Intrapleural Tenecteplase for Complicated Parapneumonic Pleural Effusion

Intrapleural thrombolytics have shown promising results in complicated parapneumonic pleural effusions reducing the need for surgical interventions. Until now, studies have evaluated primarily streptokinase, urokinase, and recently, alteplase. In this case series, we share our experience with tenecteplase—a tissue-specific plasminogen activator in 15 patients. We observed that tenecteplase is effective in 14/15 (93.3%) of our patients, and none of them had any bleeding episodes.

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Pleuroperitoneal Leak Complicating Peritoneal Dialysis: A Case Series

International Journal of Nephrology ◽

10.4061/2011/526753 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 8

Author(s):

C. Kennedy ◽

C. McCarthy ◽

S. Alken ◽

J. McWilliams ◽

R. k. Morgan ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Pleural Effusion ◽

Relative Frequency ◽

Surgical Repair ◽

Surgical Intervention ◽

Case Series ◽

Abdominal Pressure ◽

Pleural Effusions ◽

Management Options ◽

The Third

Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.

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Pleural cytokines MIF and MIP-3α as novel biomarkers for complicated parapneumonic effusions and empyema

Scientific Reports ◽

10.1038/s41598-021-81053-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Chia-Yu Yang ◽

Yu-Hsuan Kuo ◽

Min Chen ◽

Chih-Liang Wang ◽

Li-Jane Shih ◽

...

Keyword(s):

Pleural Effusion ◽

Characteristic Curve ◽

Diagnostic Value ◽

High Morbidity ◽

Parapneumonic Effusion ◽

Pleural Effusions ◽

Parapneumonic Pleural Effusion ◽

Diagnostic Values ◽

Novel Biomarkers ◽

Pleural Infection

AbstractPatients with complicated parapneumonic effusion (CPPE)/empyema have high morbidity and mortality, particularly when adequate management is delayed. We aimed to investigate novel dysregulated cytokines that can be used as biomarkers for infectious pleural effusions, especially for CPPE/empyema. Expression of 40 cytokines in parapneumonic effusions (PPE) was screened in the discovery phase, involving 63 patients, using a multiplex immunobead-based assay. Six cytokines were subsequently validated by enzyme-linked immunosorbent assays (ELISAs). We then used ELISA to further evaluate the diagnostic values and cutoff values of these cytokines as potential biomarkers in an expanded group that included 200 patients with uncomplicated parapneumonic effusion (UPPE), CPPE, empyema, transudates, other exudates, and malignant pleural effusion (MPE). The pleural levels of four cytokines (MIF, MIP-3α, IL-1β, ENA-78) were highest and significantly increased in CPPE/empyema compared with those in other etiologies. According to receiver operating characteristic curve analysis, the four cytokines (MIF, MIP-3α, IL-1β, and ENA-78) had areas under the curve (AUCs) greater than 0.710 for discriminating parapneumonic pleural effusion from noninfectious pleural effusions. In a comparison of nonpurulent CPPE with UPPE, logistic regression analysis revealed that pleural fluid MIF ≥ 12 ng/ml and MIP-3α ≥ 4.3 ng/ml had the best diagnostic value; MIF also displayed the highest odds ratio of 663 for nonpurulent CPPE, with 97.5% specificity, 94.44% sensitivity, and an AUC of 0.950. In conclusion, our results show that elevated MIF and MIP-3α may be used as novel biomarkers for PPE diagnosis, particularly in patients with CPPE/empyema; the findings indicate that dysregulated cytokine expression may provide clues about the pathogenesis of pleural infection.

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Protein analysis of pediatric parapneumonic pleural effusion after intrapleural urokinase treatment

Cell Biology International ◽

10.1042/cbi034s069c ◽

2010 ◽

Vol 34 (8) ◽

pp. S69-S69

Author(s):

Jieh‑Neng Wang ◽

Pao‑Chi Liao ◽

Yu‑Chin Tasi ◽

Jing‑Ming Wu

Keyword(s):

Pleural Effusion ◽

Protein Analysis ◽

Parapneumonic Pleural Effusion

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CLINICAL SYMPTOMS, BIOCHEMISTRY AND CYTOLOGY OF PLEURAL, PERITONEAL EFFUSIONS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2015.6.10 ◽

2016 ◽

pp. 66-71

Author(s):

Van Mao Nguyen ◽

Huyen Quynh Trang Pham

Keyword(s):

Pleural Effusion ◽

Clinical Symptoms ◽

Cross Sectional Study ◽

Malignant Cells ◽

Sectional Study ◽

Pleural Effusions ◽

Cross Sectional ◽

Breath Sounds ◽

Peritoneal Effusion ◽

Neutrophil Leukocytes

Background: The cytology and the support of clinical symptoms, biochemistry for diagnosis of the cases of effusions are very important. Objectives: - To describe some of clinical symptoms and biochemistry of effusions. - To compare the results between cytology and biochemistry by the causes of pleural, peritoneal fluids. Material & Method: A cross-sectional study to describe all of 47 patients with pleural, peritoneal effusions examinated by cytology in the Hospital of Hue University of Medicine and Pharmacy from April 2013 to January 2014. Results: In 47 cases with effusions, pleural effusion accounting for 55.32%, following peritoneal effusions 29.79% and 14.89% with both of them. The most common symptoms in patients with pleural effusions were diminished or absent tactile fremitus, dull percussion, diminished or absent breath sounds (100%), in patients with peritoneal effusions was ascites (95.24%). 100% cases with pleural effusions, 50% cases with peritoneal effusions and 80% cases with pleural and peritoneal effusions were exudates. The percentage of malignant cells in patients with pleural effusions was 26.92%, in peritoneal effusions was 28.57%, in pleural and peritoneal effusions was 42.86%. The percentage of detecting the malignant cells in patients with suspected cancer in the first test was 57.14%, in the second was 9.53% and 33.33% undetectable. Most of cases which had malignant cells and inflammatory were exudates, all of the cases which had a few cells were transudates. Besides, 7.5% cases which had high neutrophil leukocytes were transudates. Conclusion: Cytology should be carry out adding to the clinical examinations and biochemistry tests to have an exact diagnosis, especially for the malignant ones. For the case with suspected cancer, we should repeat cytology test one more time to increase the ability to detect malignant cells. Key words: Effusion, pleural effusion, peritoneal effusion, cytology, biochemistry

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

Journal of Fatima Jinnah Medical University ◽

10.37018/jfjmu.558 ◽

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.

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Pancreatico‑pleural Fistula: Case Series

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_23_17 ◽

2018 ◽

Vol 09 (01) ◽

pp. 026-031 ◽

Cited By ~ 1

Author(s):

Manoj Munirathinam ◽

Pugazhendhi Thangavelu ◽

Ratnakar Kini

Keyword(s):

Magnetic Resonance ◽

Pleural Effusion ◽

Pleural Fluid ◽

Case Series ◽

Magnetic Resonance Cholangiopancreatography ◽

Fluid Analysis ◽

High Index Of Suspicion ◽

Enhanced Computed Tomography ◽

Acute And Chronic Pancreatitis ◽

Pancreatic Pathology

ABSTRACTPancreatico‑pleural fistula is a rare but serious complication of acute and chronic pancreatitis. The pleural effusion caused by pancreatico‑pleural fistula is usually massive and recurrent. It is predominately left‑sided but right‑sided and bilateral effusion does occur. We report four cases of pancreatico‑pleural fistula admitted to our hospital. Their clinical presentation and management aspects are discussed. Two patients were managed by pancreatic endotherapy and two patients were managed conservatively. All four patients improved symptomatically and were discharged and are on regular follow‑up. Most of these patients would be evaluated for their breathlessness and pleural effusion delaying the diagnosis of pancreatic pathology and management. Hence, earlier recognition and prompt treatment would help the patients to recover from their illnesses. Pancreatic pleural fistula diagnosis requires a high index of suspicion in patients presenting with chest symptoms or pleural effusion. Extremely high pleural fluid amylase levels are usual but not universally present. A chest X‑ray, pleural fluid analysis, and abdominal imaging (magnetic resonance cholangiopancreatography/magnetic resonance imaging abdomen more useful than contrast‑enhanced computed tomography abdomen) would clinch the diagnosis. Endoscopic retrograde cholangiopancreatography with stent or sphincterotomy should be considered when pancreatic duct (PD) reveals a stricture or when medical management fails in patients with dilated or irregular PD. Surgical intervention may be indicated in patients with complete disruption of PD or multiple strictures.

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Masses of the Sternoclavicular Area: Case Series and Review of the Literature

Clinical Medicine Insights Pediatrics ◽

10.1177/11795565211021600 ◽

2021 ◽

Vol 15 ◽

pp. 117955652110216

Author(s):

Parisa Oviedo ◽

Morgan Bliss

Keyword(s):

English Language ◽

Pediatric Patients ◽

Tertiary Care ◽

Case Series ◽

Review Of The Literature ◽

Incision And Drainage ◽

Surgical Interventions ◽

Ganglion Cysts ◽

Icd 10 ◽

Bronchogenic Cysts

Objective: Masses of the sternoclavicular area are rare, and are not well described in the literature. We aim to present a series of patients with masses in this location and to review all reported English language cases of sternoclavicular masses in pediatric patients. Methods: This is a case series of pediatric patients with masses of the sternoclavicular area presenting to a tertiary care pediatric hospital from 2010 through 2017. Data was collected by using ICD-9 and ICD-10 codes to query the electronic medical record. Chart review included age at presentation, mass characteristics, medical and surgical interventions, and pathology results. A review of the literature was then performed. Results: Ten patients with masses overlying the sternoclavicular area were identified. Four patients presented with abscess and were treated with incision and drainage. Three of these patients were then treated with staged excision once infection cleared. Two additional patients were treated with primary excision. Four patients were treated with observation. The most common histopathologic finding was epidermoid. One patient was found to have a dermoid cyst, and 1 had a congenital cartilaginous rest. Conclusion: Epidermoids and dermoids are the most common masses overlying the sternoclavicular area. Controversy remains regarding the embryologic origin of sternoclavicular masses. The differential for masses in this area also includes branchial remnants, bronchogenic cysts, ganglion cysts, or septic arthritis.

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The Use of Somatex Shunt for Fetal Pleural Effusion: A Cohort of 8 Procedures

Fetal Diagnosis and Therapy ◽

10.1159/000515849 ◽

2021 ◽

pp. 1-8

Author(s):

Man Yan Chung ◽

Wing Cheong Leung ◽

Wing Ting Tse ◽

Yuen Ha Ting ◽

Kwok Ming Law ◽

...

Keyword(s):

Pleural Effusion ◽

Gestational Age ◽

Single Case ◽

Perinatal Outcomes ◽

In Utero ◽

Good Survival ◽

Pleural Effusions ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Live Births

Introduction: Fetal pleural effusion may require in utero shunting which is associated with procedure-related complications. Objective: To evaluate the efficacy and complications of the newly designed Somatex shunt in treating fetal pleural effusion. Methods: Consecutive cases with primary fetal pleural effusion who were treated with the Somatex shunt between 2018 and 2019 were evaluated. Perinatal outcomes and complications were retrospectively analyzed. Results: There were 6 cases of unilateral and 1 case of bilateral pleural effusion, and hence a total of 8 pleuroamniotic shunting procedures were performed. The median gestational age at diagnosis and shunting was 20.7 and 22.6 weeks, respectively. All 8 procedures were successful, achieving complete in utero drainage. All but one were live births (85.7%) with a median gestational age of 38 weeks. The single case of in utero death occurred 4.7 weeks after successful shunting, and no cause could be identified after autopsy. The rates of preterm birth and premature rupture of membranes were 33.3% (2/6) and 16.7% (1/6), respectively. Four of the 8 procedures (50%) had minor shunt-related complications such as dislodgement and entrapment, occurring at a median of 7.7 weeks after shunting. None of the shunts became blocked. Conclusions: The Somatex shunt is effective in relieving fetal pleural effusions with good survival rate. Overall, it was a safe instrument, though minor shunt complications occurred.

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Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature

Open Medicine ◽

10.1515/med-2021-0243 ◽

2021 ◽

Vol 16 (1) ◽

pp. 387-396

Author(s):

Sing-Ting Wang ◽

Chieh-Lung Chen ◽

Shih-Hsin Liang ◽

Shih-Peng Yeh ◽

Wen-Chien Cheng

Keyword(s):

Acute Myeloid Leukemia ◽

Pleural Effusion ◽

Adenosine Deaminase ◽

Myeloid Leukemia ◽

Diagnostic Yield ◽

Leukemic Cells ◽

Pleural Effusions ◽

Diagnostic Dilemma ◽

True Incidence ◽

Acute Myeloid

Abstract Pleural effusions are rarely observed in association with acute myeloid leukemia (AML), and their true incidence remains unknown. Given the low diagnostic yield from cytopathologic analysis of malignant pleural effusions and the fact that patients with leukemia are often thrombocytopenic and unable to tolerate invasive procedures, the incidence of leukemic effusions may be underestimated. Here, we report a rare case of pleural effusion in a patient with newly diagnosed AML. Initial analysis revealed an exudative, lymphocyte-predominant effusion. High levels of adenosine deaminase (ADA) were detected in pleural fluid, consistent with a diagnosis of tuberculosis. However, the analysis of pleural cytology revealed leukemic cells, permitting the diagnosis of leukemic effusion to be made. The patient underwent induction chemotherapy and pleural effusion resolved without recurrence. This case emphasizes the diagnostic dilemma presented by high levels of ADA in a leukemic pleural effusion, as this association has not been previously considered in the literature.

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Atypical presentation of rheumatoid arthritis: a case of massive bilateral pleural effusions in a patient with Caplan syndrome

BMJ Case Reports ◽

10.1136/bcr-2019-231899 ◽

2019 ◽

Vol 12 (10) ◽

pp. e231899

Author(s):

Yinglun Wu ◽

Philip C Dittmar

Keyword(s):

Rheumatoid Arthritis ◽

Atrial Fibrillation ◽

Pleural Effusion ◽

Connective Tissue ◽

Minimal Change Disease ◽

Connective Tissue Disorder ◽

Minimal Change ◽

Atypical Presentation ◽

Pleural Effusions ◽

Recent Treatment

Rheumatoid arthritis (RA) is a common connective tissue disorder affecting the synovial joints. In patients with RA, involvement of the lungs occurs in 30%–40% of cases while pleural effusions occur in only 3%–5%. However, the majority of RA-associated pleural effusions are small, unilateral and asymptomatic. We present a case of massive bilateral pleural effusions in a patient with established rheumatoid pneumoconiosis (Caplan syndrome). Interestingly, the pleural effusion occurred following recent treatment for minimal change disease and atrial fibrillation.

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