جستجوی مقالات مرتبط با کلیدواژه « Pleural Effusion » در نشریات گروه « پزشکی »

Anthracosis of lung is assumed to be a disease that causes parenchymal accumulation of macrophage-laden anthracotic nodules, which leads to bronchial obstruction, lung mass, and lymphadenopathy. Pleural surface anthracosis involvement as extra-parenchymal involvement has been rarely reported. Still, due to presentation with a transudate pattern, pleural effusion is considered to be a side effect of lung collapse. I represent two subjects with patches of anthracosis in the presumptive place of anatomical fenestra of lymphatic vessels in the parietal pleural. It may cause inhibition of reabsorption of pleural fluid and finally accumulation of transudate pleural effusion. Involvement of the pleura by anthracosis, and black discoloration of the parietal pleura have already been discovered by physicians who perform pleuroscopy. The pleural involvement by anthracosis is usually diffuse. In these two subjects, pleural involvement was in the early stage of anthracosis, which helped me to introduce a new mechanism for transudative pleural effusion due to blockage of the pleural lymphatic channels entrance.

The current study decided to assess CT scan findings in patients with any kind of pleural effusion to obtain any diagnostic value of this modality of imaging to discriminate malignant conditions from benign ones, especially pleural or pulmonary tuberculosis.

Through a cross-sectional design, patients with pleural effusion enrolled in this study when their diagnosis was known as malignancy or tuberculosis. The findings of chest CT-scan were compared between the two conditions and the frequency and statistically different variables were reported as discriminating factors between malignancy and tuberculosis.

Among our findings, male sex was prone to tuberculosis, but pleural thickening >10 mm, lung collapse and lung mass in CT-scan, were the most prevalent findings in malignancy and absent in tuberculosis cases. No significant differences were observed in the free or loculated effusion, air-fluid level and gas, Hounsfield score and loculation involvement between groups.

CT scan, despite its unconfirmed diagnostic values, could be considered as a very useful part of diagnosing malignancies against benign or infective causes of pleural effusion, especially in terms of pleural thickening more than 10 mm, lung collapse and lung mass disregarding transudative or exudative as well as uni- or bilateral, free or loculated, mild or severe, or other kinds. CT scan scoring system may be the next topic to work on by authors.

Pleural effusion (PLEFF) is mainly caused by volume overload, heart failure, trauma, and pleuro-pulmonary infection, it is common in emergency and ICU patients. Although the function of ultrasonography in detecting PLEFF has long been noted, controversial results have been reported. This study aimed to review the literature on ultrasound and radiography in detecting PLEFF.

A search was done in Medline, ISI Web of Knowledge, EMBASE, and Scopus databases. Two reviewers independently searched, screened, and included the data and a third author resolved any conflict.

The findings proved that as a screening tool, chest ultrasound has greater diagnostic accuracy in identifying multiple pleural effusions than radiography. Chest ultrasound enables clinicians visualize pleural effusions and also helps differentiate between various types. In addition, chest ultrasound is crucial for thoracentesis and thoracostomy drainage as it enhances safeness and reduces life-threatening complications. This is important not only when inserting a needle or tube drain, but also when monitoring the amount of her PLEFF deflated. In addition, chest ultrasound is often more specific and sensitive than chest radiography, helping to diagnose coexisting lung disease without X-ray exposure.

Thoracic Ultrasound (TUS) is a simple, non-invasive, bedside procedure for diagnosing PLEFF with greater sensitivity and specificity than a chest X-ray. This is crucial for visualizing exudate and helps differentiate various forms of her PLEFF. More recently, ultrasound has been used to guide thoracentesis and insert chest tubes to raise the safeness of this invasive method, especially if an ICU patient is on a ventilator or has a small localized pleural effusion. Additionally, TUS can monitor the PLEFF drainage and determine when to extract the drainage.

Increased vascular permeability is one of the main mechanisms in the production of pleural effusion (PE) and vascular endothelial growth factor (VEGF) has a significant role in its pathogenesis. This study aimed to compare pleural levels of VEGF in transudative and exudative PEs besides the other pleural markers.
In this prospective cross-sectional study, 80 patients with PE were divided into 4 groups as transudative (N=15), parapneumonic (N=15), tuberculosis (N=25), and malignant (N=25) PE. Biochemical tests measured the pleural protein, LDH, cholesterol, glucose, polymorphonuclear cell (PMN), and lymphocyte. ELISA measured the pleural VEGF level.
Out of 80 patients, 51 were male, and the total mean age was 55.34±18.53. There were significant differences in pleural VEGF between exudative and transudative effusion (P<0.001) and between malignant and benign effusion (P=0.014). The highest mean difference in pleural VEGF levels was seen in the comparison of transudative and malignant groups (Mean difference=-136.56; P<0.002). The VEGF level in 3 groups was not significantly different; transudative vs tuberculous, parapneumonic vs tuberculous, and parapneumonic vs malignant. Furthermore, VEGF higher than 73.09 pg/ml had a 64% sensitivity and 82% specificity for the diagnosis of malignancy. Among pleural markers (VEGF, protein, LDH, and glucose), VEGF had the highest area under curve (AUC=0.734). Moreover, pleural protein, LDH, and glucose levels significantly correlated with pleural VEGF; however, pleural cholesterol, PMN, and lymphocyte were not correlated.
VEGF is assumed as an important factor in the pathogenesis of exudative PE, especially malignant effusion. It can distinguish between lymphocytic exudative PEs.

 chronic granulomatous disease (CGD) is a genetic disease characterized by recurrent life-threatening fungal and bacterial infections and granuloma formation. Pericardial effusion is rare in this disease.

 The study reports a 13-year-old boy with CGD and a history of recurrent infections such as pneumonia and abscesses. The patient presented with shortness of breath, cough, abdominal pain, and chest pain and was diagnosed with severe pericardial and pleural effusion. The patient was treated with antibiotics, antifungals, and steroids and finally underwent pericardiotomy.

 Treatment of CGD patients with recurrent infections and inflammatory lesions is challenging and requires individual decision-making for each patient.

Pleural effusion is a typical extrapulmonary cause of Tuberculosis (TB). The routine culture experiences an absence of affectability. Numerous markers in pleural fluid are assessed to analyze tubercular pleural fluid, yet no one is perfect. We have contemplated Adenosine deaminase (ADA), protein (CRP C - responsive) and Lymphocyte/Neutrophil (L/N) ratio in amalgamation for the determination of pleural effusion of tubercular origin.Material & All patients presented with pleural effusion were put through thoracentesis and differentiated into transudative and exudative using Light's criteria. Patients with exudative pleural effusion aetiology were further bisected into two groups with a sample size of 30 patients. Group I consisted of patients with tubercular cause, and Group II comprised other than tubercular. ADA, CRP and L/N ratio of these subjects were estimated in pleural fluid. The sensitivity, specificity and predictive values were calculated. The ADA, CRP, and L/N ratio's sensitivity, specificity, positive predictive value, and negative predictive value were, respectively, 83.3%, 90.0%, 89.29%, 84.37%, 76.67%, 90.0%, 88.46%, 79.41%, 96.67%, 43.33%, 63.04%, and 92.86%. The conjunction of ADA and CRP exhibited the highest specificity for pleural effusion caused by Tuberculosis; however, both ADA and CRP showed comparable specificity on their own. Diagnosing tubercular from non-tubercular individuals was made easier with the help of Pleural fluid ADA and CRP. Combining ADA, CRP, and L/N ratio does not offer any significant advantages beyond just combining ADA and CRP.

The coronavirus disease 2019 (COVID-19) outbreak started in December 2019. The disease can manifest in various respiratory and non-respiratory symptoms and clinical findings. The signs and symptoms of this disease in children are not entirely known yet. Ground-glass opacity and pleural effusion in the chest computed tomography scan have been reported in infected patients. The pleural effusion has been reported in a few cases. The present case report describes a pediatric patient with the chief complaints of fever, diarrhea, and vomiting who presented to an emergency department with a differential diagnosis of a gastrointestinal infection. However, he was diagnosed with COVID-19, which was complicated by respiratory distress and pleural effusion.

The aim of our study is to determine the clinical availability accessibility of cancer ratio and cancer ratio plus formulations, previously validated and reported to have clinical value in distinguishing malignant pleural effusion from tuberculosis pleurisy and parapneumonic effusion.

Retrospective study of patients hospitalized with Malignant Pleural Effusion (MPE), tuberculosis (TPE) and pararapneumonic effusion (PPE) between 2009 and 2018.

Totally 232 patients, 101(43.5 %) having MPE, 86 (37.1 %) having PPE and 45 (19.4 %) TPE were examined. When compared with each other, ‘’serum LDH / PS Lymphocyte %’’, ‘’Cancer ratıo’’ and ‘’Cancer ratıo plus’’ values were statistically different between the groups (p = 0.021, p <0.001 and p = 0.015, respectively). In multivariate logistic regression analysis, cancer ratio, serum LDH: pleural fluid lymphocyte count ratio was in positive correlation with MPE. The sensitivity and specificity of ‘’cancer ratio’’, “cancer ratio plus” and ‘’ratio of serum LDH: pleural fluid lymphocyte count’’ were 84.2 % (95% CI 75.6– 90.7) and 52.7 (95% CI 43.8– 61.5), and 82.2 % (95% CI 73.3– 89.1) and 45.8 (95%CI 37.1– 54.7), 53.5% (95% CI 43.3– 63.5) and 67.2% (95% CI 0.68–0.94) at the cut-off level of >14.25, >28.7, and >636, respectively. When considering only MPE and TPE patients, the specificity of cancer ratıo and cancer ratıo plus increased.

The cancer ratio plus rate ( the ratio of ‘’cancer ratio’’formulation  to the percentage of differential pleural lymphocyte count ) was almost the same as the cancer ratio in separating the malignant pleural effusion from the TPE and PPE, while it has better specificity only in differentiating malignant effusions from tuberculosis effusions.

Pancreaticopleural fistulas (PPF) are a rare etiology of pleural effusions. We describe a case of a 61-year-old man, with left chest pain with six months of progression who presented with a large volume unilateral pleural effusion. A thoracentesis was performed, which showed a dark reddish fluid(exudate) and high content of pancreatic amylase. After that an abdominal computed tomography (CT)and magnetic resonance cholangiopancreatography (MRCP) was done, revealing fistulous pathways that originated in the pancreas. The patient was admitted for conservative and endoscopic treatment by Endoscopic Retrograde Cholangiopancreatography (ERCP) and a prosthesis was placed on a fistulous path. He was discharged without complications, with the resolution of the pleural effusion and fistula.The interest of this case lies in the rarity of the event and absence of symptoms of the probable primary event (acute pancreatitis). The possible iatrogenic association with several drugs of his usual medication makes it even more complex.

Pleural effusion is an accumulation of fluid in the pleural space. It can be transudative or exudative. Mechanisms like alteration in Starling’s forces lead to transudative effusions while inflammation and infiltration by infections, malignancy, connective tissue diseases, etc lead to exudative effusions. Tuberculosis, viral, bacterial infections, and malignancy are common causes of exudative effusions whereas congestive heart failure, renal failure, and liver failure, etc are common causes of transudative effusions. Nearly 40% of patients with malignancy have pleural effusion at the time of presentation. Bronchogenic carcinoma, carcinoma of the breast, lymphoma are the leading causes of malignant pleural effusion (MPE) followed by gastrointestinal, genitourinary, and gynecological causes. Pleural fluid Adenosine DeAminase (ADA) has good diagnostic sensitivity and specificity for tuberculosis whereas pleural fluid cytology /biopsy are the main diagnostic modalities for MPE. However pleural fluid cytology is positive in only 48.5% of cases in the first sample but the yield increases with repeated analysis or other more invasive investigations like blind pleural biopsy/thoracoscopy. In cases with negative pleural fluid cytology, a biochemical marker known as Cancer ratio i.e serum LDH and pleural fluid ADA can be useful in predicting malignant causes. A cancer ratio cutoff of more than 20 helps in guiding the physician for further workups like FDG PET or tumor markers in evaluating malignancies. With this background our study aimed at the usefulness of cancer ratio in patients with exudative pleural effusion. It's a cross sectional observational study done for a period of 18months.100 adult patients with exudative pleural effusions were recruited into the study. Those who didn’t give consent, hemodynamically unstable, whose diagnosis is known were excluded. Serum LDH, pleural fluid ADA were done in all cases and the cancer ratio is validated for diagnosis of malignant effusions.  The mean age of patients was 55.48±9.32 years. There were 57 malignant and 43 nonmalignant cases. Bronchogenic carcinoma was the leading cause of MPE and tuberculosis was the commonest cause of non-malignant pleural effusions. Mean serum LDH, Pleural fluid ADA, and cancer ratio in malignant cases and nonmalignant cases was 434.54 and 350.04IU/ml,19.05 and 32.97IU/ml and 25.13, 20.45 respectively. The sensitivity of cancer ratio was 70.17%, specificity was 76.74%, Positive predictive value was 80% and Negative predictive value was 66.6%. Cancer ratio is an easy and valid diagnostic tool in suspecting malignant pleural effusions with good sensitivity and specificity

The red cell distribution width (RDW) value has been recently recognized as a valuable biomarker in clinical practice. The RDW value has not been evaluated so far in patients with pleural effusion. Thus, this study aimed to investigate whether RDW could distinguish between exudative and transudative pleural effusions.

We measured protein and lactate dehydrogenase levels on both pleural fluids and serum samples from 223 cases and classified them as transudates or exudates based on the classic Light’s criteria. We collected blood cell count elements such as RDW from the medical records. We also investigated the correlation between RDW and the nature of pleural effusion.

In 55.2% of the patients, pleural fluid was exudative. Although we found no significant association between RDW and the nature of the pleural fluid, we detected a significantly higher amount of RDW (14.9 ≤) in patients with exudative pleural effusion compared to transudate (66.7% vs. 33.3%; P= 0.01). In this category, neoplastic conditions were mostly observed in the patients (76.3%), followed by pulmonary thromboembolism (21.1%) and systemic lupus erythematous (2.6%).

The findings could not reveal any noticeable correlation between RDW and the Light criteria. However, it appears that elevated RDW levels give insights into the valuable nature of RDW in different conditions such as neoplastic diseases.

Choriocarcinoma is the most aggressive kind of gestational trophoblastic neoplasia (GTN). Although the risk of brain metastasis in GTN is rare, in patients with choriocarcinoma, the incidence of brain metastasis is 11%. In this paper, we reported a case of choriocarcinoma with brain metastasis, which was successfully treated with an etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMACO) regimen.

A 34-year-old woman was presented with vaginal bleeding, dyspnea, and moderate abdominal pain. She had a menstrual delay of about two weeks. She had a primary β-human chorionic gonadotropin (β-hCG) of 132 600 mIU/mL. On lung computed tomography (CT) scan images, a metastatic lesion with a size of 68×50 mm was observed in the lower lobe of the left lung. The patient underwent dilation and curettage (D&C) that revealed choriocarcinoma. Brain magnetic resonance imaging (MRI) also showed a small metastatic mass with a size of 7 mm at the right occipital lobe. The patient was started on chemotherapy with an EMACO regimen. The patient’s β-hCG decreased continuously, and it was negative after the fourth cycle and six sessions of radiotherapy. It also remained negative six months after chemotherapy. The final examinations of the patient had no abnormal findings.   

Brain metastasis may be relatively asymptomatic in patients with choriocarcinoma, and it should be considered by physicians, even when there are no neurological symptoms. Also, the EMACO regimen seems to be an appropriate regimen for the treatment of metastatic choriocarcinoma.

Pulmonary complications after cardiac surgery are a major source of morbidity and mortality, as well as increased lengths of hospital stay and resource utilization. Pleural effusion following coronary artery bypass graft surgery (CABG) has been reported in 65% to 89% of cases. The present study was designed to determine the prevalence of pleural effusion after open-heart surgery.

This study evaluated 600 patients who underwent open-heart surgery. The study population was divided into 3 groups: group A consisted of 200 patients who underwent CABG, group B comprised 200 patients who underwent aortic valve replacement (AVR) and mitral valve replacement (MVR), and group C encompassed 200 patients who underwent    valve surgery and CABG. Chest radiography was performed before surgery and afterward on the first, third, and seventh postoperative days.

The study population was comprised of 330 (55%) men and 270 (45%) women. The size of the pleural effusion was small in a large proportion of the patients (45%, n = 270). Additionally, 90 (15%) patients had moderate effusion, occupying between 20% and 40% of the hemithorax, and 84 (14%) patients had large effusion.

Pleural effusion was detected in 37% of the patients after CABG, 25% after valve surgery (MVR+AVR), and 20% after CABG and valve surgery. Most of the cases of effusion after cardiac surgery were left-sided. (Iranian Heart Journal 2020; 21(3): 48-54)