Pleural Effusion in Pulmonary and Extrapulmonary Blastomycosis

Objective: Pleural effusion secondary to blastomycosis infection is an uncommon clinical manifestation of the disease. We undertook a retrospective study to assess the incidence and involvement of pleural effusion in patients with blastomycosis infection. Study Design: Institutional cytology and surgical pathology records were searched from December 1995 to October 2017 for cases of blastomycosis. The cytologic, surgical pathology, and clinical pertinent information was reviewed in detail. Results: A total of 77 cases of blastomycosis infection were recorded, with a male-to-female ratio of 1.7:1.0. Forty-eight cases of blastomycosis were pulmonary (62.3%), while 29 cases of blastomycosis were found in extrapulmonary sites (37.7%). The diagnosis of pulmonary blastomycosis was established by 24 lung biopsies/wedge resections, 22 bronchial alveolar lavages, and 2 lung fine needle aspirations. The 29 cases of extrapulmonary blastomycosis included 13 cases of bone (44.8%), 8 cases of skin (27.6%), 6 cases of soft tissue (20.7%), and 2 cases of brain infections (6.8%). Twenty-eight of 48 pulmonary cases were complicated by unilateral or bilateral pleural effusion (58.3%) detected by imaging studies. Four of the 28 pleural effusions were aspirated and examined by cytology. Two of the 4 pleural fluid cytologies showed involvement by blastomycosis (50%). In the extrapulmonary blastomycosis group, 9 of 29 patients showed unilateral or bilateral pleural effusions (31.0%), including 4 cases of bone, 4 cases of skin, and 1 case of brain involvement. Only 2 of the 9 pleural effusions were aspirated for cytology study. One of the 2 pleural fluid cytologies showed blastomycosis (50%). Conclusion: Pleural effusion detected by imaging is common in blastomycosis patients. Blastomycosis can involve pleural fluid in both pulmonary and extrapulmonary diseases. A broad infectious differential that includes blastomycosis should be considered to make a timely diagnosis and initiate antifungal therapy to prevent systemic infection and further dissemination of the disease.

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

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2018.944 ◽

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.

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Congenital chylothorax: a rare entity

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20201665 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1162

Author(s):

Prachi Gandhi ◽

Sushma Malik ◽

Nilesh N. Jamkar ◽

Vinaya A. Singh ◽

Poonam Wade

Keyword(s):

Pleural Effusion ◽

Rare Case ◽

Medium Chain Triglyceride ◽

Rare Entity ◽

Pleural Effusions ◽

Female Ratio ◽

Common Cause ◽

Medium Chain ◽

Congenital Chylothorax ◽

Male To Female

Pleural effusions in a neonate are generally congenital in about one third of the cases and acquired in the remaining two thirds. Congenital isolated pleural effusion is rare. It has an incidence of approximately 1 in 12000 to 1 in 15000 pregnancies. Chylothorax is the most common cause of neonatal congenital pleural effusion. Incidence of congenital chylothorax is 1 in 8600 to 1 in 10000 deliveries with a male to female ratio of 2:1. It poses both a diagnostic as well as therapeutic challenge to the neonatologist. Authors hereby present a rare case of congenital chylothorax which was medically managed and discharged. The neonate responded well to octreotide and medium chain triglyceride (MCT)-diet and was discharged without any complications.

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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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The Differential Diagnostic Values of Cytokine Levels in Pleural Effusions

Mediators of Inflammation ◽

10.1155/mi.2005.2 ◽

2005 ◽

Vol 2005 (1) ◽

pp. 2-8 ◽

Cited By ~ 15

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.

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Use of C-reactive protein level in diagnosis of tubercular pleural effusion

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v8i1.25264 ◽

2019 ◽

Vol 8 (1) ◽

pp. 20-23

Author(s):

Subash Pant ◽

Sanjeet Krishna Shrestha ◽

Lucky Sharma ◽

Bibechana Shrestha

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Protein Level ◽

College Teaching ◽

C Reactive Protein ◽

Biochemical Tests ◽

Cross Sectional ◽

Female Ratio ◽

Protein Levels ◽

Reactive Protein

Background: C-reactive protein in both pleural fluid and serum has been found to be higher in tubercular pleural effusion than in other causes of pleural effusion. Objectives: The main aim of this study was to find out the diagnostic value of C-reactive protein in patients withlymphocytic pleural effusion. Methodology: A cross-sectional study was conducted in 90 patients with pleural effusion who underwent thoracocentesis at Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal. The complete biochemical tests of pleural fluid and serum were performed. The C-reactive protein concentrations of both pleural fluid and serum were then measured from samples from patients with lymphocytic exudative pleural effusion. Results: Ninety patients with exudative lymphocytic pleural effusion were included. Male patients were 56 (62.2%) and female were 34 (37.8%) with the male to female ratio of 1.64. Mean age of the patients was 51±21.54 (Mean ± Standard Deviation). The pleural fluid C-reactive protein levels in tubercular pleural effusion were higher (48.87±24.19 mg/dl) compared to non-tubercular group (38.30±17 mg/dl; p<0.001). Similarly, the serum fluid C-reactive protein levels in tubercular pleural effusion were higher (29.60±13mg/dl) compared to non-tubercular group (18.14±9.2mg/dl; p< 0.001). The sensitivity of pleural fluid C-reactive protein level in diagnosing tubercular pleural effusion was 86%. Conclusion: Simple and inexpensive test like C-reactive protein is useful in the diagnostic workup of lymphocytic pleural effusions. High C-reactive protein levels are very suggestive of tubercular pleural effusion.

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

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v11i02.22957 ◽

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.

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

KYAMC Journal ◽

10.3329/kyamcj.v9i1.36620 ◽

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

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

POCUS Journal ◽

10.24908/pocus.v6i2.15193 ◽

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.

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TYPHOID FEVER WITH JAUNDICE

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.04.1322 ◽

2015 ◽

Vol 22 (04) ◽

pp. 439-442

Author(s):

Muhammad Usman Anjum ◽

Hafizullah Khan ◽

Syed Humayun Shah

Keyword(s):

Typhoid Fever ◽

Liver Enzymes ◽

Systemic Infection ◽

Liver Function Tests ◽

Exclusion Criteria ◽

Female Ratio ◽

The Mean ◽

System Disorder ◽

Male To Female ◽

Study Setting

Typhoid fever is a systemic infection which is caused by Samonella entericaserotype typhi. It is a multi-system disorder involving many organs including liver. Liverinvolvement could be in the form of jaundice, rise in liver enzymes or hepatomegaly. It canpresent as acute hepatitis in rare cases, called typhoid hepatitis. Objectives: This study wascarried out to study the association of typhoid fever in patients with jaundice. To determinethe frequency of typhoid fever among patients presenting with jaundice. Design: Descriptivecross sectional study Setting: at Gastroenterology Unit, Ayub Teaching Hospital, Abbottabad,Period: March 2011 to December 2011. Methods: Total 115 patients were included in thestudy based on inclusion and exclusion criteria. Typhidot IgM test was performed to confirmthe diagnosis of typhoid fever. Results: The mean age of patients was 28.5 ± 10.14 years,with 54.8% male gender predominating the overall sample. The male to female ratio was 1.2:1.Typhoid fever was found in 22 (19.1%) out of 115 patients with jaundice and there were 68.2%were males and 31.8% were females. Conclusions: Typhoid fever is not rare to present asjaundice in our part of the world where typhoid fever is endemic. Therefore, all those patientswho have fever, jaundice, abnormal liver function tests or hepatomegaly must be screened fortyphoid fever especially in areas where typhoid fever is endemic.

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Assessment of the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions

Bionatura ◽

10.21931/rb/2021.06.03.10 ◽

2021 ◽

Vol 3 (3) ◽

pp. 1944-1947

Author(s):

Hanie Raji ◽

Seyed Hamid Borsi ◽

Mehrdad Dargahi MalAmir ◽

Ahmad Reza Asadollah Salmanpour

Keyword(s):

Pleural Effusion ◽

Tumor Marker ◽

Pleural Fluid ◽

Tumor Markers ◽

Low Cost ◽

High Specificity ◽

Diagnostic Value ◽

Pleural Effusions ◽

Cross Sectional ◽

The Mean

Pleural effusion is divided into exudative and transudative effusion, and the distinction between exudate and transudate requires multiple investigations of biochemical parameters and their comparison in pleural fluid and serum. This study aimed to assess the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions. This epidemiological and cross-sectional study was performed on 50 patients aged between 18 to 90 years with the diagnosis of exudative pleural effusion referred to Imam Khomeini Hospital in Ahvaz in 2018 and 2019. Demographic and clinical information of patients were collected. The pleural effusion was diagnosed based on physical examination and chest radiography. Pleural effusion was confirmed by thoracentesis. A pleural fluid sample was taken from all patients, and the levels of CEA, CA125, and CRP markers were measured in the pleural fluid. Differentiation of transudate and exudate pleural effusions was performed using Light criteria. The mean CEA and CA125 level of pleural fluid were significantly higher, and the mean CRP level of pleural fluid was significantly lower in patients with malignant diagnoses (P <0.05). Cut-off value with highest sensitivity and specificity in differentiating types of exudative pleural effusions was obtained for CEA tumor marker (greater than 49.8), CA125 tumor marker (greater than 814.02), and CRP marker (less than 7.56). Also, in differentiating types of exudative pleural effusions, CEA tumor marker had sensitivity (89.03%) and specificity (78.42%); CA125 tumor marker had sensitivity (53.18%) and specificity (62.44%), and CRP marker had sensitivity (82.16%), and specificity (89.05%) were. Although the tumor markers had high specificity in the present study, the low sensitivity of some of these tumor markers reduced their diagnostic value. On the other hand, given the numerous advantages of tumor markers, such as low cost and non-invasive, combining them with another can increase the diagnostic value and accuracy.

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