIL-2R levels in differentiating tuberculous and carcinomatous pleural effusions were 50% (21 of 42 samples) and 81% (34 of 42 samples), respectively. CONCLUSIONS: Although increased plasma and pleural fluid levels of sIL-2R should not be viewed as a diagnostic test specific for tuberculous pleural effusion, sIL-2R level appears to be clinically useful as a biochemical marker to differentiate tuberculous and carcinomatous pleural effusions.

Adult↗
PubMed1998

Isoenzymes of adenosine deaminase in pleural effusions: a diagnostic tool?

SETTING: Tygerberg Hospital, an academic teaching hospital, Republic of South Africa. OBJECTIVE: To identify the adenosine deaminase (ADA) isoenzymes as a diagnostic tool for tuberculosis in pleural effusions with increased ADA activity. DESIGN: Patients (n = 157) with exudative effusions and ADA activities >20 U/l, due to causes which satisfied predetermined diagnostic criteria, participated in the study. They consisted of 87 tuberculous effusions, 27 infective effusions (12 empyematous and 15 non-empyematous), 37 malignant effusions and six other exudative effusions (systemic lupus erythematosus, pancreatitis and lung embolus). In each case the ADA isoenzymes in the pleural fluid were identified using polyacrylamide gel electrophoresis. In addition, microbiology and cytology (including differential cell counts) were also carried out. RESULTS: Although ADA1c and ADA2 were the predominant isoenzymes observed in tuberculous effusions, while ADA1c and ADA1m were predominant in infective non-empyematous effusions, no additional diagnostic value was obtained. In the case of neoplastic effusions and other exudates, determination of ADA isoenzyme patterns also did not assist in diagnosing these conditions. CONCLUSION: Determination of patterns of ADA isoenzymes does not enhance the overall diagnostic value of ADA activity in pleural effusions.

Adenosine Deaminase↗
PubMed2004

Ultrasonic detection of middle ear effusion: a preliminary study.

OBJECTIVE: To assess the ability to detect and characterize middle ear effusion in children using A-mode ultrasonography. DESIGN: Prospective nonblinded comparison study. SETTING: Tertiary children's hospital. PATIENTS: Forty children (74 ears) scheduled to undergo bilateral myringotomy with pressure equalization tube placement. INTERVENTIONS: Before myringotomy, ultrasound examination of the tympanic membrane and middle ear space was performed on each ear. Afterward, myringotomy was performed and the type of effusion (serous, mucoid, or purulent) was recorded. Pressure equalization tubes were then placed. MAIN OUTCOME MEASURE: Comparison of ultrasound findings with the visual assessment of the type of middle ear effusion present. RESULTS: Of the 74 ears tested, 45 (61%) had effusion on direct inspection. The effusion was purulent in 8 ears (18%), serous in 9 ears (20%), and mucoid in 28 ears (62%). Ultrasound identified the presence or absence of effusion in 71 cases (96%) (P = .04). Ultrasound distinguished between serous and mucoid effusion with 100% accuracy (P = .04). The probe did not distinguish between mucoid and purulent effusion. CONCLUSIONS: Ultrasonography is an accurate method of diagnosing middle ear effusion in children. Moreover, it can distinguish thin from mucoid fluid. Further refinements in probe design may further improve the sensitivity of fluid detection and allow differentiation of sterile vs infectious effusion.

Child↗
PubMed1986

An assessment of the long-term results of controlling the reaccumulation of malignant effusions using intracavity bleomycin.

Fifty-four consecutive patients with malignant effusions either pleural or peritoneal were treated by a simple aspiration followed by the administration of bleomycin to prevent a recurrence. All patients were followed up until reaccumulation of the effusion or death, with assessments being made of the patient's response at 30 days, 60 days, 90 days, 6 months, 1 year and then annually. There were 42 evaluable patients at 30 days, when the overall response rate for pleural effusions was 80.5% (21/26) and 62.5% (10/16) for peritoneal effusions. Patients who developed an effusion from primary breast neoplasms responded better than other groups, with an overall rate of 81% and 80% for pleural and peritoneal effusions respectively. Thirty percent (13) of the patients whose effusions was controlled by bleomycin required a further aspiration due to a recurrent effusions 9% (4) within the first 90 days and the remainder 21% (9) between 3 and 45 months after initial treatment. Altogether 19% (8/42) of the evaluable patients were effusion free at 1 year and 12% (5/42) clear at 3 years, but only two patients were still alive at four years. Side effects were minimal as 92% (50/54) patients treated experienced no adverse effects and there was no evidence of myelosuppression. The dose of bleomycin instilled varied between 60 mg and 180 mg, with 60 mg being given to 58% of patients and 90 mg to 30%, but there was no evidence to suggest that doses higher than 60 mg were more effective. The author concludes that the instillation of bleomycin following the simple aspiration of a malignant effusion is a safe, effective treatment which can benefit patients with this distressing complication of their malignant disease.

Adult↗
PubMed2004

Pleurodesis for malignant pleural effusions.

BACKGROUND: Approximately half of all patients with metastatic cancer develop a malignant pleural effusion which is likely to lead to a significant reduction in quality of life secondary to symptoms such as dyspnoea and cough. The aim of pleurodesis in these patients is to prevent re-accumulation of the effusion and thereby of symptoms, and avoid the need for repeated hospitalization for thoracocentesis. Numerous clinical studies have been performed to try to determine the optimal pleurodesis strategy, and synthesis of the available evidence should facilitate this. OBJECTIVES: The aims of this review were to ascertain the optimal technique of pleurodesis in cases of malignant pleural effusion; to confirm the need for a sclerosant; and to clarify which, if any, of the sclerosants is the most effective. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials was searched for studies on 'pleurodesis'. Studies for inclusion were also identified from MEDLINE (1980 to June 2002) and EMBASE (1980 to May 2002). No language restriction was applied. SELECTION CRITERIA: RCTs of adults subjects undergoing pleurodesis for pleural effusion in the context of metastatic malignancy (or a malignant process leading to pleural effusion) were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected studies for inclusion in the review, and extracted data using a standard data collection form. Primary outcome measures sought were effectiveness of pleurodesis as defined by freedom from recurrence of effusions, and mortality after pleurodesis. Secondary outcomes were adverse events due to pleurodesis. Dichotomous data were meta-analysed using a fixed effect model and expressed as relative risk. The number-needed-to-treat (NNT) was calculated for pleurodesis efficacy. In addition, for adverse events, the overall percentage of patients across studies exhibiting a particular adverse effect such as fever, pain, or gastrointestinal symptoms was calculated. MAIN RESULTS: A total of 36 RCTs with 1499 subjects were eligible for meta-analysis. The use of sclerosants (mitozantrone, talc and tetracycline combined)compared with control (instillation of isotonic saline or equivalent pH isotonic saline or tube drainage alone) was associated with an increased efficacy of pleurodesis. The relative risk (RR) of non-recurrence of an effusion is 1.20 (95% CI 1.04 to 1.38) in favour of the use of sclerosants based on five studies with a total 228 subjects. Comparing different sclerosants, talc was found to be the most efficacious. The RR of effusion non-recurrence was 1.34 (95% CI 1.16 to 1.55) in favour of talc compared with bleomycin, tetracycline, mustine or tube drainage alone based on 10 studies comprising 308 subjects. This was not associated with increased mortality post pleurodesis. The RR of death was 1.19 (95% CI 0.08 to 1.77) for talc compared to bleomycin, tetracycline, mustine and tube drainage alone based on six studies of 186 subjects. Death was not reported in all studies and, when reported, was attributed to underlying disease, only one death being reported as procedure-related. In the comparison of thoracoscopic versus medical pleurodesis, thoracoscopic pleurodesis was found to be more effective. The RR of non-recurrence of effusion is 1.19 (95% CI 1.04 to 1.36) in favour of thoracoscopic pleurodesis compared with tube thoracostamy pleurodesis utilizing talc as sclerosant based on two studies with 112 subjects. Comparing thoracoscopic versus bedside instillation (with different sized chest tubes) of various sclerosants (tetracycline, bleomycin, talc or mustine) the RR of non-recurrence of effusion is 1.68 (95% CI 1.35 to 2.10) based on five studies with a total of 145 participants.Adverse events were not reported adequately to enable meta-analysis. REVIEWER'S CONCLUSIONS: The available evidence supports the need for chemical sclerosants for successful pleurodesis, the use of talc as the sclerosant of choice, and thoracoscopic pleurodesis as the preferred technique for pleurodesis based on efficacy. There was no evidence for an increase in mortality following talc pleurodesis.

Humans↗
PubMed1992

Pericardial effusion and its relationship to cardiac disease in children with acquired immunodeficiency syndrome.

Over 200 children with acquired immunodeficiency syndrome (AIDS) have been followed at our institution. We retrospectively evaluated 45 children from the above group. 26 of the 45 children had a pericardial effusion documented at echocardiography and/or at post-mortem examination. This report describes the association of pericardial effusion, myocarditis, and pericarditis in children with AIDS and the implications for imaging. Half of the children with a pericardial effusion had a normal cardiac silhouette on chest radiography. 18 children with a pericardial effusion, had associated cardiac abnormalities. These abnormalities were ventricular dilatation and/or hypertrophy, myocarditis, or pericarditis. The presence of pericardial effusion also correlated highly with pleural effusion and ascites. The presence of a pleural effusion and a pericardial effusion was almost exclusively seen in the children with cardiac abnormalities. Pericardial effusion and cardiac disease should not only be suspected in any child with radiographic signs of cardiomegaly, but be strongly suspected in any child with pleural effusions or ascites, even with a normal cardiac silhouette, especially if they are not responding to conventional medical therapy and their respiratory condition is not improving.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Vascular endothelial growth factor in malignant pleural effusion associated with lung cancer.

The presence of vascular endothelial growth factor (VEGF) was examined by enzyme immunoassay in 60 cytology-documented malignant pleural effusions associated with primary lung cancer and 51 other benign and malignant pleural effusions. Exudative pleural effusions contained significantly higher amounts of VEGF than transudative pleural effusions. Among exudative pleural effusions, levels of VEGF in malignant pleural effusions associated with lung cancer were significantly higher than those of benign exudative pleural effusions. There was no significant difference in pleural VEGF in patients with different histological types or clinical stages of lung cancer. Serial measurement of pleural VEGF levels was performed in six lung cancer patients treated with intrapleural instillation of recombinant interferon gamma, and reduction of pleural effusion was associated with decreasing pleural VEGF levels. These findings suggest that VEGF has a role in the accumulation of exudative pleural effusions, especially that of malignant pleural effusion associated with lung cancer.

Adenocarcinoma↗
PubMed1997

Thoracoscopic partial pericardiectomy in the diagnosis and management of pericardial effusion.

BACKGROUND: An effort was made to present our experience with thoracoscopy in the diagnosis and management of pericardial effusions. METHODS: Twenty-two partial pericardiectomies were performed with the thoracoscopic approach in patients with pericardial effusions, the etiology of which was uremic (n = 7), neoplastic (n = 8), idiopathic (n = 5), septicemia (n = 1), and postpericardiotomy (n = 1). All cases had grade III-IV/IV radiological cardiomegaly and ultrasonographic confirmation of the effusion. We found hemodynamic compromise in 17 patients. The operation, requiring the insertion of three trocars, enabled us to remove a large part (approximately 6 x 10 cm) of the left anterolateral side of the pericardium and aspirate the effusion contents for diagnostic and therapeutic purposes. RESULTS: In five cases we found coexisting pleural effusions. The pericardial effusion had a mean volume of 817 ml, which was serous in 11 cases, hematic in six, serohematic in four, and purulent in one. Cytology of the pericardial effusion was positive for neoplasia in four cases (one pulmonary neoplasia, two breast carcinomas, and one lymphoma). We observed conversion to grade I/IV cardiomegaly in 16 cases and a return to normality in the other six, with the absence of ultrasonographic effusion in all cases. There was no recurrence during the mean follow-up period of 20.5 months (range: 2-47). CONCLUSIONS: The thoracoscopic management of pericardial effusions is a simple and effective technique that allows us to create a large pericardial window that drains the effusion definitively, determines its etiology, and explores and treats coexisting pleural lesions, all without recurrences.

Adolescent↗
PubMed1978

Localization of pericardial effusion with wide angle phased array echocardiography.

Twenty-eight patients with proved pericardial effusions were studied in the left lateral decubitus position with an 80 degrees phased array sector scanner to determine the distribution of pericardial effusions of various sizes. Twenty-one of 28 patients were studied 2 minutes after assuming the sitting position to determine the change in the distribution of the effusions with postural change. In small volume effusions, the fluid was truly posterior at and below the atrioventricular groove. With moderate-sized effusions a more uniform distribution of the fluid was found, and with large effusions more fluid was visualized apically, posteromedially, laterally and anteriorly. Upright redistribution of the fluid was seen with moderate to large nonloculated effusions. Assumption of a uniform distribution of pericardial effusion used for M mode quantification is most valid for moderate effusions and less valid for small and large effusions. Imaging was performed in two additional patients with cardiac tamponade to assess qualitative changes in short axis ventricular volumes with respiration. The introduction of a pericardiocentesis needle was visualized. Clinical implications are discussed.

Adolescent↗
PubMed1999

Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature.

BACKGROUND: Human immunodeficiency virus (HIV)-associated pericardial effusion is common. We present its clinical features, cause, and prognosis on the basis of a review of 40 cases at a single public hospital. METHODS: A retrospective study was conducted of 122 patients with pericardial effusion (of which 40 were HIV associated) admitted to Queens Hospital Center from January 1988 to April 1997. A review of the literature is also presented. RESULTS: Forty patients with HIV-associated pericardial effusion represent 33% of the 122 patients with pericardial effusion admitted during that period. The most common symptom of the 40 patients was dyspnea (75%). Echocardiogram detected small effusions in 18 (45%), moderate effusions in 10 (25%), and large effusions in 12 (30%). Sixteen (40%) patients had cardiac tamponade, in 15 of whom pericardiocentesis or pericardiostomy was performed. Causes of cardiac tamponade were Mycobacterium species in 3 (19%), Streptococcus pneumoniae in 1 (6%), Staphylococcus aureus in 1 (6%), Kaposi's sarcoma in 1 (6%), and unknown in 10 (63%). In comparison, causes of cardiac tamponade in 74 cases of acquired immunodeficiency syndrome in the literature were 45% idiopathic, 20% mycobacteria, 19% bacteria, 7% lymphoma, 5% Kaposi's sarcoma, 3% viruses, and 1% fungus. Thirteen of the 40 patients were lost to follow-up. Among the other 27, 11 (41%) were alive at 3 months and 5 (19%) at 1 year. Ten of the 27 patients had cardiac tamponade, of whom 5 (50%) were alive at 3 months and 3 (30%) at 1 year. CONCLUSIONS: HIV-associated pericardial effusion is the most common type of pericardial effusion in our inner city hospital. Causes are diverse. The development of pericardial effusion predicts a poor prognosis in HIV infection.

Adult↗
PubMed2003

Outcomes of clinically significant idiopathic pericardial effusion requiring intervention.

There is a paucity of outcome data on patients with idiopathic pericardial effusion requiring intervention. All patients who had clinically significant pericardial effusion confirmed by echocardiography and requiring interventions between 1979 and 2000 were identified through the Echo-guided Pericardiocentesis Registry and Echocardiography and Surgical Databases. Clinical data and outcomes were obtained by review of medical records and surveys. The study population consisted of 92 patients (mean age 59 +/- 15 years). Five patients were referred directly for pericardiectomy (3 had effusion in the context of chronic relapsing pericarditis, 2 had effusive constrictive disease), and 87 underwent echo-guided pericardiocentesis as their initial treatment. In 47 of these patients, primary management involved extended pericardial catheter drainage, which was associated with a trend to lower recurrence rates than in those without catheter drainage (p = 0.052). Three patients had transient right ventricular entry with no sequelae, and 7 patients (8%) later had surgical pericardiectomy because of the recurrence of effusion, 2 of whom were also found to have evidence of effusive constrictive disease during surgery. One patient had bleeding after pericardiectomy that required repeat thoracotomy. Mean follow-up of the cohort was 3.8 +/- 4.3 years. For most patients with clinically significant idiopathic pericardial effusion requiring intervention, echo-guided pericardiocentesis was the definitive treatment. Pericardiectomy was necessary for patients in whom effusion occurred in the context of effusive constrictive disease, chronic relapsing pericarditis, or recurrent effusion despite pericardiocentesis. The prognosis for the cohort was favorable, and survival did not appear to differ from that of the general population (p = 0.372).

Aged↗
PubMed2001

[Pleural effusion in pneumonia].

Parapneumonic effusions are frequent (40%) but normally no clinical problem. If a parapneumonic effusion is seen on chest X-ray or by ultrasonic investigation, a thoracocentesis should be done whenever possible without risk. Investigations of the pleural fluid should include: aspect, pH-value, protein, glucose, microbiology (gram stain and culture, and cytology. Based on the extent of the effusion, the finding of free floating or loculated effusion and the results of pleura fluid investigation patients could be categorized in four risk groups. Very low and low risk for poor outcome is normally characterized by a small or moderately free floating effusion, clear pleural fluid and a pH > 7.2. In these risk groups no further intervention seems to be necessary. For patients with moderate or high risk (pus, large effusion (> 1/2 hemithorax), loculated effusion, pH < 7.2 a drainage therapy is recommended. For larger parapneumonic effusions and for complicated parapneumonic free floating effusion tube drainage therapy seems to be sufficient. However, for empyema or large lobulated effusions video-assisted thoracoscopy surgery followed by local fibrinolytic treatment might produce the best results.

Anti-Bacterial Agents↗
PubMed2003

The implication of elevated carcinoembryonic antigen level in pleural fluid of patients with non-malignant pleural effusion.

OBJECTIVE: The aim of this study was to evaluate the false positive rate for pleural fluid carcinoembryonic antigen (CEA) level in non-malignant pleural effusions and to determine whether the falsely elevated CEA level has any relation to other biochemical parameters of pleural effusions. METHODOLOGY: We performed a retrospective analysis of 654 consecutive patients with a pleural effusion admitted to the pulmonary department of a tertiary referral teaching hospital from March 1997 to March 1999. The aetiology of the pleural effusions were classified as tuberculosis (n = 262), malignancy (n = 204), pneumonia (n = 145), exudates of other origin (n = 28) and transudate (n = 1). RESULTS: A false positive result for pleural fluid CEA level (> 5 ng/mL) was registered in 13.8% of non-malignant pleural effusion cases: empyema (38.6%), parapneumonic effusion (14.7%), exudates of other origin (14.3%), tuberculosis (7.3%) and transudate (6.7%). In analysis of the subgroup with false positive results for pleural fluid CEA level, the CEA level of non-malignant pleural effusion showed a significant relationship to the severity of pleural inflammation in terms of the following variables: LDH (rs = 0.4201, P= 0.001), adenosine deaminase (ADA) (rs = 0.4440, P= 0.0004), white blood cell count (rs = 0.4266, P= 0.0004), polymorphonuclear cell percentage (rs = 0.5080, P= 0.0001), and polymorphonuclear cell count (rs = 0.5095, P= 0.0002). In the parapneumonic effusion and empyema groups, the changes in pleural fluid CEA level exhibited a positive association with the changes in the pleural fluid ADA level (rs = 0.8143, P= 0.0002). CONCLUSIONS: The results from our series indicated that false positive results for pleural fluid CEA level were most commonly observed in patients with empyema and parapneumonic effusion and the CEA level showed a significant correlation to the indices of pleural inflammation. The serial measurement of pleural fluid CEA level may be useful as a means of monitoring resolution of pleural inflammation and excluding the possibility of a malignant pleural effusion.

Adolescent↗
PubMed1997

[Diagnosis of pleural effusion in intensive care patients with supine digital thoracic imaging. A study of CT validated cases].

PURPOSE: The significance of the recumbent chest x-ray using digital luminescence radiography was to be assessed in respect of diagnosis of pleural effusions. MATERIAL AND METHODS: Three experienced radiologists evaluated 32 digital recumbent chest x-rays of 32 intensive-care patients. The radiologists were asked to estimate the effusion volume and to assess whether typical x-ray signs of pleural effusions were seen. These evaluations were compared with one another and with the simultaneously produced CTs. RESULTS: Diagnostic accuracy of the digital recumbent chest x-ray is of medium quality in respect of diagnosis of pleural effusions (sensitivity: 69%, specificity: 54%, positive predictive value: 81%, negative predictive value: 34%, rate of accuracy: 65%). Diagnostic safety is the same for right-sided or left-sided pleural effusions, and increases with increasing effusion volume. The ratings by the radiologists are statistically not significantly different, but are significantly different from the CT measurements (Wilcoxon test, p < 0.05). Correlations of the assessments and the measurements were weakly positive (r = 0.24, r = 0.36, r = 0.47). The pleural effusions were on the average underestimated by the radiologists. The median predictive error was 203 ml. CONCLUSIONS: Recumbent chest x-ray with digital luminescence radiography is an imaging method of limited accuracy in respect of diagnosis of pleural effusions. Supplementary diagnostic methods are recommended, as the present results show, especially in such cases where the recumbent chest x-ray does not reveal an effusion or if the volume must be determined accurately. Digital recumbent chest x-ray ranks equal with conventional x-ray in the diagnosis of pleural effusions.

Adolescent↗
PubMed2005

Malignant pleural effusions in lymphoproliferative disorders.

In order to determine variables that correlate with malignant pleural effusion and mortality in patients with lymphoproliferative disorders and pleural effusion, a retrospective study was performed. Clinical data of hospitalized patients with a lymphoid malignancy and pleural effusion who underwent thoracentesis from January 1993 to December 2002 were collected. A logistic regression analysis was carried out to determine prognostic variables that predict malignant pleural effusion and hospital mortality. There were 86 patients who were admitted on 91 occasions. The median age was 70 years (range 4 - 92) and the male:female ratio was 44:42. Sixty-four patients (74%) had advanced disease, 43 (50%) had received prior chemotherapy and 9 (10%) were in remission. Of 91 cases of pleural effusions, 44 (48%) were bilateral, 80 (88%) were exudates and 48 (53%) were due to malignant involvement of pleura. In multivariate analysis, symptomatic pleural effusion (odds ratio 10.3, 95% confidence interval 1.7 - 98.3), pleural fluid mesothelial cell count < 5% (odds ratio 8.0, 95% confidence interval 1.4 - 58.2), pleural fluid:serum lactate dehydrogenase (LDH) > or =1 (odds ratio 6.4, 95% confidence interval 1.2 - 45.6) and pleural fluid lymphocyte percentage > or =50 (odds ratio 6.4, 95% confidence interval 1.2 - 50) were significantly correlated with malignant effusion. A secondary cancer (odds ratio 11.9, 95% confidence interval 2.3 - 88.8), pleural fluid:serum LDH > or =1 (odds ratio 10.9, 95% confidence interval 2.6 - 64.9), and pneumonia (odds ratio 6.4, 95% confidence interval 1.7 - 28.6) were significantly correlated with hospital mortality. In conclusion, malignant pleural effusion is the common etiology of pleural effusion in patients with lymphoid malignancy. Many clinical and cytochemical markers have discriminatory values in identifying malignant effusion. A high pleural fluid to serum LDH level correlates with malignant pleural involvement and hospital mortality.

Adolescent↗