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PubMed2002

The effect of pleural fluid content on the development of pleural thickness.

SETTING: Residual pleural thickness (RPT) is a common complication of tuberculous pleurisy (TP), and the degree of RPT cannot be predicted in advance. OBJECTIVES: To determine whether pleural fluid content has an effect on the development of RPT. DESIGN: Forty-seven patients with TP were enrolled in the study. A set of biochemical tests: lactate dehydrogenase, glucose, total proteins, adenosine deaminase, tumour necrosis factor alpha (TNF-alpha), alpha-1 acid glycoprotein (AAG), alpha-2 macroglobulin, C-reactive protein (CRP), complement 3 and complement 4 were studied in the pleural fluid samples. After 6 months of anti-tuberculosis treatment, patients were re-evaluated for RPT. RPT was defined in a posteroanterior chest radiograph as a pleural space of >2 mm or >10 mm measured in the lower lateral chest at the level of an imaginary horizontal line intersecting the diaphragmatic dome. RESULTS: Seventeen patients (36.17%) had an RPT of <2 mm, 18 (38.29%) had an RPT of 2-10 mm, and 12 (25.53%) had an RPT of >10 mm. TNF-alpha levels were lower in patients with an RPT of <2 mm than in patients with an RPT of 2-10 mm or >10 mm (P < 0.05 and P < 0.01, respectively). The level of TNF-alpha was higher in patients with an RPT of >10 mm compared to the 2-10 mm group (P < 0.05). Meanwhile, pleural fluid glucose, AAG and CRP concentrations were significantly higher in patients with an RPT of >10 mm than in patients with <2 mm RPT (P < 0.05, P < 0.01, and P < 0.05, respectively). CONCLUSION: In TP, the development and degree of RPT are significantly correlated to the glucose, CRP, AAG, and TNF-alpha levels in the pleural fluid.

Adult↗
PubMed2004

Comparison of needle biopsy with pleural fluid analysis for the evaluation of pleural lesions.

A total of 60 pleural biopsies were received at Nidaan Clinic, Kathmandu during the period of two years from January 2000 to December 2002. The age of the patient ranged from 8 years to 82 years. Male: female ratio seen was 3:1. The most common lesion was found to be chronic nonspecific; pleuritis seen in 50.0% cases followed by tuberculous pleuritis in 36.7% cases, metastatic adenocarcinoma in 8.3% cases, metastatic small cell carcinoma in 3.3% cases and anaplastic large cell carcinoma in 1.7% cases. 63.3% cases of chronic nonspecific pleuritis showed transudative pleural fluid effusion. None of the cases of tuberculous pleuritis had transudative pleural effusion. 2 cases (40.0%) of metastatic adenocarcinoma had transudative pleural fluid effusion which suggests the need to perform pleural biopsy in all the cases of transudative pleural effusion whether encountered for malignancy or not.

Adenocarcinoma↗
PubMed1990

[The significance of pleural fluid cytology in the differential diagnosis of pleurisy showing lymphocyte-predominant pleural effusion].

We examined the significance of pleural fluid cytology in differentiation between tuberculous and non-tuberculous pleurisy in patients with lymphocyte-predominant pleural effusion. We divided pleural fluid cytologic findings into two patterns, that is "tuberculous" and "non-tuberculous pattern", according to the report by Spieler, and compared the cytologic pattern with the final clinical diagnosis. Thirteen out of 19 cases (68.4%) with tuberculous pleurisy showed "tuberculous pattern" in the pleural fluid cytology, while four (pleurisy associated with collagen-vascular disease, asbestosis and carcinoma, and idiopathic pleurisy) out of 13 (30.8%) with non-tuberculous pleurisy revealed "tuberculous pattern". The pleural fluid cytology could be used as one of the additional means to differentiate between tuberculous and non-tuberculous pleurisy, though it is impossible to differentiate between them with the pleural fluid cytology alone.

Diagnosis, Differential↗
PubMed1997

[Massive pleural effusion secondary to pancreatic-pleural fistula as first manifestation of chronic pancreatitis. Report of three cases].

Patients with chronic pancreatitis develop massive pleural effusion in less than 1% and its frequency as the first clinical manifestation of the disease is unknown. Three patients with massive pleural effusion and dyspnea which led to the diagnosis of chronic pancreatitis are referred. The patients were 28, 37 and 41 years old, they were hard-drinking and they came to the hospital because of quick and progressive dyspnea, with hypoxemia and hypocapnia. Two patients had right and one left pleural effusion. The thoracothentesis gave 10, 9 and 3.5 l of serohematic liquid rich in pancreatic enzymes. All cases showed tomographic changes of chronic pancreatitis and pancreatic pseudocysts. Only in one of them the link between the pseudocyst and pleural effusion through a fistula in the right support of the diaphragm could be identified. The different therapeutic possibilities are discussed. Pancreatopleural fistula diagnosis should be considered in patients with massive fast pleural effusion and a history of high alcohol intake. High levels of pancreatic enzymes in the pleural liquid confirm the diagnosis.

Adult↗
PubMed1979

Myelomatous pleural effusion: clinical course and immunologic characterization of the pleural fluid cells.

Multiple myeloma is a disease that infrequently involves nonreticuloendothelial tissues and rarely causes pleural effusion. A 59-year-old woman had pleural effusion as the major manifestation of multiple myeloma. Light microscopy of her pleural fluid with Wright stained preparations showed all cells to be bizarre and often multinucleated plasmacytes. Electron microscopy confirmed these results. Intracellular immunofluorescence revealed IgG-kappa immunoglobulin (Ig) in greater than 90% of these cells. Surface immunofluorescence using anti-Ig sera was seen on less than 5% of the pleural fluid cells. 3H leucine incorporation into Ig in vitro was measured for these cells, and secretory curves were obtained that have the typical secretory kinetics of bone marrow plasmacytes. This demonstrates that such cells are viable and are able to synthesize and release immunoglobulin. Treatment of our patient with prednisone, melphalan, and cyclophosphamide resulted in symptomatic improvement and complete resolution of her pleural effusion. Pleural effusion is an unusual but important complication of multiple myeloma and does not necessarily carry the grave prognosis implied in previous reports.

Female↗
PubMed2003

Diffusion-weighted MR imaging of pleural fluid: differentiation of transudative vs exudative pleural effusions.

The aim of this study was to evaluate the ability of diffusion-weighted MRI in differentiating transudative from exudative pleural effusions. Fifty-seven patients with pleural effusion were studied. Diffusion-weighted imaging (DWI) was performed with an echo-planar imaging (EPI) sequence (b values 0, 1000 s/mm(2)) in 52 patients. The apparent diffusion coefficient (ADC) values were reconstructed from three different regions. Subsequently, thoracentesis was performed and the pleural fluid was analyzed. Laboratory results revealed 20 transudative and 32 exudative effusions. Transudates had a mean ADC value of 3.42+/-0.76 x 10(-3) mm(2)/s. Exudates had a mean ADC value of 3.18+/-1.82 x 10(-3) mm(2)/s. The optimum cutoff point for ADC values was 3.38 x 10(-3) mm(2)/s with a sensitivity of 90.6% and specificity of 85%. A significant negative correlation was seen between ADC values and pleural fluid protein, albumin concentrations and lactate dehydrogenase (LDH) measurements ( r=-0.69, -0.66, and -0.46, respectively; p<0.01). The positive predictive value, negative predictive value, and diagnostic accuracy of ADC values were determined to be 90.6, 85, and 88.5%, respectively. The application of diffusion gradients to analyze pleural fluid may be an alternative to the thoracentesis. Non-invasive characterization of a pleural effusion by means of DWI with single-shot EPI technique may obviate the need for thoracentesis with its associated patient morbidity.

Diagnosis, Differential↗
PubMed1993

Improvement of the diagnosis of the cause of pleural effusion in patients with lung cancer by simultaneous quantification of carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) pleural levels.

Carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) level determinations were carried out by radioimmunoassay in pleural fluid and plasma samples obtained from 24 patients with malignant pleural effusions and 18 patients with non-malignant pleural effusions, and compared to cytological and pathological results. Using a pathological cut-off level of 25 ng/ml for CEA and 8 ng/ml for NSE, we demonstrated that, in the diagnosis of the malignant nature of pleural effusions, the simultaneous quantification of CEA and NSE in pleural fluid possesses better discriminative values than the simultaneous quantification of both markers in plasma or the separate quantification of each marker, in pleural fluid and in plasma.

Biomarkers, Tumor↗
PubMed2004

Pleural perfusion thermo-chemotherapy under VATS: a new less invasive modality for advanced lung cancer with pleural spread.

BACKGROUND: We conducted a trial of a new less invasive, locoregional modality for lung cancer with pleural spread. This study was planned to investigate the feasibility, safety, and pharmacokinetics of pleural perfusion thermochemotherapy (PPTC) under video-assisted thoracoscopic surgery (VATS) and its modified method with a short perfusion time for preventing heat damage to the lung during the procedure. METHODS: Seventeen patients, 59 to 79 years old, underwent surgical resection of the primary lesions and PPTC under VATS without thoracotomy. All had pleural spread with malignant effusion due to lung cancer proven before the treatment. PPTC consists of irrigating the pleural space with 42 degrees C saline solution containing cisplatin (200 mg/m(2)) using a devised circuit. The time for perfusion was two hours in 10 patients (group L), and one hour in 7 patients (group S). RESULTS: All patients successfully completed this treatment with acceptable toxicities. The pharmacokinetic analysis showed that high platinum levels for the regional pleural exposure, which was 20- to 40-fold greater than those for the plasma in both groups. These values were equivalent between the groups, although the levels for the plasma were higher in group L than in group S. Postoperative lung damage was seen in 4 patients with no serious conditions in group L, and none in group S. The median survival for the L and S groups was 17 and 19 months, respectively. CONCLUSIONS: This less invasive modality seems to offer a safe, feasible, and pharmacokinetically advantageous procedure to have excellent local control for lung cancer with pleural spread.

Aged↗
PubMed2005

Pleural adenosine deaminase in the separation of transudative and exudative pleural effusions.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of a new parameter, pleural adenosine deaminase (PADA), for separating transudative pleural effusion from exudative pleural effusion, and to compare the results with other tests (albumin gradient and protein gradient). METHODS: From November 2001 to January 2003, 359 consecutive patients with pleural effusion who underwent a diagnostic thoracentesis were included in the study. Effusions were individually classified as transudates or exudates after the careful evaluation of all clinical data and biochemical parameters of pleural fluid and serum of patients on the basis of Light's criteria. The means and standard deviations of PADA, pleural/serum ADA (P/S ADA) ratio, albumin gradient and protein gradient were evaluated for transudative and exudative effusions. The best cut-off values for each test were identified by using the receiver operating characteristic (ROC) curve. The optimum cut-off level was determined by selecting points of test values that provided the greatest sum of sensitivity and specificity. RESULTS: There were 113 transudates and 246 exudates. For each test, differences in mean value between the transudate group and the exudate group were statistically significant (t test, P<0.001). The optimum cut-off levels for PADA and P/S ADA were 15.3 U/L and 0.66 U/L, respectively. ROC analysis confirmed previous recommendations for albumin gradient (12 g/L) and protein gradient (31 g/L). For detecting exudates, the PADA test yielded a sensitivity and specificity of 85.8% and 82.3%, respectively. Sensitivity and specificity of the albumin gradient were found to be 88.5% and 79.3%, and of the protein gradient 85% and 83.2%, respectively. The areas under the curve (AUC) data and accuracy demonstrated similar discriminative properties in the examined tests. CONCLUSIONS: The measurement of PADA is suggested as a reliable test in the separation of pleural exudates from transudates with accuracy similar to that of the albumin gradient and protein gradient.

Adenosine Deaminase↗
PubMed2005

Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter.

Many patients with various forms of cancer develop sooner or later malignant pleural effusions, resulting in feelings of discomfort and reduced quality of life. Several palliative options exist, including repeated thoracocentesis and pleurodesis with a sclerosing agent. However, these "therapeutic" possibilities are not always successful and sometimes even contraindicated. Also, patients need to visit the hospital regularly or have to stay hospitalised for several days. A chronic indwelling pleural catheter could provide a simple, completely outpatient way to provide respiratory relief and improvement in quality of life in patients with malignant pleural effusions. We evaluated retrospectively the course of 17 patients with malignant pleural effusions who were treated with a chronic indwelling pleural catheter (PleurX). Eligible patients were selected in the years 2001-2003 from a single institution. In 70-80% of patients, catheter use was uncomplicated and provided significant symptom relief. Mean duration of catheter use was 2.3 (range 1-6) months. Mean fluid removal was 360 (range 150-1000 cc) per 24 h in the first weeks of treatment. Infection was seen in two (12%) patients, dislocation of the catheter in three (18%). In the final analysis, catheter use was unsatisfactory in two patients (12%). We conclude that a chronic indwelling catheter is a very useful tool in the management of recurrent malignant pleural effusions. Treatment can be accomplished completely at home, whereas complications are rare.

Aged↗
PubMed1981

[Calcified pleural scars and pleural empyema with mural calcification (author's transl)].

The differential diagnosis between calcified pleural scars and pleural empyemas with mural calcification was studied by computer tomography, bearing in mind the patient's history. In view of the high complication rate of pleural empyemas, such as internal or external fistulae, it is desirable to elucidate every form of pleural shadowing which is more than 20 mm thick. Criteria are offered, which permit the differentiation of the pleural changes by means of conventional radiological examinations. Valuable additional information can be obtained by computer tomography. Forty-nine patients with calcification in the pleura were found among 1.900 chest x-rays which had been examined. Out of these, seven had a pleural empyema. In one case an echinococcus cyst with mural calcification was punctured under x-ray control.

Adult↗
PubMed2002

Isolation and identification of Mycobacterium kansasii from pleural fluid of a dog with persistent pleural effusion.

A 3-year-old spayed female Whippet was examined for cough and respiratory distress. Lung lobe torsion with pleural effusion was diagnosed, and lung lobectomy was performed. Pleural effusion recurred during the following 27 months; conventional bacteriologic cultures of pleural effusion did not result in bacterial growth. A second lung lobectomy, pleuroperitoneal shunt placement. and pericardectomy were subsequently performed. Mycobacterium kansasii was eventually isolated from pleural fluid and identified by polymerase chain reaction amplification and DNA sequencing. The dog was euthanatized before therapeutic response could be evaluated. To our knowledge, this is the first report of M. kansasii infection in a dog. Additionally, this is the first report of mycobacterial isolation from pleural fluid, and one of few reports of antemortem mycobacterial isolation from a body fluid, as opposed to identification in specimens during histologic examination. Routine bacteriologic culture methods are insufficient to isolate mycobacterial agents, and special methods are indicated in dogs with persistent pleural effusion.

Animals↗
PubMedDate not supplied

Pleural changes in malignant pleural effusions: appearance on computed tomography.

BACKGROUND: Tumors metastatic to the pleura are a leading cause of pleural effusions. The computed tomographic (CT) appearance of malignant pleural effusions varies from uniformly low attenuation without pleural abnormalities to thickened, irregular, contrast-enhanced pleura with or without discrete masses. There may be associated changes in the subcostal tissues. OBJECTIVE: To determine the prevalence of abnormalities observed with CT scanning in patients with malignant pleural effusion. METHODS: We analyzed the CT appearance of the pleura in 86 patients with documented malignant pleural effusions. Patients with primary malignancy of the pleura (mesothelioma) were excluded. RESULTS: In 98% of the malignant effusions the fluid was homogeneous. Focal tumor masses were identified within the effusion in 10%. CT evidence of fluid loculation was seen in 40%. Pleural thickening, either smooth or irregular, was identified in 62%. CONCLUSIONS: The transaxial anatomic display afforded by CT scanning facilitates demonstration of several features that should arouse the suspicion of the radiologist and the clinician to the possibility of malignancy involving the pleura.

Breast Neoplasms↗
PubMed1999

[Pleural amyloidosis as a cause of excessive pleural effusions].

A 83-year-old woman known with a stable disease multiple myeloma was hospitalized frequently with dyspnoea caused by copious bilateral pleural effusions. Thoracentesis was performed repeatedly but pleural effusions returned. Extensive laboratory and radiological examinations failed to reveal the cause of the pleural effusions. Finally, after pleural biopsy the diagnosis of amyloidosis of the pleura could be made. The patient died in hospital from a stroke. Pleural amyloidosis is rarely reported and is accompanied by large uni- or bilateral pleural effusions even without amyloidosis of the heart.

Aged↗
PubMed2006

[Chronic indwelling pleural catheter for malignant pleural effusion in 25 patients].

OBJECTIVE: To describe the experience with an indwelling pleural catheter in patients with pleuritis carcinomatosa. DESIGN: Prospective follow-up study. METHOD: The placement of an indwelling pleural catheter was considered as a treatment possibility for patients who presented with symptomatic accumulation of pleural fluid that returned following previous drainage or pleurodesis or when the fluid had not been drained off previously but there were strong radiological indications for a 'trapped lung'. The intervention was considered to be contraindicated by the following: dyspnoea that had not been reduced by previous pleural punctures performed for relief, dyspnoea caused by many different factors, a tendency for haemorrhaging that could not be corrected. The drain used was a Pleurx indwelling catheter, a thorax drain that is tunnelled subcutaneously, can remain in situ for a long time and offers the patient the opportunity to drain off fluid himself at any desired moment. RESULTS: In the period September 2003-May 2005, the treatment was considered in 40 patients. Ultimately, the catheter was inserted in 25 patients; the clinical deterioration of most of the other patients was too quick. Of the group, 33 patients (82%) died with a median survival of 70 days. All catheters functioned until they were removed or until the patient died. In 3 patients, the drainage procedure was complicated by empyema and in 1 patient by haemoptysis. From the total number of catheters, 9 were removed while the patient was still alive and in 6 patients, spontaneous pleurodesis occurred following 3, 4, 4, 5, 6, and 8 months respectively. In general, the patients were able to handle the catheter without problems and the symptoms were brought and kept adequately under control. CONCLUSION: The Pleurx indwelling pleural catheter was an efficacious treatment supplement for patients with malignant pleural effusion, in whom the standard pleurodesis was not effective.

Adult↗
PubMed1989

[Pleural effusion: diagnostic usefulness of pleural puncture biopsy].

To assess the diagnostic usefulness of thoracocentesis with pleural needle biopsies, we retrospectively studied 316 procedures performed in 254 patients between 1977 and 1984. Of these, 130 were ultimately found to have pleural malignant disease, with a diagnostic cytologic study in 60% of the patients, a positive pleural biopsy in 52.30% and both methods combined in 81.53% of the patients. The marginal gains from pleural biopsy in the presence of negative cytology results were 63.46%. In 59 patients, the primary neoplasm was lung cancer, the most frequent tumor (45.30%); in second place, 30 patients presented carcinoma of the breast (23%). Needle biopsy of the pleura proved to be nonspecific for the diagnosis of nonmalignant diseases except for tuberculous pleurisy: in our study 55 patients presented tuberculosis (21.65%) and in 35 of them, the pleural biopsy was characteristic. The culture of pleural fluid revealed Koch bacillus in 5.45% of these patients. Routine culture of biopsy specimen for tubercle bacillus was not carried out. Complications occurred in 4.4% of needle biopsies, with no death.

Adolescent↗
PubMed1981

[Pleural effusion as the presenting feature of rheumatoid disease. The value of the level of complement in the pleural fluid. A propos of 2 cases].

The authors report two cases of rheumatoid pleural effusion where the pleural syndrome preceded the joint manifestations. From a clinical standpoint, there was an effusion of moderate volume, pseudo-purulent in one case and straw coloured in the other. Signs of rheumatoid arthritis developed after a period of seven weeks in the first case and after a few days only in the second. Amongst the various characteristics of the pleural fluid which were analysed, the authors noted the value of a fall in glucose level, the lack of specificity of anti-gamma globulin factors, and the diagnostic value of the fall in pleural complement and its fractions. In view of the difficulty in obtaining specific histological proof by pleural biopsy, the reduced complement level is of valuable assistance in the aetiological diagnosis of rheumatoid pleural effusion, exceptional as a presenting feature.

Aged↗
PubMed1994

Clinical utility of bone scan features of pleural effusion: sensitivity and specificity for malignancy based on pleural fluid cytopathology.

UNLABELLED: Asymmetric chest activity with malignant and benign pleural effusions has been described in bone scans. However, the clinical utility of this finding is not elucible from the literature. We developed specific scintigraphic criteria for malignant pleural effusion and retrospectively assessed their sensitivity and specificity in a group of patient scans. METHODS: Pleural fluid was submitted for cytopathology from 850 patients over a 5-yr period. Bone scans were done within 2 mo of the thoracentesis in 74 patients. As a consensus panel, we reread the scans and reviewed the cytology. RESULTS: The effusions were cytologically malignant in 25/74 patients (34%), indeterminate in 9/74 (12%) and benign in 40/74 (54%). Based on cytopathology, malignant pleural effusions were detected by bone scans with a sensitivity of 34%-50% and a specificity of 78%-89%; true sensitivity and specificity was somewhere in between averaging 42% (95% confidence interval 24%-60%) and 84% (95% confidence interval 73%-95%), respectively. CONCLUSIONS: The bone scan is frequently the first examination suggesting pleural metastasis, and when it is detected it should be pursued beyond pleural fluid cytology, if negative or indeterminate.

Adult↗