PLEURAL EFFUSIONS | Pleural Fluid Analysis, Thoracentesis, Biopsy, and Chest Tube

2006 ◽  
pp. 362-367
Author(s):  
J.E. Heffner
Keyword(s):  
Pleural Fluid ◽  
Chest Tube ◽  
Pleural Effusions ◽  
Fluid Analysis

scholarly journals Application of Computed Tomography (CT) Attenuation Values in Diagnosis of Transudate and Exudate in Patients with Pleural Effusion

2018 ◽  
Vol 11 (02) ◽  
pp. 19-25
Author(s):  
Keshab Sharma ◽  
PS Lamichhane ◽  
BK Sharma
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Ct Scan ◽  
Pleural Fluid ◽  
Pleural Effusions ◽  
Hounsfield Units ◽  
Fluid Analysis ◽  
Ct Attenuation ◽  
The Mean ◽  
Attenuation Values

Background: Pleural effusion is the pathologic accumulation of fluid in the pleural space. The fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Analysis of pleural fluid by thoracentesis with imaging guidance helps to determine the cause of pleural effusion. The purpose of this study was to assess the accuracy of computed tomography (CT) in characterizing pleural fluid based on attenuation values and CT appearance. Materials and Methods: This prospective study included 100 patients admitted to Gandaki Medical College and Teaching Hospital, Pokhara, Nepal between January 1, 2017 and February 28, 2018. Patients who were diagnosed with pleural effusion and had a chest CT followed by diagnostic thoracentesis within 48 hours were included in the study. Effusions were classified as exudates or transudates using laboratory biochemistry markers on the basis of Light’s criteria. The mean attenuation values of the pleural effusions were measured in Hounsfield units in all patients using a region of interest with the greatest quantity of fluid. Each CT scan was also reviewed for the presence of additional pleural features. Results: According to Light’s criteria, 26 of 100 patients with pleural effusions had transudates, and the remaining patients had exudates. The mean attenuation of the exudates (16.5 ±1.7 HU; 95% CI, range, -33.4 – 44 HU) was significantly higher than the mean attenuation of the transudates (11.6 ±0.57 HU; 95% CI, range, 5 - 16 HU), (P = 0.0001). None of the additional CT features accurately differentiated exudates from transudates (P = 0.70). Fluid loculation was found in 35.13% of exudates and in 19.23% of transudates. Pleural thickening was found in 29.7% of exudates and in 15.3% of transudates. Pleural nodule was found in 10.8% of exudates which all were related to the malignancy. Conclusion: CT attenuation values may be useful in differentiating exudates from transudates. Exudates had significantly higher Hounsfield units in CT scan. Additional signs, such as fluid loculation, pleural thickness, and pleural nodules were more commonly found in patients with exudative effusions and could be considered and may provide further information for the differentiation.

scholarly journals The Use of Thoracic Ultrasound to Predict Transudative and Exudative Pleural Effusion

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 97-102
Author(s):  
Peter T. Evans ◽  
Robert S. Zhang ◽  
Yulei Cao ◽  
Sean Breslin ◽  
Nova Panebianco ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Patient Characteristics ◽  
Pleural Effusions ◽  
Predictive Values ◽  
Fluid Analysis ◽  
Imaging Characteristics ◽  
Characteristics Of Image ◽  
Reliable Differentiation ◽  
Exudative Pleural Effusion

Objectives: Pleural effusion is a common reason for hospital admission with thoracentesis often required to diagnose an underlying cause. This study aimed to determine if the imaging characteristics of TUS effectively differentiates between transudative and exudative pleural fluid. Methods: Patients undergoing TUS with pleural fluid analysis were retrospectively identified at a single center between July 2016 and March 2018. TUS images were interpreted and characterized by established criteria. We determined diagnostic performance characteristics of image criteria to distinguish transudative from exudative pleural effusions.  Results: 166 patients underwent thoracentesis for fluid analysis of which 48% had a known malignancy. 74% of the pleural effusions were characterized as exudative by Light’s Criteria. TUS demonstrated anechoic effusions in 118 (71%) of samples. The presences of septations on TUS was highly specific in for exudative effusions (95.2%) with high positive predictive values (89.5%) and likelihood ratio (2.85). No TUS characteristics, even when adjusting for patient characteristics such as heart failure or malignancy, were sensitive for exudative effusions.  Conclusions: Among our cohort, anechoic images did not allow reliable differentiation between transudative and exudative fluid. Presence of complex septated or complex homogenous appearance was high specific and predictive of exudative fluid.

Pleural Effusion

2015 ◽  
Author(s):  
Rafael S. Andrade ◽  
Eitan Podgaetz
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Tube Placement ◽  
Pleural Effusions ◽  
Computed Tomographic ◽  
Fluid Analysis ◽  
Management Algorithm ◽  
Practical Guidelines ◽  
Basic Facts ◽  
Subcutaneous Tunneling

Pleural effusions can occur in a wide variety of clinical situations. The most important test for the initial diagnosis and evaluation of a pleural effusion is the chest radiograph. Further investigation, such as imaging, pleural fluid analysis, pleural biopsy, and thoracoscopy, may be required to determine the etiology of the pleural effusion. This review covers the clinical evaluation, investigative studies, and management of pleural effusion, as well as basic facts of the pleura. An algorithm shows the approach to the patient with a pleural effusion. Figures show chest radiographs of patients with pleural effusion; six computed tomographic scans (showing right-side empyema showing a loculated effusion; a free-flowing, sickle-shaped, right-side effusion; parapneumonic effusion [PPE] at diagnosis, after initial chest tube placement, and after fibrinolytics; and left-side chylothorax secondary to lymphoma); an algorithm to manage known malignant pleural effusions; and a photograph of a PleurX catheter after placement and subcutaneous tunneling. Tables list the pathophysiologic mechanisms of pleural effusion, differential diagnosis for pleural effusions, relationship between pleural fluid appearance and causes, pleural fluid tests for causative assessment, practical guidelines for definitive management of malignant pleural effusion, and categorization of PPE by risk of poor outcome. Techniques for bedside thoracentesis and tube thoracostomy as well as for bedside fibrinolytic use are also presented. This review contains 1 management algorithm, 8 figures, 6 tables, and 92 references.

scholarly journals Pleural fluid analysis in neutropenia

2021 ◽  
Author(s):  
Isadore M Budnick ◽  
Samuel F Oliver ◽  
Andrew J Barros ◽  
Jeffrey Michael Sturek
Keyword(s):  
Pleural Fluid ◽  
Final Diagnosis ◽  
Decompensated Cirrhosis ◽  
Solid Organ ◽  
Pleural Effusions ◽  
Test Characteristics ◽  
Fluid Analysis ◽  
Independent Review ◽  
Different Populations ◽  
Case Data

Light's criteria is the standard for determining the etiology of pleural effusions. Test characteristics of Light's criteria varies in different populations, and Light's criteria may misclassify effusions in patients with impaired immunity such as in neutropenia. This study evaluates the test characteristics of Light's criteria and other clinically available pleural fluid tests in a cohort of patients with neutropenia. Cases were defined as a thoracentesis performed with an absolute neutrophil count of less than 1000 cells/ul documented at least 24 hours prior to the procedure. The etiology of the effusion was adjudicated by independent review of the case data and hospital course by two board certified pulmonologists. Categories for final diagnosis included exudate due to infection, exudate due to malignancy, exudate due to other, and transudate. A total of 83 thoracenteses from 80 patients were identified. Comorbidities included hematologic and solid tumor malignancies, recipients of allogeneic stem cell and solid organ transplants, heart failure, chronic kidney disease, and decompensated cirrhosis. Light's criteria had a sensitivity of 92% and a specificity of 55% for identifying exudates, LR+ 2.07 and LR-0.14. A pleural fluid protein value of >2.9 g/dl had a sensitivity of 42% and a specificity of 96%, LR+11.12 and LR- 0.61. When comparing exudative effusions, the percentage of neutrophils in the pleural fluid was significantly higher in infection, despite peripheral neutropenia. Together these results show a reduced specificity of Light's criteria in neutropenia, and underscore the complexity of pleural effusions in this setting.

scholarly journals Ruptured mediastinal pseudocyst with pancreaticopleural fistula formation in a 15-year-old boy presenting with white-out hemithorax: A case report

2022 ◽  
pp. 547-549
Author(s):  
Mohd Monis ◽  
Md Khalaf Saba ◽  
Syed M Danish Qaseem ◽  
Nadeem Arshad
Keyword(s):  
Pleural Fluid ◽  
Rare Case ◽  
Rare Complication ◽  
Necrotizing Pancreatitis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Fistula Formation ◽  
Direct Visualization ◽  
Pleural Effusions ◽  
Fluid Analysis ◽  
Progressive Dyspnea

Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis described more commonly in adults with alcoholic and necrotizing pancreatitis. We report a rare case of ruptured mediastinal pseudocyst with the formation of PPF in a 15-year-old boy who presented with progressive dyspnea and large left-sided pleural effusion that recurred despite repeated drainage. On the basis of imaging findings and pleural fluid analysis, the diagnosis of PPF with ruptured mediastinal pseudocyst was made. The diagnosis of PPF should be considered in patients with non-resolving large left-sided pleural effusions. The diagnosis can be confirmed either by significantly raised amylase levels in pleural fluid or direct visualization of the fistula on Computed tomography/magnetic resonance cholangiopancreatography.

Predicting malignant and tuberculous pleural effusions through demographics and pleural fluid analysis of patients

2014 ◽  
Vol 9 (2) ◽  
pp. 203-213 ◽  
Author(s):  
Luis Valdés ◽  
Esther San-José ◽  
Lucía Ferreiro ◽  
Antonio Golpe ◽  
Francisco-Javier González-Barcala ◽  
...  
Keyword(s):  
Pleural Fluid ◽  
Pleural Effusions ◽  
Fluid Analysis

Molecular Testing on Pleural Fluid Samples

2019 ◽  
Vol 40 (03) ◽  
pp. 340-346
Author(s):  
Scott Oh ◽  
Reza Ronaghi ◽  
Guoping Cai
Keyword(s):  
Pleural Fluid ◽  
Malignant Disease ◽  
Active Area ◽  
Molecular Testing ◽  
Pleural Effusions ◽  
Therapeutic Implications ◽  
Malignant Pleural Effusions ◽  
Fluid Analysis ◽  
Low Sensitivity ◽  
Common Manifestation

AbstractPleural effusions are a common manifestation of both malignant and nonmalignant diseases. The sampling of pleural fluid helps categorize effusions as transudative or exudative and helps differentiate paramalignant from malignant disease. Accurate pleural fluid analysis is critical to the appropriate staging of cancers with significant prognostic and treatment implications. However, the etiology of pleural effusions remains unclear in a significant number of cases after routine thoracentesis and pleural fluid analysis. For malignant pleural effusions, cytologic evaluation of pleural fluid has a relatively low sensitivity. We describe the evolving field of molecular pleural fluid analysis in the setting of malignant disease as an active area of investigation with both diagnostic and therapeutic implications.

scholarly journals Pleural Fluid Analysis: Standstill or a Work in Progress?

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
T. Hassan ◽  
M. Al-Alawi ◽  
S. H. Chotirmall ◽  
N. G. McElvaney
Keyword(s):  
Pleural Fluid ◽  
Current Practice ◽  
Clinical History ◽  
Diagnostic Information ◽  
Diagnostic Utility ◽  
Pleural Effusions ◽  
Or Management ◽  
Work In Progress ◽  
Fluid Analysis ◽  
Future Direction

Pleural fluid analysis yields important diagnostic information in pleural effusions in combination with clinical history, examination, and radiology. For more than 30 years, the initial and most pragmatic step in this process is to determine whether the fluid is a transudate or an exudate. Light's criteria remain the most robust in separating the transudate-exudate classification which dictates further investigations or management. Recent studies have led to the evaluation and implementation of a number of additional fluid analyses that may improve the diagnostic utility of this method. This paper discusses the current practice and future direction of pleural fluid analysis in determining the aetiology of a pleural effusion. While this has been performed for a few decades, a number of other pleural characteristics are becoming available suggesting that this diagnostic tool is indeed a work in progress.

scholarly journals Pleural fluid cholesterol level is an important parameter in differentiating exudative from transudative pleural effusions

2018 ◽  
Vol 5 (3) ◽  
pp. 520
Author(s):  
Chakradhar Majhi ◽  
Butungeshwar Pradhan ◽  
Bikash C. Nanda ◽  
Sagnika Tripathy
Keyword(s):  
Pleural Effusion ◽  
Cholesterol Level ◽  
Pleural Fluid ◽  
Sensitivity And Specificity ◽  
Pleural Effusions ◽  
Biochemical Tests ◽  
Etiological Diagnosis ◽  
Multiple Parameters ◽  
Fluid Analysis ◽  
Cholesterol Levels

Background: The first important step is to decide whether the pleural effusion is transudate or exudates by Light’s criteria. Light’s criteria can misclassify 25% of pleural transudates as exudates. Pleural fluid cholesterol level can differentiate transudates from exudates as a single parameter instead of multiple parameters used in Light’s criteria. Measurement of pleural fluid cholesterol levels to differentiate transudative effusions from exudative effusions.Methods: Consecutive 60 cases of pleural effusion were taken in the study. Pleural fluid analysis was done for parameters of Light’s criteria along with pleural fluid cholesterol levels. First exudative and transudative effusion was classified by Light’s criteria. Other  clinical and relevant  biochemical tests were done to arrive in  the final etiological diagnosis  and data were collected and analysed .Pleural fluid cholesterol levels was  correlated to Light’s criteria.Results: Total 60 cases of pleural effusion were there in the study. There were 43 exudative and 17 transudative effusions. Mean cholesterol level was 64.2± 7.5mg/dl in exudative effusions and 26.05±8.01 mg/dl in transudates. Pleural fluid cholesterol was ≥55mg /dl in 43 cases of exudates and <55mg/dl in 17 cases of transudates.Conclusions: Pleural fluid cholesterol level of ≥ 55mg/dl had similar sensitivity and specificity to Light’s criteria and as a single important parameter to differentiate exudative from transudative pleural effusion

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