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PubMed1994

Peripheral neuroectodermal tumor presenting pleural effusion.

Pleural effusion is a common finding of peripheral neuroectodermal tumor (PNET) of the chest wall (Askin's tumor), but little is known about the characteristics. A case of Askin's tumor with pleural effusion is reported. Repeated cytologies were negative for malignancy, but levels of lactic dehydrogenase (LDH) and neuron-specific enolase (NSE) in the pleural effusion were increased. Surgical biopsy was performed and immunohistochemical study of the tumor revealed the diagnosis.

Adult↗
PubMed1998

Emergency department presentation of an unusual pleural effusion.

Pleural effusion as a manifestation of malignancy is commonly encountered in clinical practice; most are transudates or exudates of endogenous body fluids. We report a case of pleural effusion that is directly related to the inadvertent infusion of chemotherapeutic agents into the hemithorax of a patient with ovarian carcinoma. With the increasingly common use of outpatient intravenous therapy, emergency department presentations of unusual pleural effusions should be considered.

Aged↗
PubMed2000

Clinical management of the patient with pleural effusion.

Pleural effusion is a frequent medical problem with a wide span of different causes. We wish to highlight the clinical management of the patient with pleural effusions but anatomic, physiologic and diagnostic management of the main pleural diseases will also be considered.

Collagen Diseases↗
PubMed1986

Malignant pleural effusions.

Pleural effusions are common in cancer patients, developing either from the malignant condition or from unrelated causes, such as congestive heart failure, pulmonary infarction, or infection. Diagnosis of malignant pleural effusion rests on demonstration of the presence of malignant cells in the pleural fluid or pleural biopsy specimen. Treatment is usually aimed at relief of symptoms rather than at the underlying malignancy. Specific therapeutic measures include thoracentesis, chest tube drainage, pleurodesis with chemicals or biologic agents, radiation and systemic chemotherapy, surgical pleurodesis, and pleuroperitoneal shunt. These should be supplemented by ancillary measures to maintain fluid and nutritional balance and prevent complications.

Chyle↗
PubMed1988

Diagnostic value of cancer antigen 15-3 (CA15-3) detected by monoclonal antibodies (115D8 and DF3) in exudative pleural effusions.

Pleural fluid levels of the cancer antigen 15-3 (CA15-3) detected by monoclonal antibodies (115D8 and DF3) were determined in 40 patients with carcinomatous pleural effusions and in 41 patients with tuberculous pleural effusions. Using a cut off level of 16 U/ml, 15 of the 40 carcinomatous fluids but none of the 41 tuberculous fluids were positive. Pleural fluid levels of CA15-3 were not correlated with those of carcinoembryonic antigen (CEA) or carbohydrate antigen 19-9 (CA19-9). Combined assay of CEA and CA15-3, or CA19-9 and CA15-3, increased the positive rate from 79 to 82% and from 67 to 73%, respectively. Measurement of pleural fluid CA15-3 levels are less useful in separating carcinomatous from tuberculous effusions than is measurement of CEA or CA19-9.

Adult↗
PubMed2002

Epidemiology, presentation and treatment of pleural effusion.

Pleural effusion (PE) is the most common manifestation of pleural disorders. In children a PE is usually secondary to an underlying disorder. In developing countries PE most frequently results as a complication of a bacterial pneumonia. A high index of suspicion is required in order to avoid delays in diagnosis that may influence treatment and outcome. The diagnosis of PE in children is based on chest radiographs, thoracentesis and pleural fluid analysis. This review discusses the usefulness of diagnostic methods and treatment in children with parapneumonic pleural effusion.

Age Factors↗
PubMed1977

Acid glycosaminoglycans (mucopolysaccharides) in the differential diagnosis of pleural effusion.

Pleural fluid glycosaminoglycans (GAG) in 64 patients with various diseases were isolated by anion-exchange chromatography after proteolysis, and characterised by spectrophotometric, electrophoretic and enzymatic techniques. GAG concentrations ranged from 7 to 1178 microng hexuronate/ml pleural fluid. The highest values (1178, 161 and 160 micron/ml) were found in patients with diffuse mesothelioma. Over 90% of the pleural fluid GAG consisted of hyaluronic acid (HA) in these patients. In other types of pleural effusion the relative HA content varied from 42 to 70% of the total GAG. Determination of pleural fluid HA consequently appears extremely valuable in the diagnosis of the form of mesothelioma producing HA. The mean GAG concentration of pleural fluid was significantly higher in tuberculous pleurisy than in hydrothorax (P less than 0.01), secondary malignant pleural effusion (P less than 0.0005) and idiopathic pleurisy (Pless than 0.03). It was impossible to demonstrate definite correlations between GAG and protein, and GAG and glucose concentrations of pleural fluid.

Diagnosis, Differential↗
PubMed1992

Pleural effusions.

Pleural effusions are a common development in patients with cancer. The optimal means of control are not defined, but systemic treatment is often effective in patients with drug-sensitive tumors. Local treatments advocated in the management of malignant pleural effusions differ in the means of drainage, the length of time pleural tubes are left in situ, and the type of intrapleural therapy administered. Randomized trials published in the past few months have suggested that bleomycin sulfate may be superior to tetracycline as a sclerosant and that mitoxantrone does not add to control of effusions compared with large-bore pleural tube alone placed at time of thoracoscopy.

Algorithms↗
PubMed2001

[Management of parapneumonic pleural effusions].

Pleural effusion in children is most often due to bacterial pneumonia. Between 0.6 and 2% of pneumonias are complicated by empyema and approximately 40% of children hospitalized with pneumonia have a pleural effusion. In recent years Streptococcus pneumoniae is the most prevalent organism. Treatment is based on the early and judicious use of antibiotics, imaging techniques, thoracocentesis, pleural drainage, fibrinolytics, thoracoscopy and thoracotomy. Indications for early pleural drainage are gross pus, positive Gram stain in pleural fluid, pleural glucose less than 50mg/dL, pleural fluid pH of less than 7 and sonographic evidence of loculations. Local fibrinolytics may decrease the need for surgical treatment, with a success rate between 38 and 100%, according to the effusion stage. Thoracoscopic debridement is useful in the fibrinopurulent stage with loculations, with favorable results in 30-100% of patients, also depending on the effusion stage.

Algorithms↗
PubMed1996

Early administration of intrapleural streptokinase in the treatment of multiloculated pleural effusions and pleural empyemas.

In the treatment of multiloculated pleural effusions and empyemas tube thoracostomy often fails and more aggressive surgical therapy is required. Intrapleural administration of fibrinolytics is a valuable alternative. Between October 1994 and December 1995 28 patients (aged 22 to 62 years) with multiloculated pleural effusions were treated with intrapleural instillations of streptokinase after unsuccessful conventional chest tube drainage. Twenty-three pleural effusions were grossly purulent, others were loculated effusions with low pH. The most common cause of the pleural effusions was pneumonia. Duration of illness before hospitalization was 3 to 105 (mean 21.8) days. Treatment with streptokinase was started most commonly one day after chest tube placement. Once a day after clamping the chest tube streptokinase was administered intrapleurally for 10-15 minutes as a solution of 250,000 units in 100 ml normal saline. The tube remained clamped for 3 hours. Two to 8 (mean 3.7) instillations per patient were needed. Twenty-one cases (72.4%) showed excellent resolution of pleural effusion and needed no more therapy. However, one patient died in hospital due to purulent meningitis and bilateral pneumonia. Eight patients needed further surgical treatment, e.g. decortication, in 5 cases together with wedge lung resection. Eleven patients experienced some adverse effects of streptokinase therapy, most frequently chest pain and elevation of body temperature in one case pleural effusion became hemorrhagic, and one patient had nasal bleeding. We conclude that usage of intrapleural streptokinase in the treatment of multiloculated pleural effusions (including pleural empyemas) reduces the need for major surgical interventions in quite a large group of patients.

Adult↗
PubMed2003

[Clinical value of tumor supplied group of factor combined with CEA in diagnosing tuberculosis pleural effusion and malignant pleural effusion].

OBJECTIVES: To determine the clinical value of tumor supplied group of factor (TSGF) combined with carcinoembryonic antigen (CEA) in diagnosing tukerculosis pleural effusion and malignant pleurul effusion. METHODS: TSGF and CEA were detected by ELISA in 14 patients with tuberculosis pleural effusion and 28 patients with malignant pleural effusion. RESULTS: The average levels of TSGF and CEA in patients with malignant pleural effusion were higher than those with tuberculosis pleural effusion. The diagnostic sensitivity of TSGF and CEA in the malignant pleural effusion was 67.5% and 57.5%, the specificity was 85.7% and 78.6%, and the agreement rate was 72.2% and 62.9% respectively; while the sensitivity, specificity and agreement rate of TSGF combined with CEA were 93%, 67.4%, and 88.9%. CONCLUSION: The sensitivity and agreement rate of TSGF combined with CEA are higher than those of either of the two methods. TSGF combined with CEA is important in differentiating tuberculosis and malignant pleural effusion.

Adult↗
PubMed1986

Diagnostic significance of cancer antigen 125, pancreatic oncofetal antigen, and carcinoembryonic antigen in malignant and tuberculous pleural effusions.

Pleural fluid levels of cancer antigen 125 (CA 125), pancreatic oncofetal antigen (POA), and carcinoembryonic antigen (CEA) were determined in 56 patients with malignant pleural effusion and in 35 patients with tuberculous effusion. Malignant effusions had significantly higher pleural fluid CA 125 and CEA levels than those of tuberculous origin (p less than 0.005). No significant difference in POA titers was found between the two kinds of effusion. Assays of CA 125 and CEA in pleural fluid may be useful in separating malignant from tuberculous effusions. Concurrent measurement of CA 125 and CEA proved superior to determination of CEA alone in discriminating between the two groups.

Adenocarcinoma↗
PubMed1989

Pleural peritoneal shunting for benign and malignant pleural effusions.

Pleural peritoneal shunting is a new technique that can be used for patients with symptomatic pleural effusion recalcitrant to the usual methods of treatment. Sclerotherapy with a thoracostomy tube is still the mainstay of treatment, but this new procedure has a place if other methods fail. Success can be anticipated in most of the patients with simple insertion under local anesthesia. The occasional obstructed shunt is readily remedied by easy insertion of another pleural peritoneal shunt. No adverse long-term effects have been noted, and satisfactory function can be achieved with minimal morbidity for at least 21 months.

Aged↗
PubMed2004

[Current diagnostic approach to pleural effusion].

Pleural effusion is a common pneumologic and interdisciplinary problem. Transudate/exsudate discrimination of the pleural fluid by thoracentesis remains the diagnostic basic algorithm. Regardless of a number of new markers, classical LIGHT's criteria comprising the pleural fluid protein- and LDH-values (or their serum ratio respectively) reveal the highest potency with an overall accuracy of 95 %. Expansion to cholesterol-determination (triplet test) may be helpful to identify transudates in indeterminate cases. The need for further local diagnostic evaluation is then usually restricted to exudates. Bacterial pleurisy, malignant and tuberculous effusion are the principal differential diagnoses. With the use of a variety of conventional biochemical, cytologic, immunologic and microbiologic investigations, thoracentesis will allow- or substantially narrow-diagnosis of exudates in about 70 %, with novel cell biological markers in some conditions up to 90 %. In bacterial pleurisy thoracentesis provides information directly relevant to management in terms of local interventions. It also constitutes a platform for more invasive imaging- or endoscopy-guided investigations with a focus on medical thoracoscopy (pleuroscopy). Blind needle biopsy is diagnostic in a range of 40 - 70 % both in malignancy and inflammatory disease, thoracoscopy may clarify exudative conditions in about 95 %. Thus malignancy may be specifically diagnosed in 97 % of cases, tuberculous effusion in virtually 100 %. The value of thoracoscopy is augmented by interventional options including complete evacuation of the pleural cavity, eventually followed by talc pleurodesis ("poudrage") in recurrent effusions or adhesiolysis, irrigation and fibrinolysis protocols in certain inflammatory conditions. These combined features as accomplished in local anesthesia on a remarkably high safety level characterise medical thoracoscopy as a gold standard tool for the management of pleural disease even in comparison to more elaborate surgical procedures.

Biopsy, Needle↗
PubMed2006

Diagnosis and management of infectious pleural effusion.

Pleural infection remains a common illness, with a high morbidity and mortality. The development of frank empyema from a simple exudative pleural effusion is a result of biochemical changes within the pleural space in response to bacterial invasion. These changes can be used in the diagnosis of pleural infection and used to predict which patients will require intercostal drainage for resolution of infection. Recent large trials in empyema have further advanced our knowledge of microbiologic patterns, informing important decisions about empiric antibacterial therapy. Diagnosis of pleural infection relies on high clinical suspicion in association with clinical features, radiology, and pleural fluid characteristics. Treatment of pleural infection is based upon accurate and often empiric choice of antibacterial agents, intercostal drainage in certain contexts, and appropriate surgical referral. Intrapleural thrombolytic therapy is not currently recommended for the treatment of pleural infection, on the basis of evidence from the largest randomized trial in empyema to date.

Anti-Bacterial Agents↗
PubMed1980

Pleural effusions.

Pleural effusions develop following changes in capillary permeability, capillary hydrostatic pressure, plasma colloid osmotic pressure, or lymphatic drainage. Generalized fluid retention or a transudate suggests a systemic cause while an exudate suggests a local cause. The diagnosis can usually be established by clinical assessment, chest radiography, analysis of pleural fluid, pleural biopsy, and appropriate special investigations. When no cause can be found, particular care should be taken to exclude secondary carcinoma, tuberculosis, pulmonary infarction, and mesothelioma; the patient should be followed-up. Symptomatic malignant effusions may be managed initially by basal intercostal tube drainage alone. For recurrences, local instillation first of tetracycline and then of mustine may be tried. Pleurectomy should be considered if the prognosis is otherwise good.

Alkylating Agents↗
PubMed1983

High levels of complement breakdown products in tuberculous pleural effusions.

Pleural fluids from 10 patients with tuberculous pleural effusions contained high levels of small molecular weight breakdown products of C3 (C3d) and of properdin factor B (Ba) when compared to 16 patients with effusions of neoplastic origin (P less than 0.001). The same fluids exhibited overlapping values of haemolytic factor B, classical or alternative pathway-mediated haemolytic activity and native C3. A significant correlation between Ba and lysozyme levels was found in all effusions tested (P less than 0.05). These findings suggest that activation of the complement system is an important aspect of the extensive inflammation and tissue destruction characteristic of human tuberculosis.

Complement Activation↗
PubMed1987

Effective treatment of malignant pleural effusions.

Pleural effusions are a common complication of malignant disease. Inadequate treatment results in a need for recurrent aspirations, repeated hospitalization, and risk of loculation of the effusion. Effective local treatments are available which will relieve the distressing symptom of breathlessness.

Drainage↗