The chest

2019 ◽  
pp. 71-88
Author(s):  
Justin Bowra ◽  
Osama Loubani ◽  
Paul Atkinson
Keyword(s):  
Pleural Effusion ◽  
Pulmonary Oedema ◽  
Pulmonary Disease ◽  
Pleural Fluid ◽  
Clinical Examination ◽  
Pleural Space ◽  
Pleural Disease ◽  
Fine Detail ◽  
Linear Probe ◽  
Chest X Ray

Lung ultrasound is more accurate than clinical examination and chest X-ray for pleural disease (e.g. pneumothorax, pleural effusion) and pulmonary disease (e.g. consolidation, pulmonary oedema/fibrosis). Begin with a curved probe with the depth set at 15 cm and with the probe placed perpendicular to the ribs, with ‘filters’ (tissue harmonics and compounding) ideally turned off. M-mode may assist but normally is not required. Change to a linear probe for fine detail (pleural space and subpleural consolidation). Doppler is not normally recommended but has been used to differentiate pleural fluid from thickening and to differentiate the causes of consolidation.

Pleural Effusion

Chest Imaging ◽  
2019 ◽  
pp. 165-170
Author(s):  
Christopher M. Walker
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Lateral Displacement ◽  
Pleural Space ◽  
Gravitational Effects ◽  
Pleural Thickening ◽  
Air Bubble ◽  
Fluid Analysis ◽  
Exudative Pleural Effusion

Pleural effusion discusses the radiographic and computed tomography (CT) manifestations of this entity. Pleural effusion is classified based on pleural fluid analysis using Light’s criteria: transudative and exudative. Free pleural fluid collects in the most dependent aspect of the pleural space due to gravitational effects. It exhibits a meniscus configuration on upright chest radiography. Pleural effusion in a supine or semiupright patient is more difficult to identify but may be suspected in cases with a homogeneous or gradient-like opacity over the lower hemithorax, elevation of the hemidiaphragm contour, or an apical cap. Subpulmonic pleural effusion manifests with lateral displacement of the apex of the ipsilateral hemidiaphragm contour and increased distance between the gastric air bubble and pseudodiaphragmatic contour. Exudative pleural effusion should be suspected in cases with CT findings of pleural thickening, enhancement, septations, and/or loculations.

Introduction to Pleural Disease

Chest Imaging ◽  
2019 ◽  
pp. 155-158
Author(s):  
Christopher M. Walker
Keyword(s):  
Pleural Effusion ◽  
Asbestos Exposure ◽  
Pleural Space ◽  
Pulmonary Vasculature ◽  
Pleural Disease ◽  
Pleural Thickening ◽  
Pleural Plaques ◽  
Pleural Surface ◽  
Pleural Neoplasm ◽  
Ct Features

The chapter titled introduction to pleural disease discusses the imaging and clinical features of diseases of the pleura. The pleural space is a potential space located between the visceral and parietal pleural surfaces. Pleural effusion and pneumothorax are the most common manifestations of pleural disease and are caused by a wide variety of disease processes. Pleural thickening may be related to benign or malignant processes. Bilateral discontinuous nodular pleural thickening is characteristic of pleural plaques. Pleural thickening with calcification may also be seen in fibrothorax. Malignant pleural disease may manifest with pleural effusion, pleural nodules or masses, or a combination of the two. There are several CT features suggestive of malignant pleural thickening including circumferential pleural thickening, pleural nodules or masses, involvement of the mediastinal pleural surface, and pleural thickening measuring greater than 1 cm in thickness. Metastatic disease is the most common pleural neoplasm. Mesothelioma is uncommon but remains the most common primary pleural malignancy and is almost always seen in patients with previous asbestos exposure. Pleural abnormalities must be differentiated from pulmonary processes. Pleural masses may exhibit obtuse angles with the adjacent pleural surfaces, displace rather than engulf adjacent pulmonary vasculature, and may exhibit the incomplete border sign.

scholarly journals Clinical profile of patients with pleural effusion admitted to KMCTH

1970 ◽  
Vol 7 (4) ◽  
pp. 438-444 ◽  
Author(s):  
KR Dhital ◽  
R Acharya ◽  
R Bhandari ◽  
P Kharel ◽  
KP Giri ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Clinical Presentation ◽  
Lateral View ◽  
Parapneumonic Effusion ◽  
Age Group ◽  
Common Cause ◽  
Fluid Analysis ◽  
Blood Haemoglobin ◽  
Chest X Ray

Background: pleural effusion is the common findings in patients presenting with cardiopulmonary symptoms but specific studies are lacking in Nepal. Objective: The main objective of this study is to find out the various causes of pleural effusion, their mode of clinical presentation and laboratory analysis of blood and pleural fluid to aid diagnosis of patients with pleural effusion. Materials and methods: Retrospective data from July 2009 to July 2007 from all the cases diagnosed with pleural effusion were taken. Altogether 100 cases diagnosed with pleural effusion by chest X-ray (Posterior- Anterior and Lateral view) and Ultrasonogram of the chest were studied. The following parameters were analysed: Patients demographic profile, causes, location (Unilateral, Bilateral), Blood haemoglobin and count, sputum profile, Monteux test, chest Xray and USG findings and pleural fluid analysis[Biochemical, Haematological, Microbiological(culture and stain) and cytological]. This study was analysed by using SPSS 16. Results: The mean age of the patient was 44.89 ± 21.59 and must patients with pleural effusion belong to age group 21- 30. Most common cause of pleural effusion was found to be tubercular effusion followed by parapneumonic effusion. Right sided effusion was seen in most cases of tubercular parapneumonic and malignant effusion whereas bilateral effusion was seen in 87.5% of the patient (7 out of 8) having congestive heart failure and all cases of renal disease (4 out of 4). Shortness of breath (83%), cough (67%) and fever (66%) are the most common mode of clinical presentation. Conclusion: Our study concluded that the most common cause of unilateral pleural effusion is tuberculosis followed by parapneumonic effusion and most cases of those belong to younger age group (21 -30yrs) and most common cause of bilateral pleural effusion is congestive cardiac failure. Key words: Pleural effusion; Tuberculosis; pneumonia; malignancy; protein; ADA DOI: 10.3126/kumj.v7i4.2772 Kathmandu University Medical Journal (2009) Vol.7, No.4 Issue 28, 438-444

scholarly journals CORRELATION BETWEEN ADENOSINE DEAMINASE ACTIVITY IN PLEURAL FLUID AND SERUM OF PATIENTS WITH PLEURAL EFFUSION

2018 ◽  
Vol 24 (2) ◽  
pp. 180
Author(s):  
Pande Putu Ayu Patria Dewi ◽  
Aryati Aryati ◽  
Leonita Anniwati ◽  
Isnin Anang Marhana
Keyword(s):  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Gastrointestinal Disease ◽  
Pleural Space ◽  
Systemic Diseases ◽  
Cross Sectional ◽  
Adenosine Deaminase Activity ◽  
Abnormal Accumulation ◽  
Cross Sectional Design

Pleural effusion is an abnormal accumulation of fluid in the pleural space resulting from increased production of fluid or decreased resorption of fluid in the pleural space. Pleural effusion can be caused by infectious diseases, malignancies, collagen disease, gastrointestinal disease, heart disease and other causes such as medication. Adenosine Deaminase (ADA) is an enzyme involved in the catabolism of purines. This enzyme can be measured in pleural fluid, serum and other body fluids such as cerebrospinal and ascites fluid. The aim of this study was to analyze the correlation between adenosine deaminase activity in pleural fluid and serum in patients with pleural effusion. This research was an observational study with a cross-sectional design. Examination of ADA activity was performed in pleural fluid and serum. Adenosine deaminase activity was examined using photometric methods (Non-Giusti), using Diazyme reagent by TMS 24i Premium. Subjects were 46 patients with pleural effusion caused by malignancies, tuberculosis and systemic diseases. Mean±SD ADA activity for all pleural effusion samples in serum was 13.037± 8.365 (0.5-34.1) U//L and pleural fluid 30.843± 28.860 U//L (1.3-140.8). No correlation between ADA activity in serum and pleural fluid (r=0.173, p= 0.252) was found in all samples. No correlation between ADA activity in serum and pleural fluis was found in malignancies (r=0.109, p=0.630), tuberculosis (r= 0.366, p=0.123), systemic diseases (r =0.466, p=0.429) and non-tuberculosis group (r=0.126, p=0.532). There was no correlation between pleural fluid ADA activity and serum. 

STUDY OF EXUDATIVE PLEURAL EFFUSION IN THE AGE GROUP OF 15-40 YEARS WITH SPECIAL REFERENCE TO ADENOSINE DEAMINASE AND TUBERCULIN SKIN TEST IN THE DIAGNOSIS OF TUBERCULOUS ETIOLOGY

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Dr. Sourindra Nath Banerjee ◽  
Dr. Niranjan Kumar Sit ◽  
Dr. Santanu Ghosh
Keyword(s):  
Pleural Effusion ◽  
Tuberculin Skin Test ◽  
Pleural Fluid ◽  
Skin Test ◽  
Pleural Space ◽  
P Value ◽  
Age Group ◽  
Malignant Effusion ◽  
Tuberculous Pleural Effusion ◽  
Pale Yellow

Background: A tubercular pleural effusion can either be a sequel to a primary infection acquired 3 to 6 month previously or represent reactivation tuberculousis. Two different pathogenic mechanism can lead to tuberculous pleural effusion. By far the more common is the entry of only a few M. tuberculosis into the pleural space; in the presence of specific cell mediated immunity, tubercle bacilli provoke an intense hypersensitivity reaction and outpouring of fluid. Chest radiograph may or may not reveal associated parenchymal involvement. In the second variety, a subpleural caseous focus or cavity rupture into the pleural space and results in a pleural effusion. In this case chest radiograph nearly always shows parenchymal abnormalities. A definitive diagnosis of TBPE can be difficult to make because of the low sensitivity and / or specificity of noninvasive traditional diagnostic tools.  In most series of patients with TBPE the result of pleural fluid staining for acid fast bacilli are virtually always negative and pleural fluid cultures are positive for mycobacteria in <35% of cases. Without underlying lung parenchymal lesion sputum examination may be positive in 4% to 11% of patient with TBPE. On the other hand, pleural biopsy specimen will demonstrate granulomatous pleuritis in 50% to 80% of patients. This study was taken whether pleural fluid ADA and tuberculin skin test has any role in the diagnosis of tubercular pleural effusion. Methods and Materials: In the present study 120 cases of exudative pleural effusion in the age group of 15-40 years of varying etiology are taken who attended the pulmonary medicine department of Burdwan Medical College and Hospital. The study was conducted the period of March 2017 to February 2018 apart from relevant history taking a detail clinical examination, full investigation were done to reach a complete and final diagnosis. Result: In our study 120 patient of aged 15-40 years were taken. Different aetiological groups and there frequency as diagnosed by various mean were Tuberculous – 85%,  Paraneumonic effusion – 10 %, Malignant effusion – 10%. There was male preponderance in all groups of pleural effusion. History of contact was present in 34 % cases of tuberculous effusion. Sputum for AFB was found 10.78% cases of tuberculous effusion. These patients also had pulmonary lesions. 80.39% cases of tuberculous effusion had pale yellow coloured effusion but 13.72 % cases had haemorrhagic fluid. 66.66% malignant effusion had haemorrhagic fluid and 33.37% of malignant effusion had pale yellow coloured fluid. Pleural fluid for malignant cell was positively 66.67% of malignant effusion. Pleural fluid for Z-N stain detect 1.96% cases tubercle bacilli in TBPE group. Plural biopsy was found positive in 68.18% cases of TBPE and 60% cases of MPE. Pleural fluid ADA level was significantly higher (P<0.001) in patients of tuberculous effusion than non-tuberculous effusion. Taking a cut off value of 70 U/L sensitivity and specificity is 95.09% and 33.33%. But when parapneumonic effusion was excluded, the specificity increases. Lymphocytic pleural effusion below the age group of 40 years with cut off value of ADA <40 U/L can be used as a screening test for malignant effusion. In TBPE tuberculin skin test was positive in 74.50% cases. Taking a cut off value of 10 mm or more induration of tuberculin skin test, "P" value is less than 0.001. Sensitivity and specificity of tuberculin skin test in tuberculous pleural effusion is 74.50% and 50%. If we compare the efficacy of ADA > 70 U/L and tuberculin skin test positivity to diagnose tuberculous pleural effusion the former is superior statistically to the later (P value is less than 0.01) specificity of tuberculin skin test is low because it may be positive with infection with NTM and prior BCG vaccination. Conclusion: Maximum incidence of tuberculous pleural effusion occurs in the age group of 20-30 years. Malignant pleural effusion is less likely below the age group of 30 years. Increased ADA level >70 U/L in pleural fluid is a sensitive, minimally invasive, cost effective, easy method for diagnosis of tuberculous pleural effusion. Lower level of pleural fluid ADA level (<40 U /L) is a sensitive, specific, minimally invasive, cost effective easy method for suspecting malignant effusion. Its value is much more important when younger patients (<40 years of age) present with malignant effusion, especially so when the pleural fluid is also appeared pale yellow. A low ADA level will guide us to look for malignancy in this age group. Tuberculin skin testing with intermediate strength PPD has a high sensitivity in patients with pleural tuberculosis. It was seen negative in 1/3rd  cases of TBPE. This negative tuberculin skin test in TBPE may be due to recent tuberculous infection or may be due to sequestration of PPD reactive T-lymphocytes in the pleural space or patient may be anergic. Our study is insufficient to comment this negative result. More precise study need to comment.

Managing Pleural Disease in Acute Medicine (I): Pleural Effusion

2007 ◽  
Vol 6 (3) ◽  
pp. 114-120
Author(s):  
Nazir I. Lone ◽  
◽  
George Antunes ◽  
Keyword(s):  
Clinical Practice ◽  
Pleural Effusion ◽  
Pleural Space ◽  
Diagnostic Approach ◽  
Initial Assessment ◽  
Common Finding ◽  
Pleural Disease ◽  
Pleural Effusions ◽  
Acute Medicine ◽  
Recent Developments

A pleural effusion is the accumulation of fluid in the pleural space. It is a relatively common finding in clinical practice. The diagnostic approach to the patient presenting with a pleural effusion is aimed at defining the effusion as a transudate or an exudate. This review summarises the initial assessment and investigation of pleural effusions diagnosed during the acute medical take, and who should be referred for specialist advice. In addition, recent developments, including the measurement of NT-proBNP levels and diagnostic markers for mesothelioma, are presented.

Pleural effusion

2007 ◽  
pp. 145-152
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Chest Radiograph ◽  
Pleural Space ◽  
Parietal Pleura ◽  
Clinical Approach ◽  
Clinical Scenario ◽  
Pleural Effusions ◽  
Wide Range

Introduction 146 Causes 146 Clinical approach 147 Pleural fluid 149 Management 151 Pleural effusions are a common clinical scenario with a wide range of causes. They are defined as an accumulation of fluid between the visceral and parietal pleura. There is normally around 20 ml of fluid present in the pleural space. Around 400 ml needs to be present before clinically apparent, whilst >200 ml is visible on the PA chest radiograph....

scholarly journals Significant Role of Interleukin-8 in Pathogenesis of Pulmonary Disease Due to Mycoplasma pneumoniaeInfection

2001 ◽  
Vol 8 (5) ◽  
pp. 1028-1030 ◽  
Author(s):  
Mitsuo Narita ◽  
Hiroshi Tanaka ◽  
Satoshi Yamada ◽  
Shosaku Abe ◽  
Tadashi Ariga ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pulmonary Disease ◽  
Pleural Fluid ◽  
Mycoplasma Pneumoniae ◽  
Significant Role ◽  
Critical Role ◽  
Interleukin 8 ◽  
Fibrotic Change

ABSTRACT We found elevated levels of interleukin-8 in pleural fluid samples from patients with pleural effusion and with a sustained fibrotic change of the lung due to Mycoplasma pneumoniaeinfection. This result suggests a critical role of interleukin-8 in the pathogenesis of a certain type of pulmonary disease caused by M. pneumoniae.

scholarly journals URINOTHORAX: AN UNUSUAL CAUSE OF MASSIVE PLEURAL EFFUSION

2019 ◽  
Vol 2 (1) ◽  
pp. 18-19
Author(s):  
Jose Luis Bauza Quetglas ◽  
Maria Isabel Fullana ◽  
Javier Asensio ◽  
Manuel Díaz ◽  
A.M. Pinheiro ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diffuse Abdominal Pain ◽  
Thoracic Drainage ◽  
History Of ◽  
Chest X Ray ◽  
Blood Leukocyte ◽  
Diagnostic Criterion ◽  
Serum Ratio

A 74 year-old male with a history of high blood pressure and hyperuricemia was admitted to the hospital with asthenia, unquantified weight loss, dyspnea on moderate exertion for 2 weeks, and diffuse abdominal pain. Blood leukocyte count was 12400/uL, creatinine 0.98 mg/dL, CRP 19 mg/dL, and LDH 318 U/L. The chest X-ray showed a right pleural effusion and the pleural fluid was suggestive of an exudate. Thorax and abdominal CT scan revealed a polycystic right kidney with grade IV hydronephrosis and suggested the presence of a nephropleural fistula. The thoracocentesis was repeated and the pleural fluid / serum ratio of creatinine obtained was higher than 1 (1.35 mg/dL), which is a diagnostic criterion for urinothorax. Finally, a retrograde pyelography was carried out, and confirmed the passage of urinary tract fluid into the pleural cavity. A thoracic drainage tube and a nephrostomy through the superior calyx were placed, both draining purulent material. One month later, the control CT shows a right atrophic kidney and a reduction of the size of the fistulous path. Urinothorax is an infrequent and underdiagnosed pathology, with few cases reported. It is usually presented as a transudative pleural effusion. Currently, no test is available to confirm the diagnosis, although the ratio of serum creatinine/pleural creatinine could suggest the presence of urinothorax. Radiographic imaging is useful to support the diagnosis. Management of a urinothorax requires a multidisciplinary approach with an emphasis on the correction of the underlying urinary tract pathology, and once corrected, this often leads to a rapid resolution of the pleural effusion.

scholarly journals URINOTHORAX: AN UNUSUAL CAUSE OF MASSIVE PLEURAL EFFUSION

2019 ◽  
Vol 2 (1) ◽  
pp. 18-19
Author(s):  
Jose Luis Bauza Quetglas ◽  
Maria Isabel Fullana ◽  
Javier Asensio ◽  
Manuel Díaz ◽  
A.M. Pinheiro ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diffuse Abdominal Pain ◽  
Thoracic Drainage ◽  
History Of ◽  
Chest X Ray ◽  
Blood Leukocyte ◽  
Diagnostic Criterion ◽  
Serum Ratio

A 74 year-old male with a history of high blood pressure and hyperuricemia was admitted to the hospital with asthenia, unquantified weight loss, dyspnea on moderate exertion for 2 weeks, and diffuse abdominal pain. Blood leukocyte count was 12400/uL, creatinine 0.98 mg/dL, CRP 19 mg/dL, and LDH 318 U/L. The chest X-ray showed a right pleural effusion and the pleural fluid was suggestive of an exudate. Thorax and abdominal CT scan revealed a polycystic right kidney with grade IV hydronephrosis and suggested the presence of a nephropleural fistula. The thoracocentesis was repeated and the pleural fluid / serum ratio of creatinine obtained was higher than 1 (1.35 mg/dL), which is a diagnostic criterion for urinothorax. Finally, a retrograde pyelography was carried out, and confirmed the passage of urinary tract fluid into the pleural cavity. A thoracic drainage tube and a nephrostomy through the superior calyx were placed, both draining purulent material. One month later, the control CT shows a right atrophic kidney and a reduction of the size of the fistulous path. Urinothorax is an infrequent and underdiagnosed pathology, with few cases reported. It is usually presented as a transudative pleural effusion. Currently, no test is available to confirm the diagnosis, although the ratio of serum creatinine/pleural creatinine could suggest the presence of urinothorax. Radiographic imaging is useful to support the diagnosis. Management of a urinothorax requires a multidisciplinary approach with an emphasis on the correction of the underlying urinary tract pathology, and once corrected, this often leads to a rapid resolution of the pleural effusion.

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