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Sindu D, Bansal S, Buddhdev B, McAnally K, Mohamed H, Walia R, Mohanakumar T, Tokman S. Late-Onset Exudative Pleural Effusions Without Concomitant Airway Obstruction or Lung Parenchymal Abnormalities: A Novel Presentation of Chronic Lung Allograft Dysfunction. Transpl Int 2024; 37:12395. [PMID: 38357217 PMCID: PMC10866027 DOI: 10.3389/ti.2024.12395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024]
Abstract
Restrictive allograft syndrome (RAS) is an aggressive variant of CLAD characterized by progressive restrictive ventilatory decline and persistent pleuro-parenchymal changes that can be seen on chest CT. We identified four lung transplant recipients with a progressive restrictive ventilatory defect due to lymphocyte-predominant exudative pleural effusions, but no pleuro-parenchymal abnormalities typical of RAS. Using molecular analysis, we also found increased levels of previously described immune markers of RAS, including NFkB, 20S proteasome, lipocalin, TNFα, and TGFβ, within the circulating small extracellular vesicles of the remaining living lung transplant recipient. Despite the absence of lung parenchymal changes, these patients had a poor prognosis with rapid deterioration in allograft function and no response to pleural-based interventions such as thoracentesis, decortication, and pleurodesis. We hypothesize that these cases represent a distinct CLAD phenotype characterized by progressive restriction due to pleural inflammation, lymphocyte-predominant pleural effusion, resultant compressive atelectasis, and eventual respiratory failure in the absence of lung parenchymal involvement.
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Affiliation(s)
- Devika Sindu
- Norton Thoracic Institute, Phoenix, AZ, United States
| | | | - Bhuvin Buddhdev
- Norton Thoracic Institute, Phoenix, AZ, United States
- School of Medicine, Creighton University, Phoenix, AZ, United States
| | - Kendra McAnally
- Norton Thoracic Institute, Phoenix, AZ, United States
- School of Medicine, Creighton University, Phoenix, AZ, United States
| | - Hesham Mohamed
- Norton Thoracic Institute, Phoenix, AZ, United States
- School of Medicine, Creighton University, Phoenix, AZ, United States
| | - Rajat Walia
- Norton Thoracic Institute, Phoenix, AZ, United States
- School of Medicine, Creighton University, Phoenix, AZ, United States
| | | | - Sofya Tokman
- Norton Thoracic Institute, Phoenix, AZ, United States
- School of Medicine, Creighton University, Phoenix, AZ, United States
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Gupta S, Thameem D. Spontaneous Resolution of Recurrent Pleural Effusion in Atraumatic Splenic Rupture. Cureus 2023; 15:e40232. [PMID: 37435245 PMCID: PMC10332821 DOI: 10.7759/cureus.40232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
Spontaneous splenic rupture is an uncommon cause of acute-onset left-sided pleural effusion. It is often immediate with a high preponderance for recurrence, sometimes even requiring splenectomy. We report a case of spontaneous resolution of recurrent pleural effusion presenting a month after the initial atraumatic splenic rupture. Our patient was a 25-year-old male without significant medical history who was taking Emtricitabine/Tenofovir for pre-exposure prophylaxis. He presented to the pulmonology clinic for left-sided pleural effusion, diagnosed in the emergency department a day prior. He had a history of spontaneous grade III splenic injury one month before, where he was diagnosed with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) co-infection on polymerase chain reaction (PCR) testing and was managed conservatively. The patient underwent thoracentesis in the clinic, which showed exudative lymphocyte predominant pleural effusion and no malignant cells. The remainder of the infective workup was negative. He was readmitted two days later with worsening chest pain, and imaging revealed re-accumulation of pleural fluid. The patient declined thoracentesis, and a chest X-ray was repeated a week later, showing worsening pleural effusion. The patient insisted on continuing conservative management, and he was seen a week later with a repeat chest X-ray that showed near resolution of pleural effusion. Splenomegaly and splenic rupture can lead to pleural effusion due to posterior lymphatic obstruction, which can be recurrent. There are no current guidelines on management, and treatment options include watchful monitoring, splenectomy, or partial splenic embolization.
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Affiliation(s)
- Sushan Gupta
- Internal Medicine, Carle Foundation Hospital, Champaign, USA
| | - Danish Thameem
- Pulmonary and Critical Care Medicine, Carle Foundation Hospital, Champaign, USA
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Abdeen Y, Ortiz WJ, Cala-Garcia JD, Cervantes M. Pleural Effusion as a Potential Complication of Foreign Body Reaction to Silicone Breast Implants: A Case Study. Cureus 2023; 15:e38734. [PMID: 37303460 PMCID: PMC10249646 DOI: 10.7759/cureus.38734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Breast augmentation surgery, like any other surgery, has potential complications, including the less common complication of pleural effusion. We present a unique case of a 44-year-old female who developed pleuritic chest pain and shortness of breath 10 days after her breast augmentation surgery, with no prior history of cardiac or autoimmune conditions. The temporal relationship between the surgery and the onset of symptoms suggested a possible direct link to the implants. Imaging showed a small- to moderate-sized left pleural effusion, and pleural fluid analysis revealed findings suggestive of a foreign body reaction (FBR), including evidence of mesothelial and inflammatory cells with a lymphocyte percentage of 44% and monocytes of 30%. The patient received intravenous steroids at a dose of 40 mg every eight hours for three days while hospitalized, followed by a tapered oral dose of steroids upon discharge, for over three weeks. Follow-up imaging studies showed complete resolution of the pleural effusion. The diagnosis of pleural effusion resulting from FBR to silicone gel-filled breast implants involves a clinical history, cytopathological examination, and the exclusion of other potential causes. This case highlights the importance of considering FBR as a potential cause of pleural effusion post-breast augmentation surgery.
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Affiliation(s)
- Yazan Abdeen
- Pulmonary and Critical Care Medicine, HCA (Hospital Corporation of America) Houston Healthcare Pearland, Houston, USA
- Pulmonary and Critical Care Medicine, Pulmonary and Sleep Physicians of Houston, Webster, USA
| | - Wendolin J Ortiz
- General Surgery, Universidad Autónoma de Baja California, Mexicali, MEX
- Pathology, HCA (Hospital Corporation of America) Houston Healthcare Pearland, Houston, USA
| | | | - Mario Cervantes
- Pathology, HCA (Hospital Corporation of America) Houston Healthcare Pearland, Houston, USA
- Pathology, HCA (Hospital Corporation of America) Houston Healthcare West, Houston, USA
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Fazli Khalaf F, Asadi Gharabaghi M, Balibegloo M, Davari H, Afshar S, Jahanbin B. Pleural CEA, CA-15-3, CYFRA 21-1, CA-19-9, CA-125 discriminating malignant from benign pleural effusions: Diagnostic cancer biomarkers. Int J Biol Markers 2023:3936155231158661. [PMID: 36942429 DOI: 10.1177/03936155231158661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION There is a need for a rapid, accurate, less-invasive approach to distinguishing malignant from benign pleural effusions. We investigated the diagnostic value of five pleural tumor markers in exudative pleural effusions. METHODS By immunochemiluminescence assay, we measured pleural concentrations of tumor markers. We used the receiver operating characteristic curve analysis to assess their diagnostic values. RESULTS A total of 281 patients were enrolled. All tumor markers were significantly higher in malignant pleural effusions than benign ones. The area under the curve of carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 15-3, cytokeratin fragment 19 (CYFRA) 21-1, CA-19-9, and CA-125 were 0.81, 0.78, 0.75, 0.65, and 0.65, respectively. Combined markers of CEA + CA-15-3 and CEA + CA-15-3 + CYFRA 21-1 had a sensitivity of 87% and 94%, and specificity of 75% and 58%, respectively. We designed a diagnostic algorithm by combining pleural cytology with pleural tumor marker assay. CEA + CYFRA 21-1 + CA-19-9 + CA-15-3 was the best tumor markers panel detecting 96% of cytologically negative malignant pleural effusions, with a negative predictive value of 98%. CONCLUSIONS Although cytology is specific enough, it has less sensitivity in identifying malignant pleural fluids. As a result, the main gap is detecting malignant pleural effusions with negative cytology. CEA was the best single marker, followed by CA-15-3 and CYFRA 21-1. Through both cytology and suggested panels of tumor markers, malignant and benign pleural effusions could be truly diagnosed with an accuracy of about 98% without the need for more invasive procedures, except for the cohort with negative cytology and a positive tumor markers panel, which require more investigations.
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Affiliation(s)
- Farzaneh Fazli Khalaf
- Pathology Department, Cancer Institute, Tehran University of Medical Science, Tehran, Iran
| | - Mehrnaz Asadi Gharabaghi
- Department of Pulmonary Medicine, Thoracic Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Maryam Balibegloo
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network, Chicago, IL, USA
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Davari
- General Thoracic Surgery Ward, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Afshar
- Cancer Institute, Tehran University of Medical Science, Tehran, Iran
| | - Behnaz Jahanbin
- Pathology Department, Cancer Institute, Tehran University of Medical Science, Tehran, Iran
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Patel BH, Melamed KH, Wilhalme H, Day GL, Wang T, DiNorcia J, Farmer D, Agopian V, Kaldas F, Barjaktarevic I. Implications of Pleural Fluid Composition in Persistent Pleural Effusion following Orthotopic Liver Transplant. Med Sci (Basel) 2023; 11:medsci11010024. [PMID: 36976532 PMCID: PMC10058754 DOI: 10.3390/medsci11010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/03/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Persistent pleural effusions (PPEf) represent a known complication of orthotopic liver transplant (OLT). However, their clinical relevance is not well described. We evaluated the clinical, biochemical, and cellular characteristics of post-OLT PPEf and assessed their relationship with longitudinal outcomes. We performed a retrospective cohort study of OLT recipients between 2006 and 2015. Included patients had post-OLT PPEf, defined by effusion persisting >30 days after OLT and available pleural fluid analysis. PPEf were classified as transudates or exudates (ExudLight) by Light's criteria. Exudates were subclassified as those with elevated lactate dehydrogenase (ExudLDH) or elevated protein (ExudProt). Cellular composition was classified as neutrophil- or lymphocyte-predominant. Of 1602 OLT patients, 124 (7.7%) had PPEf, of which 90.2% were ExudLight. Compared to all OLT recipients, PPEf patients had lower two-year survival (HR 1.63; p = 0.002). Among PPEf patients, one-year mortality was associated with pleural fluid RBC count (p = 0.03). While ExudLight and ExudProt showed no association with outcomes, ExudLDH were associated with increased ventilator dependence (p = 0.03) and postoperative length of stay (p = 0.03). Neutrophil-predominant effusions were associated with increased postoperative ventilator dependence (p = 0.03), vasopressor dependence (p = 0.02), and surgical pleural intervention (p = 0.02). In summary, post-OLT PPEf were associated with increased mortality. Ninety percent of these effusions were exudates by Light's criteria. Defining exudates using LDH only and incorporating cellular analysis, including neutrophils and RBCs, was useful in predicting morbidity.
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Affiliation(s)
- Bhavesh H Patel
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Kathryn H Melamed
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Holly Wilhalme
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Gwenyth L Day
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Tisha Wang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Joseph DiNorcia
- Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Douglas Farmer
- Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Vatche Agopian
- Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Fady Kaldas
- Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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Rodriguez KM, Vaught J, Dilley M, Ellsworth K, Heinen A, Abud EM, Zhang Y, Smith RJH, Sheets R, Geng B, Hoffman HM, Worthen HM, Dimmock D, Coufal NG. Rapid genome sequencing identifies novel variants in complement factor I. Cold Spring Harb Mol Case Stud 2022; 8:a006239. [PMID: 36577522 PMCID: PMC9808552 DOI: 10.1101/mcs.a006239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/05/2022] [Indexed: 12/30/2022] Open
Abstract
Complement factor I deficiency (CFID; OMIM #610984) is a rare immunodeficiency caused by deficiencies in the serine protease complement factor I (CFI). CFID is characterized by predisposition to severe pneumococcal infection, often in infancy. We report a previously healthy adolescent male who presented with respiratory failure secondary to pneumococcal pneumonia and severe systemic inflammatory response. Rapid genome sequencing (rGS) identified compound heterozygous variants in CFI in the proband, with a novel maternally inherited likely pathogenic variant, a single nucleotide deletion resulting in premature stop (c.1646del; p.Asn549ThrfsTer25) and a paternally inherited novel likely pathogenic deletion (Chr 4:110685580-110692197del).
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Affiliation(s)
- Katherine M Rodriguez
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Pediatric Critical Care, Department of Pediatrics, University of California at San Diego, San Diego, California 92123, USA
- Rady Children's Institute for Genomic Medicine, San Diego, California 92123, USA
| | - Jordan Vaught
- Rady Children's Hospital, San Diego, California 92123, USA
- Department of Pediatrics, Immunology, and Rheumatology, Department of Pediatrics, University of California at San Diego, San Diego, California 92161, USA
| | - Michelle Dilley
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California at San Diego, San Diego, California 92161, USA
| | - Kataryzna Ellsworth
- Rady Children's Institute for Genomic Medicine, San Diego, California 92123, USA
| | - Alaina Heinen
- Rady Children's Institute for Genomic Medicine, San Diego, California 92123, USA
| | - Edsel M Abud
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California at San Diego, San Diego, California 92161, USA
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, California 92093, USA
| | - Yuzhou Zhang
- Molecular Otolaryngology and Renal Research Laboratories, University of Iowa, Iowa City, Iowa 52242, USA
| | - Richard J H Smith
- Molecular Otolaryngology and Renal Research Laboratories, University of Iowa, Iowa City, Iowa 52242, USA
| | - Robert Sheets
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California at San Diego, San Diego, California 92161, USA
| | - Bob Geng
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California at San Diego, San Diego, California 92161, USA
| | - Hal M Hoffman
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California at San Diego, San Diego, California 92161, USA
| | - H Michael Worthen
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Pediatric Critical Care, Department of Pediatrics, University of California at San Diego, San Diego, California 92123, USA
| | - David Dimmock
- Rady Children's Institute for Genomic Medicine, San Diego, California 92123, USA
| | - Nicole G Coufal
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Pediatric Critical Care, Department of Pediatrics, University of California at San Diego, San Diego, California 92123, USA
- Rady Children's Institute for Genomic Medicine, San Diego, California 92123, USA
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Jabbar A, Qureshi R, Nasir K, Dhrolia M, Ahmad A. Transudative and Exudative Pleural Effusion in Chronic Kidney Disease Patients: A Prospective Single-Center Study. Cureus 2021; 13:e18649. [PMID: 34786244 PMCID: PMC8578877 DOI: 10.7759/cureus.18649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of the study is to assess the incidence of pleural effusion and to assess its etiology in admitted chronic kidney disease patients who were admitted secondary to various causes, i.e., fluid overload, sepsis, etc. Material and methods A prospective cross-sectional observational study was conducted at the Department of Nephrology, The Kidney Centre Postgraduate Training Institute, Karachi. A total of 789 patients were admitted between August 2020-February 2021. This study comprised 280 adult chronic kidney disease (chronic kidney disease and end-stage renal disease patients who were on dialysis) patients having pleural effusion (either unilateral or bilateral) secondary to various causes. Results Among 280 patients, the mean age was 55 years with 158 (56.4%) males and 122 (43.6%) females, diabetes (76%) was present in most of the patients along with hypertension (86.1%), and most of the patients were of stage IV and V. Transudative pleural effusion was present in 212 (75.7%) patients secondary to fluid overload and heart failure was the commonest cause while 68 (24.3%) patients had exudative pleural effusion with tuberculosis being the commonest etiology, 44 (15.7%) patients needed intervention while 236 (84.3%) were treated medically. The data was entered and analyzed on SPSS version 21 (IBM Corp, Armonk, USA). The cleaning and coding of data were done before analysis. Continuous variables were expressed in mean ± standard deviation, while the frequencies with percentages were obtained for categorical variables. The Chi-square test was applied to see the association between variables. A p-value of ≤ 0.05 was considered significant. Conclusion Clarification of the cause of pleural effusion is essential. Early diagnosis and prompt treatment like thoracocentesis or in the case of patients on hemodialysis, adequate dialysis may be necessary.
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Affiliation(s)
- Asfia Jabbar
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
| | - Ruqaya Qureshi
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
| | - Kiran Nasir
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
| | - Murtaza Dhrolia
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
| | - Aasim Ahmad
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
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Abuserewa ST, Esperti S, Golden T, Duff R. A Rare Cause of Exudative Pleural Effusion in a Female. Cureus 2021; 13:e16237. [PMID: 34367834 PMCID: PMC8345019 DOI: 10.7759/cureus.16237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/22/2022] Open
Abstract
Yellow nail syndrome is an extremely rare syndrome that presents with a clinical triad of thickened yellow nails, lymphedema, and recurring pulmonary manifestations (pleural effusion, chronic cough, or bronchiectasis), usually in the population above the age of 50 years. We describe a case of yellow nail syndrome in a 48-year-old lady who presented with the typical classical triad of this syndrome.
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Affiliation(s)
- Sherif T Abuserewa
- Department of Internal Medicine, Grand Strand Regional Medical Center, Myrtle Beach, USA
| | - Shawn Esperti
- Department of Internal Medicine, Grand Strand Regional Medical Center, Myrtle Beach, USA
| | - Thaddeus Golden
- Department of Pulmonary and Critical Care Medicine, Grand Strand Regional Medical Center, Myrtle Beach, USA
| | - Richard Duff
- Department of Pulmonary and Critical Care Medicine, Grand Strand Regional Medical Center, Myrtle Beach, USA
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Gong L, Huang G, Huang Y, Liu D, Tang X. Medical Thoracoscopy for the Management of Exudative Pleural Effusion: A Retrospective Study. Risk Manag Healthc Policy 2020; 13:2845-2855. [PMID: 33324122 PMCID: PMC7733339 DOI: 10.2147/rmhp.s287758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/23/2020] [Indexed: 01/01/2023] Open
Abstract
Objective The aim of this study was to evaluate the efficacy of medical thoracoscopy in the diagnosis and treatment of exudative pleural effusion. Methods A total of 82 patients with exudative pleural effusion underwent medical thoracoscopy under local anesthesia and mild sedation. The clinical characteristics, pleural fluid routine and biochemical tests, pleural biopsy, and outcomes were retrospectively evaluated. Results Among 82 patients, the color and transparency of pleural fluid and the levels of white blood cells (WBC), lactate dehydrogenase (LDH), neutrophil proportion, lymphocyte proportion, adenosine deaminase (ADA), and glucose were different among tuberculosis (TB), malignant (M), acute and chronic inflammation (ACI), and purulent (P) cases. Furthermore, 70% of M cases had a low positive rate of exfoliated cells in the sputum and pleural fluid, and more than 90% of TB cases had low positive rates of anti-tuberculosis antibodies and acid-fast bacilli in the sputum and pleural fluid. Pleural biopsy showed that 11% of cases were M, 74.4% were TB, 11% were ACI, and 3.6% were P. Medical thoracoscopy showed that 66.7% of ACI cases had pleural adhesions, 34.4% of TB cases had moderate and 34.4% of TB cases had severe pleural adhesions, 100% of M and TB cases had pleural surface nodules and 77.8% of ACI cases had pleural surface nodules, 49.2% of TB cases showed encapsulated pleural effusion, and 33.3% of M cases showed encapsulated pleural effusion. Conclusion Medical thoracoscopy has high feasibility and accuracy in the diagnosis and treatment of exudative pleural effusion.
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Affiliation(s)
- Ling Gong
- The First Clinical Medical College, Jinan University, Guangzhou 510632, People's Republic of China.,Department of Respiratory Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi 563000, People's Republic of China
| | - Guichuan Huang
- Department of Respiratory Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi 563000, People's Republic of China
| | - Yi Huang
- Department of Respiratory Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi 563000, People's Republic of China
| | - Daishun Liu
- Department of Respiratory Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi 563000, People's Republic of China
| | - Xiaoping Tang
- The First Clinical Medical College, Jinan University, Guangzhou 510632, People's Republic of China
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Seo HM, Kim M, Kim H. Refractory exudative pleural effusion in patients with chronic kidney disease not receiving dialysis: A case report. Clin Case Rep 2019; 7:675-679. [PMID: 30997062 PMCID: PMC6452446 DOI: 10.1002/ccr3.2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/26/2019] [Accepted: 02/03/2019] [Indexed: 11/27/2022] Open
Abstract
Although exudative pleural effusion can be caused by infections, malignancies, and connective tissue diseases, we need to consider uremic pleural effusion and pleuritis in differential diagnosis of exudative lymphocyte predominant pleural effusion in patients with chronic kidney disease not receiving dialysis.
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Affiliation(s)
- Hye Mi Seo
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Jeju National University HospitalJeju National UniversityJeju CityKorea
| | - Miyeon Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Jeju National University HospitalJeju National UniversityJeju CityKorea
| | - Hyunwoo Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Jeju National University HospitalJeju National UniversityJeju CityKorea
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Akturk UA, Ernam D, Akbay MO, Koçak ND, Ogur E, Irmak I. Role of the Neutrophil-Lymphocyte Ratio in the Differential Diagnosis of Exudative Pleural Effusion. Clinics (Sao Paulo) 2016; 71:611-616. [PMID: 27759851 PMCID: PMC5054976 DOI: 10.6061/clinics/2016(10)10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/18/2016] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES: Pleural effusion is a common diagnostic and clinical problem. The differential diagnosis of pleural effusion may be difficult and may require several procedures, including invasive ones. Certain studies have investigated biochemical parameters to facilitate the diagnosis of exudative pleural effusion; however, it remains a challenging problem in clinical practice. We aimed to investigate the potential role of the neutrophil-lymphocyte ratio, which can be easily obtained by determining the cell count of the pleural fluid, in the differential diagnosis of exudative pleural effusion. METHODS: Records from patients who underwent thoracentesis and pleural fluid analysis between May 1, 2013, and March 1, 2015, were obtained from the electronic database of our hospital. The patients who met the inclusion criteria were divided into five groups according to their diagnosis: malignant pleural effusion, para-malignant pleural effusion, para-pneumonic effusion, tuberculosis-related effusion or other. The neutrophil-lymphocyte ratio value was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. The patient groups were compared according to the given parameter. RESULTS: A total of 465 patients who met the inclusion criteria among 1616 patients with exudative pleural effusion were included in the study. The mean neutrophil-lymphocyte ratio value was significantly lower in tuberculosis-related pleural effusion compared to malignant, para-pneumonic and para-malignant effusions (p=0.001, p=0.001, p=0.012, respectively). The areas under the curve for tuberculosis pleurisy compared to malignant, para-pneumonic and para-malignant effusions were 0.38, 0.36, and 0.37, respectively. Lower cut-off values had higher sensitivity but lower specificity for tuberculosis pleurisy, while higher cut-off values had higher specificity but lower sensitivity for this condition. CONCLUSION: The pleural fluid neutrophil-lymphocyte ratio, which is an inexpensive, reproducible, and easily calculated hematological parameter, may facilitate the differential diagnosis of pleural effusion.
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Affiliation(s)
- Ulku Aka Akturk
- Sureyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
- E-mail:
| | - Dilek Ernam
- Sureyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Makbule Ozlem Akbay
- Sureyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Nagihan Durmus Koçak
- Sureyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Erhan Ogur
- Sureyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Ilim Irmak
- Sureyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
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Yanagawa H, Takeuchi E, Suzuki Y, Ohmoto Y, Bando H, Sone S. Vascular endothelial growth factor in malignant pleural effusion associated with lung cancer. Cancer Immunol Immunother 1999; 48:396-400. [PMID: 10501853 PMCID: PMC11037140 DOI: 10.1007/s002620050592] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Hiroaki Yanagawa
- />Third Department of Internal Medicine, The University of Tokushima School of Medicine, Kuramoto-cho 3 Tokushima, 770-8503 Japan e-mail: Tel.: +81-88-633-7127 Fax: +81-88-633-2134, , , , JP
| | - Eiji Takeuchi
- />Third Department of Internal Medicine, The University of Tokushima School of Medicine, Kuramoto-cho 3 Tokushima, 770-8503 Japan e-mail: Tel.: +81-88-633-7127 Fax: +81-88-633-2134, , , , JP
| | - Yoshihiro Suzuki
- />Third Department of Internal Medicine, The University of Tokushima School of Medicine, Kuramoto-cho 3 Tokushima, 770-8503 Japan e-mail: Tel.: +81-88-633-7127 Fax: +81-88-633-2134, , , , JP
| | - Yasukazu Ohmoto
- />Third Department of Internal Medicine, The University of Tokushima School of Medicine, Kuramoto-cho 3 Tokushima, 770-8503 Japan e-mail: Tel.: +81-88-633-7127 Fax: +81-88-633-2134, , , , JP
| | - Hiroyasu Bando
- />Department of Respiratory Diseases, Tokushima Prefectural Central Hospital, 10-3 Kuramoto-cho 1 Tokushima, 770-0042 Japan, , , , JP
| | - Saburo Sone
- />Third Department of Internal Medicine, The University of Tokushima School of Medicine, Kuramoto-cho 3 Tokushima, 770-8503 Japan e-mail: Tel.: +81-88-633-7127 Fax: +81-88-633-2134, , , , JP
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