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....

Role of aquaporin water channels in pleural fluid dynamics

2000 ◽  
Vol 279 (6) ◽  
pp. C1744-C1750 ◽  
Author(s):  
Yuanlin Song ◽  
Baoxue Yang ◽  
Michael A. Matthay ◽  
Tonghui Ma ◽  
A. S. Verkman
Keyword(s):  
Pleural Fluid ◽  
Water Transport ◽  
Water Channels ◽  
Pleural Space ◽  
Parietal Pleura ◽  
Pleural Effusions ◽  
Wild Type ◽  
Rt Pcr ◽  
Fluid Accumulation ◽  
Osmotic Equilibration

Continuous movement of fluid into and out of the pleural compartment occurs in normal chest physiology and in pathophysiological conditions associated with pleural effusions. RT-PCR screening and immunostaining revealed expression of water channel aquaporin-1 (AQP1) in microvascular endothelia near the visceral and parietal pleura and in mesothelial cells in visceral pleura. Comparative physiological measurements were done on wild-type vs. AQP1 null mice. Osmotically driven water transport was measured in anesthetized, mechanically ventilated mice from the kinetics of pleural fluid osmolality after instillation of 0.25 ml of hypertonic or hypotonic fluid into the pleural space. Osmotic equilibration of pleural fluid was rapid in wild-type mice (50% equilibration in <2 min) and remarkably slowed by greater than fourfold in AQP1 null mice. Small amounts of AQP3 transcript were also detected in pleura by RT-PCR, but osmotic water transport was not decreased in AQP3 null mice. In spontaneously breathing mice, the clearance of isosmolar saline instilled in the pleural space (∼4 ml · kg−1· h−1) was not affected by AQP1 deletion. In a fluid overload model produced by intraperitoneal saline administration and renal artery ligation, the accumulation of pleural fluid (∼0.035 ml/h) and was not affected by AQP1 deletion. Finally, in a thiourea toxicity model of acute endothelial injury causing pleural effusions and lung interstitial edema, pleural fluid accumulation in the first 3 h (∼4 ml · kg−1· h−1) was not affected by AQP1 deletion. These results indicate rapid osmotic equilibration across the pleural surface that is facilitated by AQP1 water channels. However, AQP1 does not appear to play a role in clinically relevant mechanisms of pleural fluid accumulation or clearance.

Diagnostic efficacy and suitability of trans-thoracic ultrasonography for pleural fluid detection – The future non-invasive gold-standard?

2020 ◽  
Vol 13 (4) ◽  
pp. 184-190
Author(s):  
Muhammad Irfan ◽  
Abdul Rasheed Qureshi ◽  
Zeeshan Ashraf ◽  
Muhammad Amjad Ramzan ◽  
Tehmina Naeem ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Gold Standard ◽  
Pleural Effusions ◽  
Diagnostic Efficacy ◽  
Chest Sonography ◽  
X Ray ◽  
Non Invasive ◽  
Fluid Detection

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available  and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard.   Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology  OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

scholarly journals The Differential Diagnostic Values of Cytokine Levels in Pleural Effusions

2005 ◽  
Vol 2005 (1) ◽  
pp. 2-8 ◽  
Author(s):  
Saadet Akarsu ◽  
A. Nese Citak Kurt ◽  
Yasar Dogan ◽  
Erdal Yilmaz ◽  
Ahmet Godekmerdan ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Parapneumonic Effusion ◽  
Pleural Effusions ◽  
Tuberculous Pleural Effusion ◽  
Cytokine Levels ◽  
Diagnostic Values

The aim is to examine whether the changes in pleural fluid interleukin (IL)-1β, IL-2, IL-6, and IL-8 levels were significant in differential diagnosis of childhood pleural effusions. IL-1β, IL-2, IL-6, and IL-8 levels in pleural fluids of all 36 patients were measured. The levels of IL-1β, IL-2, IL-6, and IL-8 in pleural fluids were statistically significantly higher in the transudate group compared with those of the exudate group. The levels of IL-1β, IL-6, and IL-8 were also found to be statistically significantly higher in the empyema group compared with both the parapneumonic and the tuberculous pleural effusion groups. The levels of IL-2 and IL-6 were detected to be statistically significantly higher in the tuberculous pleural effusion group in comparison with those of the parapneumonic effusion group. The results showed that pleural fluids IL-1β, IL-2, IL-6, and IL-8 could be used in pleural fluids exudate and transudate distinction.

scholarly journals Diagnostic Value of Flexible Thoracoscopy in Undiagnosed Cases of Exudative Pleural Effusion

2020 ◽  
Vol 7 (47) ◽  
pp. 2783-2786
Author(s):  
Vengada Krishnaraj S.P. ◽  
Gayathri S. Mohan ◽  
Vinod Kumar V ◽  
Sridhar R
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Complete Blood Count ◽  
Diagnostic Yield ◽  
Diagnostic Value ◽  
Parietal Pleura ◽  
Pleural Biopsy ◽  
Cardiac Evaluation ◽  
Exudative Pleural Effusion ◽  
Fluid Cytology

BACKGROUND The diagnostic yield of thoracoscopy is 95 %, of pleural fluid cytology it is 62 % and of closed pleural biopsy is 44 %, in malignant effusion. We wanted to study the diagnostic utility of flexible thoracoscopy in undiagnosed exudative pleural effusion and compare the thoracoscopy findings with the histopathology results. METHODS The study was conducted in the Department of Respiratory Medicine, Government Stanley Medical College, Chennai, from January 2019 to January 2020. 40 patients were enrolled in this longitudinal observational study with moderate to massive effusion and were evaluated with pleural fluid aspiration and sent for cytology, protein sugar analysis, total count, and ADA. Those cases which are exudative pleural effusions, with ADA value of less than 40 IU / L were subjected to thoracoscopy after being evaluated for fitness for thoracoscopy with complete blood count, bleeding time, clotting time, sputum for AFB, ECG, pulse oximetry, cardiac evaluation and CT chest. RESULTS Thoracoscopy was done in 40 enrolled patients. In this study, biopsy was taken from the parietal pleura in all the cases. Of these 40 cases, 30 were male and 10 were female, that is 75 % males and 25 % females. The mean age of the study population was 43 ± 14.9. Patient with the lowest age in this study group was 18 years and highest was 71 years. 16 cases (40 %) presented with left sided pleural effusion. 24 cases (60 %) presented with right sided pleural effusion. 30 cases presented with massive effusion, and 10 cases with moderate effusion. Of the 40 cases, 27 cases presented with straw coloured pleural effusion. 13 cases were haemorrhagic effusion. Histopathologic examination showed 11 cases as malignant and 29 cases as non-malignant out of which 18 cases were of tuberculosis aetiology. Thoracoscopy revealed adhesions in 13 cases and mass lesion in 4 cases. Of the 4 mass lesions 3 came as malignant, normal pleura in 11 cases, 10 were non-malignant and 1 was malignant. Nodules were seen in 12 cases of which 7 came as malignant. Straw coloured effusion was seen in 27 cases, of which 2 were malignant. CONCLUSIONS The most important indication for thoracoscopy is exudative undiagnosed pleural effusion. The overall diagnostic yield in pleural fluid cytology is 62 % and blind pleural biopsy is 44 %. The diagnostic yield of thoracoscopy varies from 60 % to 97 % in various studies, whereas, in our study, it is 72.5 %. Visualization of the visceral and parietal pleura is another advantage, so that we can take biopsy from the abnormal areas. KEYWORDS Flexible Thoracoscopy, Undiagnosed Exudative Pleural Effusion

Lung Ultrasound to Detect Pneumothorax or Mainstem Intubation

2021 ◽  
pp. 11-18
Author(s):  
J. Devin Roberts ◽  
Anna Clebone
Keyword(s):  
Pulmonary Edema ◽  
Chest Radiograph ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Parietal Pleura ◽  
Visceral Pleura ◽  
Pleural Effusions ◽  
Ultrasound Probe ◽  
Handheld Ultrasound

Chapter 2 covers the use of lung ultrasound to detect pneumothorax and mainstem intubation. In healthy patients, a layer of visceral pleura will slide on the parietal pleura with every breath. This can be readily imaged with a handheld ultrasound probe at the point of care, and this information can be used for diagnosis of pneumothorax or mainstem intubation. Lung ultrasound can also help the clinician to visualize pleural effusions or pulmonary edema. When trying to diagnose pneumothorax by imaging, lung ultrasound is more accurate for ruling pneumothorax in (level B evidence) or out (level A evidence) than supine anterior chest radiograph.

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.

scholarly journals The value of exfoliative cell cytology in the diagnosis of exudative pleural effusions

2018 ◽  
Vol 88 (3) ◽  
Author(s):  
Cuneyt Tetikkurt ◽  
Nail Yılmaz ◽  
Seza Tetikkurt ◽  
Şule Gundogdu ◽  
Rian Disci
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diagnostic Yield ◽  
Final Diagnosis ◽  
Exfoliative Cytology ◽  
Pleural Effusions ◽  
Cytologic Examination ◽  
Collagen Vascular Diseases ◽  
Female Ratio ◽  
Exudative Pleural Effusion

The sensitivity and specificity of exfoliative cell cytology for the diagnosis of exudative pleural effusions varies widely according to the etiologic causes. The aim of this study is to assess the diagnostic value of exfoliative cell cytology for the identification of exudative pleural effusions. This is a retrospective study of the patients with an exudative pleural effusion admitted at our clinic in the last twenty years. We have conducted the clinical, the cytological findings, and the diagnostic results of six hundred patients from hospital records.  Male to female ratio was 2.2:1 with a mean age of 42.8 years (range 18-78 years) among the patients. Samples were processed and evaluated according to the standard methods. Cytology results were reviewed and the patients were stratified according to the final diagnosis of their disease. Of the six hundred exudative effusions, 240 were malignant on exfoliative cytology pleural fluid alone. Adenocarcinoma was the most common type of malignancy. Tuberculosis was the second most frequent etiology for the exudative effusions followed by infection and collagen vascular diseases. Diagnostic accuracy of cytology showed a good correlation with the final diagnosis with an overall 70.1% sensitivity, 62.5% specificity, and a 95.9% positive predictive value for all exudative pleural effusions. Cytologic examination of the pleural fluid is a simple non-invasive procedure as the initial step for the diagnostic work up of patients with a pleural effusion.  Exfoliative cytology provides high a final diagnostic yield for the identification of an exudative pleural effusion etiology. Furthermore, cytologic analysis leads the clinician into the correct diagnostic pathway as the most informative laboratory tool even when it was not diagnostic by itself for equivocal cases.

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 Pleural fluid cytology, biochemistry and adenosine deminase level study in differentiating tubercular and non tubercular causes of pleural effusion

KYAMC Journal ◽  
2018 ◽  
Vol 9 (1) ◽  
pp. 28-31
Author(s):  
Kazi Shihab Uddin ◽  
Md Mahbub Rashid Sarker ◽  
Md Abdur Razzaque ◽  
Md Zulfikar Ali
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
High Sensitivity ◽  
Malignant Cell ◽  
Mean Value ◽  
Cell Distribution ◽  
Pleural Effusions ◽  
The World ◽  
Biochemical Examination ◽  
Fluid Cytology

Background: Adenosine deaminase (ADA) level in pleural fluid study has gained popularity for quick diagnosis and treatment of tuberculous pleural effusion in tuberculosis burden countries. Studies have confirmed high sensitivity and specificity across the world. Pleural fluid cytology, biochemistry and malignant cell examinations are already in use and widely available.Objectives: Diagnostic approach to quickly differentiate between tubercular and non tubercular pleural effusions by analyzing cytology, biochemistry and ADA level.Materials & Methods: This study was carried out on 85 patients who were admitted or visited outpatient department with pleural effusion. The pleural fluid study was including measurement of ADA level was done.Results: 41 cases were diagnosed as tubercular pleural effusion. Among the low ADA group, 9 cases were diagnosed as malignant pleural effusion with positive malignant cell and 13 cases were transudative effusion.7 cases were diagnosed as parapneumonic effusion with exudative fluid, neutrophilic cell distribution and mixed ADA activity.Conclusion: ADA was found positive with a mean value of 88.3 U/L in tubercular pleural effusions. Non tubercular pleural effusion showed low ADA level. However the cytological and biochemical examination of pleural fluid was also found to be important in differentiating tubercular from non tubercular causes.KYAMC Journal Vol. 9, No.-1, April 2018, Page 28-31

Pleurodesis with Iodized Talc for Malignant Effusions Using Pigtail Catheters

1998 ◽  
Vol 32 (7-8) ◽  
pp. 739-742 ◽  
Author(s):  
Robert L Thompson ◽  
Jonathan C Yau ◽  
Ronald F Donnelly ◽  
Debra J Gowan ◽  
Frederick RK Matzinger
Keyword(s):  
Pleural Effusion ◽  
Tertiary Care ◽  
Pleural Space ◽  
Pigtail Catheter ◽  
Pleural Effusions ◽  
Talc Pleurodesis ◽  
Malignant Pleural Effusions ◽  
Kaplan Meier ◽  
A Prospective Study ◽  
The Cost

OBJECTIVE: To assess the efficacy of using an iodized talc slurry as a sclerosing agent instilled into the pleural space via a 12-French pigtail catheter for controlling malignant pleural effusions. DESIGN: A prospective study in which patients were followed until their death. SETTING: A university-affiliated tertiary-care teaching hospital. PATIENTS: Medical oncology patients admitted with symptomatic malignant pleural effusions were considered for iodized talc pleurodesis. MAIN OUTCOME MEASURES: The control of pleural effusion. Treatment failure was defined as any reaccumulation of fluid in the pleural space. RESULTS: Fifteen patients were treated for a total of 17 instillations. The median follow-up on all patients until death was 6 months (range 1–20). The most frequent adverse effect in the study group was pleuritic chest pain (60%). The probability of control of effusion, as determined by the method of Kaplan–Meier, was 81% (SEM 9.7%). The cost of preparing 5 g of iodized talc was $4.32 (US). CONCLUSIONS: Iodized talc slurry instilled through a small-bore pigtail catheter is a safe, economical, and effective treatment for malignant pleural effusion.

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