Pleural Fluid Echogenicity Measured by Ultrasound Image Pixel Density to Differentiate Transudative vs. Exudative Pleural Effusions

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 role of pleural fluid thiol/disulphide homoeostasis in the differentiation between transudative and exudative pleural effusions

International Journal of Clinical Practice ◽

10.1111/ijcp.14051 ◽

2021 ◽

Author(s):

Nazli Gormeli Kurt ◽

Servan Gokhan ◽

Ozcan Erel ◽

Celal Gunes ◽

Ahmet Fatih Kahraman ◽

...

Keyword(s):

Pleural Fluid ◽

Pleural Effusions

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Diving into the Pleural Fluid: Liquid Biopsy for Metastatic Malignant Pleural Effusions

Cancers ◽

10.3390/cancers13112798 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2798

Author(s):

Maria Alba Sorolla ◽

Anabel Sorolla ◽

Eva Parisi ◽

Antonieta Salud ◽

José M. Porcel

Keyword(s):

Pleural Fluid ◽

Liquid Biopsy ◽

Cell Types ◽

Circulating Tumor Dna ◽

Therapeutic Interventions ◽

Driver Mutations ◽

Pleural Effusions ◽

Malignant Pleural Effusions ◽

Micro Rnas ◽

Low Sensitivity

Liquid biopsy is emerging as a promising non-invasive diagnostic tool for malignant pleural effusions (MPE) due to the low sensitivity of conventional pleural fluid (PF) cytological examination and the difficulty to obtain tissue biopsies, which are invasive and require procedural skills. Currently, liquid biopsy is increasingly being used for the detection of driver mutations in circulating tumor DNA (ctDNA) from plasma specimens to guide therapeutic interventions. Notably, malignant PF are richer than plasma in tumor-derived products with potential clinical usefulness, such as ctDNA, micro RNAs (miRNAs) and long non-coding RNAs (lncRNAs), and circulating tumor cells (CTC). Tumor-educated cell types, such as platelets and macrophages, have also been added to this diagnostic armamentarium. Herein, we will present an overview of the role of the preceding biomarkers, collectively known as liquid biopsy, in PF samples, as well as the main technical approaches used for their detection and quantitation, including a proper sample processing. Technical limitations of current platforms and future perspectives in the field will also be addressed. Using PF as liquid biopsy shows promise for use in current practice to facilitate the diagnosis and management of metastatic MPE.

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Pancreaticopleural Fistula: A Cause of Recurrent Pleural Effusions in Chronic Pancreatitis

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0040-1719222 ◽

2021 ◽

Author(s):

Ayah Megahed ◽

Rahul Hegde ◽

Pranav Sharma ◽

Rahmat Ali ◽

Anas Bamashmos

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Pleural Fluid ◽

Rare Complication ◽

Delayed Diagnosis ◽

Magnetic Resonance Cholangiopancreatography ◽

Pleural Effusions ◽

Diagnostic Challenge ◽

Abdominal Symptoms ◽

Pancreatic Duct Stenting

AbstractPancreaticopleural fistula is a rare complication of chronic pancreatitis caused by disruption of the pancreatic duct and fistulous communication with the pleural cavity. It usually presents with respiratory symptoms from recurrent large volume pleural effusions. Paucity of abdominal symptoms makes it a diagnostic challenge, leading often to delayed diagnosis. Marked elevation of pleural fluid amylase, which is not a commonly performed test, is a sensitive marker in its detection. Imaging with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can help delineate the fistula. In this report, we present the clinical features, imaging, and management of a 59-year-old male patient with pancreaticopleural fistula, wherein the diagnosis was suspected only after repeated pleural fluid drainages were performed for re-accumulating pleural effusions and it was eventually successfully treated with pancreatic duct stenting. We review the literature with regards to the incidence, presentation, diagnosis, and management of this rare entity.

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Pleural fluid characteristics of tuberculous pleural effusions

Heart & Lung ◽

10.1016/j.hrtlng.2009.12.004 ◽

2010 ◽

Vol 39 (6) ◽

pp. 540-543 ◽

Cited By ~ 4

Author(s):

Emmet E. McGrath ◽

David Warriner ◽

Paul B. Anderson

Keyword(s):

Pleural Fluid ◽

Pleural Effusions ◽

Fluid Characteristics

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Hyaluronic acid levels are increased in complicated parapneumonic pleural effusions

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2011.217 ◽

2015 ◽

Vol 75 (3) ◽

Cited By ~ 1

Author(s):

T. Zaga ◽

D. Makris ◽

I. Tsilioni ◽

T. Kiropoulos ◽

S. Oikonomidi ◽

...

Keyword(s):

Heart Failure ◽

Extracellular Matrix ◽

Congestive Heart Failure ◽

Hyaluronic Acid ◽

Pleural Fluid ◽

Inflammatory Process ◽

Serum Levels ◽

Pleural Effusions ◽

Tnf Α ◽

Malignant Effusions

Background and Aim. Hyaluronic acid (HA) is a component of extracellular matrix and may play a role in the pleural inflammation which is implicated in parapneumonic effusions.The aim of the current study was to investigate HA levels in serum and pleura in patients with parapneumonic effusions. Methods. We prospectively studied pleural and serum levels of HA in 58 patients with pleural effusions due to infection (complicated and uncomplicated parapneumonic effusions), malignant effusions and transudative effusions due to congestive heart failure. In addition to HA, TNF-α and IL-1β levels were determined in pleural fluid and serum by ELISA. Results. The median±SD HA levels (pg/ml) in pleural fluid of patients with complicated effusions (39.058±11.208) were significantly increased (p<0.005), compared to those with uncomplicated parapneumonic effusions (11.230±1.969), malignant effusions (10.837±4.803) or congestive heart failure (5.392±3.133). There was no correlation between pleural fluid and serum HA values. Pleural fluid TNF-α levels (146±127 pg/mL) and IL-1β levels (133.4±156 pg/mL) were significantly higher in patients with complicated parapneumonic effusions compared to patients with other types of effusion (p<0.05). No significant association between HA and TNF-α or IL-1β was found. Conclusions. HA may play a significant role in the inflammatory process which characterises exudative infectious pleuritis. Further investigation might reveal whether HA is a useful marker in the management of parapneumonic effusions.

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S115 Pleural Fluid Adenosine Deaminase (ada) In The Diagnosis Of Tuberculous Pleural Effusions In A Low Incidence Population

Thorax ◽

10.1136/thoraxjnl-2014-206260.121 ◽

2014 ◽

Vol 69 (Suppl 2) ◽

pp. A62-A62 ◽

Cited By ~ 1

Author(s):

D. Arnold ◽

R. Bhatnagar ◽

L. Fairbanks ◽

N. Zahan-Evans ◽

A. Clive ◽

...

Keyword(s):

Adenosine Deaminase ◽

Pleural Fluid ◽

Pleural Effusions ◽

Low Incidence

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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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