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

scholarly journals Modified thoracoscopic pleural cryo-biopsy in diagnosis of exudative pleural effusion of undetermined etiology

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ayman Ibrahim Baess ◽  
Essam Gouda Hassanein ◽  
Mohamed Al Saeed Emara ◽  
Heba Ahmed Eshmawey
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Yield ◽  
Diagnostic Value ◽  
Fat Cells ◽  
Modified Technique ◽  
Pleural Biopsy ◽  
Post Procedure ◽  
Standard Tool ◽  
Undetermined Etiology ◽  
Exudative Pleural Effusion

Abstract Background Rigid thoracoscopy is the gold standard tool for diagnosing exudative pleural effusion, but sometimes it is difficult to obtain sufficient biopsies using the conventional forceps. This study evaluated the efficacy, safety, and diagnostic value of a modified technique using cryoprobe to obtain pleural biopsies during thoracoscopy. Results This is a single-center prospective study in patients that underwent rigid thoracoscopy using conventional rigid forceps followed by a cryoprobe at the same setting after injection of subpleural mixture of adrenaline and xylocaine. Biopsies were reviewed by an independent pathologist; any complications were recorded, and all patients were followed-up post-procedure. Twenty-four patients (12 males; mean age was 56 ± 15.1years) were included. The diagnostic yield of both rigid forceps biopsy (RFB) and cryoprobe biopsy (CPB) was 100%. CPB had more surface area than RFB with no difference regarding largest diameter (p = 0.064). RFB and CPB had similar results regarding presence of fat cells. CPB had much less crushed cells than RFB with better tissue preservation (p = 0.004). No significant complications were reported. Conclusions The modified cryoprobe biopsy is a highly effective and safe way for obtaining pleural biopsy besides affording good quality and size of the biopsy especially in thick firmly adherent pleura.

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 The diagnostic yield of closed needle pleural biopsy in exudative pleural effusion: a retrospective 10-year study

2020 ◽  
Vol 8 (7) ◽  
pp. 491-491
Author(s):  
Tianli Zhang ◽  
Bing Wan ◽  
Li Wang ◽  
Chuling Li ◽  
Yangyang Xu ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Yield ◽  
Pleural Biopsy ◽  
Exudative Pleural Effusion

Filariasis presenting as isolated pleural effusion: A case report and mini review

2020 ◽  
pp. 004947552096439
Author(s):  
Phiza Aggarwal ◽  
Saravanan Subramanian ◽  
Varinder Saini ◽  
Deepak Aggarwal
Keyword(s):  
Case Report ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Retrospective Review ◽  
High Sensitivity ◽  
Causal Association ◽  
Accurate Detection ◽  
Rare Manifestation ◽  
Exudative Pleural Effusion ◽  
Fluid Cytology

Isolated pleural effusion is a rare manifestation of filariasis that mimics tuberculosis, especially in endemic regions. We describe a case of lymphocytic and exudative pleural effusion showing microfilaria on pleural fluid cytology. A retrospective review of all cases of filarial pleural effusion reported after 2000 was conducted to evaluate the association between filariasis and pleural effusion as well as to screen the features that can help in accurate detection of these patients. The analysis suggested a causal association between the parasite and the development of pleural effusion with a high sensitivity of pleural fluid cytology for diagnosis.

scholarly journals Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Exudative Pleural Effusion- A Tertiary Centre Experience from Aligarh Muslim University, Uttar Pradesh, India

2020 ◽  
Author(s):  
Mohammad Arif ◽  
Rakesh Bhargava ◽  
Mohammad Shameem ◽  
Nafees Ahmad Khan ◽  
Sadaf Sultana
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Histopathological Examination ◽  
Diagnostic Yield ◽  
Uttar Pradesh ◽  
P Value ◽  
Fisher Exact Test ◽  
Pulmonary Medicine ◽  
Medical Thoracoscopy ◽  
Exudative Pleural Effusion

Introduction: Pleural effusions are one of the most common entities encountered by pulmonologists worldwide which have a very long list of causes. Initial workup of these patients begins with a chest X-ray and percutaneous or Ultrasound (USG) guided thoracocentesis followed by biochemical and cytological evaluation of the fluid to ascertain the cause of effusion. A 20 to 25% of cases remain undiagnosed even after thoracocentesis and closed pleural biopsy. Medical Thoracoscopy is emerging as a safe diagnostic procedure in these patients. Aim: To detect the diagnostic yield of medical thoracoscopy in cases of undiagnosed exudative lymphocytic pleural effusion and to study the complications associated with it. Materials and Methods: This was a prospective observational study, carried out in the Department of Pulmonary Medicine, JN Medical College and hospital, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India, from August 2016 to August 2018. Undiagnosed exudative pleural effusion was defined as pleural effusion with Adenosine Deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy. Thoracoscopic examination of the pleural space using flexi-rigid thoracoscopy was done and biopsy was taken from suspected areas and the tissue obtained, was send for histopathological examination. The results were presented as mean±SD (Standard Deviation) or percentage. Differences in categorical data were compared using the chi-square test or the Fisher-exact test. A p-value of <0.05 was considered statistically significant. Results: Fifty patients underwent thoracoscopy for undiagnosed pleural effusion. Most common gross thoracoscopy finding was nodules which was seen in 23 patients. Malignancy was the most common histopathological finding, seen in 22 patients. Minor complications were seen in five patients. A final diagnosis could be made in 41 patients; the diagnostic yield was 82%. Conclusion: Medical thoracoscopy should be performed in all patients in which radiological and pleural fluid examinations could not lead to a definitive diagnosis as it has high sensitivity and a very low rate of complications.

scholarly journals Evaluation of diagnostic value of n-terminal pro brain natriuretic peptide in pleural fluid with cardiac origin

2018 ◽  
Vol 5 (3) ◽  
pp. 912
Author(s):  
Behzad Babapour ◽  
Mohammad Mirzaaghazadeh ◽  
Bita Shahbazzadegan ◽  
Hadi Mohsenifar ◽  
Alireza Mohammadzadeh ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diagnostic Value ◽  
Common Finding ◽  
Shortness Of Breath ◽  
Male And Female ◽  
Significant Difference ◽  
Long Time ◽  
Very High ◽  
Exudative Pleural Effusion

Background: Pleural effusion is a common finding in patients. For a long time, a light criterion is used to analysis of pleural effusion for separation of transudative from exudative fluid. Sensitivity of light criteria is very high to determine exudative pleural effusion (98%). However, the ability of these criteria for ruling out of transudative effusions is low. For this reason, this study was carried out to determine the level of NT-proBNP in pleural fluid.Methods: A descriptive-analytic study was carried out on 21 patients with complaints of shortness of breath and diagnosis of pleural effusion. Pleural fluid was tapped in these patients and the following tests were performed: LDH, total protein, albumin, cell count, cell differentiation, cytology for malignant cells, ADA, smear for AFB, gram smear and culture.The results of all experiments were analyzed using SPSS V16.Results: Mean age of participants was 65 years. Male and female frequencies were 52.4 and 47.6, respectively. 33.3% of patients had CHF, 28.5% TB, 19.4% malignancy, 4.76% hydatid, and the rest left without diagnosis. A pleural fluid in 66.7% of participants was exudative and in 33.3% was transudative. The levels of NT-proBNP (Pg/ml) in serum and pleural fluid of patients with CHF were 11288.42 and 11036.81, but in malignant patient were 1721.68 and 713.59, respectively, and the levels of NT-proBNP in serum and pleural fluid in TB patient were 2429.30 and 2810.08, respectively. Also, there was no significant difference between the levels of serum and pleural effusion NT-proBNP in transudative and exudative fluid but the level of NT-proBNP was significantly higher in CHF patients compared to others.Conclusions: The results showed that the levels of NT-proBNP in serum and pleural fluid of cardiac patients are higher than other patients, but no significant difference in NT-proBNP between transudative and exudative pleural effusion.

scholarly journals Pleural effusion: Role of pleural fluid cytology, adenosine deaminase level, and pleural biopsy in diagnosis

2016 ◽  
Vol 33 (3) ◽  
pp. 159 ◽  
Author(s):  
Biswajit Biswas ◽  
SudershanKumar Sharma ◽  
RameshwarSingh Negi ◽  
Neelam Gupta ◽  
VirenderMohan Singh Jaswal ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Pleural Biopsy ◽  
Fluid Cytology

scholarly journals DIAGNOSTIC YIELD OF ABRAMS PLEURAL BIOPSY IN PATIENTS PRESENTING WITH LYMPHOCYTIC EXUDATIVE PLEURAL EFFUSION.

2019 ◽  
Vol 26 (07) ◽  
pp. 1014-1019
Author(s):  
Kashif Sardar ◽  
Nasir Javed ◽  
Sufyan Saleem Safdar
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Yield ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Definitive Diagnosis ◽  
Care Hospital ◽  
Pleural Biopsy ◽  
Cross Sectional ◽  
Medical Thoracoscopy ◽  
Exudative Pleural Effusion

Background: Pleural effusion is the one of the most common clinical conditions encountered in pulmonology clinics and the routinely performed tests on pleural fluid do not provide definitive diagnosis in majority of the cases. Medical thoracoscopy with pleural biopsy under direct vision of the abnormal area provides the highest diagnostic yield. Abrams closed needle pleural biopsy is a conventional and cheaper procedure which can help in the definitive diagosis in cases of undiagnosed pleural effusion. Objectives: To determine the diagnostic yield of abrams pleural biopsy in patients presenting with lymphocytic exudative pleural effusion. Study Design: Cross Sectional Study. Setting: Department of Pulmonology Nishtar Hospital Multan; Tertiary care hospital of 1180 beds. Period: Six months. Results: There were 145 patients diagnosed with lymphocytic exudative pleural effusion. Of these 145 study cases, males were 83/145 (57.2%) whereas females were 62/145 (42.8%). Mean age of our patients was 41.62 ± 13.63 years while mean duration of illness was 7.0 ± 3.24 weeks. When the frequencies of various diagnosis established on the basis of histopathology results obtained from the tissue specimen obtained with Abrams pleural biopsy was noted, Tuberculosis was the major cause of lymphocytic exudative pleural effusion as its frequency was noted to be in 81/145 (55.9%) of our patients while malignancy was present in 26/145 (17.9%) of our study cases whereas the histopathology turned out to be inconclusive in 38/145 (26.2%) showing non-specific inflammation. The diagnostic yield of Abrams pleural biopsy turned out to be 73.8% whereas it was unable to establish diagnosis in 26.2%. Conclusion: Abrams needle pleural biopsy is simple, reliable and safe method of diagnosis with a good diagnostic yield. Routine use of this procedure in patients with lymphocytic exudative pleural effusion can lead to a definitive diagnosis in majority of patients.

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