Value of Ultrasonography in the Diagnosis of Pleural Effusion: Analysis of 582 Cases

Abstract Background: By comparing the different ultrasonographic manifestations in exudate and transudate, we intend to explore the value of ultrasound in auxiliary diagnosis of pleural effusion.Methods: The ultrasonic image features, including echo, separation, light spot, pleural thickness, of 275 exudative pleural effusion (EPE) cases and 307 transudate pleural effusion (TPE) cases confirmed by laboratory examination were retrospectively analyzed.Results: In 275 cases of EPE, the main primary diseases were pneumonia and tuberculous exudative pleurisy, the majority was unilateral (214 cases, 77.8%). Ultrasound showed 47.6% cases had septum, 58.5% cases had echo and those pleural thickness more than 3mm cases accounted for 39.6%. By contrast, in 307 patients with TPE, the major diseases were heart failure, cirrhosis and nephrotic syndrome. Most of the pleural effusions were bilateral, accounting for 97.1%. Ultrasound displayed echo in 3 cases (1.0%), separation in 8 cases (2.6%), light spot in 9 cases (2.9%), and pleural thickening (> 3mm) in 6 cases (2.0%). These positive findings in TPE were statistically less than its counterpart (P < 0.05). Conclusion: Ultrasound is valuable for auxiliary diagnosis of pleural effusion. Some sonographic features of pleural effusion, like echo, septum and pleural thickening, may indicate a high possibility of EPE.

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Pleural Effusion

Chest Imaging ◽

10.1093/med/9780199858064.003.0029 ◽

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.

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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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Exudative Pleural Effusion in Congestive Heart Failure: Thoracoscopic and Histologic Features

CHEST Journal ◽

10.1378/chest.2246152 ◽

2015 ◽

Vol 148 (4) ◽

pp. 427A

Author(s):

Valentina Pinelli ◽

Fiorenza Marugo ◽

Donatella Intersimone ◽

Franco Fedeli ◽

Daniele Bertoli ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Pleural Effusion ◽

Exudative Pleural Effusion

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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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A COMPARATIVE STUDY BETWEEN PLEURAL FLUID CHOLESTEROLAND LIGHT'S CRITERIA FOR DIFFERENTIATION OF EXUDATIVE AND TRANSUDATIVE PLEURAL EFFUSION

10.36106/ijsr/8521988 ◽

2021 ◽

pp. 53-55

Author(s):

Narendranath Roy ◽

Apurba Bikash Pramanik ◽

Shampa Maity ◽

Pulakesh Sinha

Keyword(s):

Pleural Effusion ◽

Serum Protein ◽

Protein Level ◽

Urban Poor ◽

General Medicine ◽

Cost Effective ◽

Pleural Effusions ◽

Mechanism Of Formation ◽

Serum Protein Level ◽

Exudative Pleural Effusion

Introduction: Pleural effusion is one of the common clinical disorders encountered in the medical wards. In a patient with pleural effusion diagnosis can be arrived by history, clinical examination and radiological techniques. Pleural effusion is collection of uid in intrapleural space and manifestation of several diseases, both pulmonary and extra pulmonary, often isolated 1. Based on the underlying pathological abnormality and mechanism of formation, effusion may be either transudative or exudative. To nd out etiology, rst step is to differentiate whether the pleural effusion is of exudate or transudate type. Etiology of pleural effusions differ in different parts of the world. Aims And Objectives: The study is conducted to compare between pleural uid cholesterol and Light's criteria for differentiation of transudative and exudative pleural effusion. The sensitivity and specicity of pleural uid cholesterol estimation as an independent biochemical marker in exudative pleural effusion. Methodology: The present work was conducted in the N.R.S. Medical College and Hospital Kolkata(Department of GENERAL MEDICINE ). Study was done from February 2018 to 1st May 2019 i.e., through one year and three month period. 70 patients both male and female Patients admitted in N.R.S MEDICALCOLLEGE with symptoms suggestive of pleural effusion. Result And Analysis: Our study showed that mean serum protein level in tuberculous effusion patients is 6.322 gm/dl. In Para pneumonic effusion cases mean serum protein level is 6.867 gm/dl. Mean serum Protein level in transudative effusion cases is 6.923 gm/dl. In patients with malignant effusion, the mean serum protein level is 6.492 gm. /dl. In empyema patients, mean serum protein level is Summary: Pleural effusion develops in a variety of illnesses. Based on the underlying pathology and mechanism of formation, effusions may be either transudates or exudates. Analysis of pleural effusion is an important diagnostic step to guide further investigations and treatment. Conclusion: Pleural uid cholesterol with a cut-off value of >55 mg/dL is better than Light's criteria in the differentiation of exudative pleural effusions. The sensitivity and specicity of differentiation can be improved by combining pleural uid protein with pleural uid cholesterol. Both these criteria are cost effective than the Light's criteria because it does not require a simultaneous blood sampling for differentiation. So in a country like India where there is maximum nancial constraints, it will be helpful for rural and urban poor patients. In resource-limited settings, pleural uid cholesterol can replace Light's criteria for classication of pleural effusion

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Sarcoidosis of the pleura: A case report

Vojnosanitetski pregled ◽

10.2298/vsp1405506j ◽

2014 ◽

Vol 71 (5) ◽

pp. 506-509 ◽

Cited By ~ 1

Author(s):

Dragana Jovanovic ◽

Violeta Vucinic ◽

Ruza Stevic ◽

Marina Roksandic-Milenkovic ◽

Natalija Samardzic ◽

...

Keyword(s):

Case Report ◽

Pleural Effusion ◽

Rare Case ◽

Definitive Diagnosis ◽

Pleural Effusions ◽

Noncaseating Granuloma ◽

Pleural Thickening ◽

Massive Pleural Effusion ◽

Trapped Lung ◽

Pleural Involvement

Introduction. Pleural involvement is an uncommon manifestation of sarcoidosis. It may manifest as pleural effusion, pneumothorax, pleural thickening and nodules, hydropneumothorax, trapped lung, hemothorax, or chylothorax. The incidence of pleural effusion with sarcoidosis ranges from 0% to 5% but has been reported to be as high as 7.5%. Pleural effusions complicate sarcoidosis in < 3% of patients. Case report. We reported a 64-year-old male patient with chronic multiorgan sarcoidosis. This patient developed pleural sarcoidosis with massive pleural effusion several years after the diagnosis of sarcoidosis. A definitive diagnosis of a sarcoid pleural effusion was based on a biopsy demonstrating noncaseating granuloma. The patient responded well to the treatment (methotrexate and methylprednisolone) with a complete withdrawal of pleural effusion following five weeks of the treatment beginning. Conclusion. The presented patient is a rare case of pleural involvement of sarcoidosis with massive effusion, who responded well to the treatment.

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Empyema

Chest Imaging ◽

10.1093/med/9780199858064.003.0030 ◽

2019 ◽

pp. 171-174

Author(s):

Christopher M. Walker

Keyword(s):

Differential Diagnosis ◽

Chest Pain ◽

Pleural Effusion ◽

Bronchopleural Fistula ◽

Disease Process ◽

Parietal Pleura ◽

Parapneumonic Effusion ◽

Pleural Thickening ◽

Trapped Lung ◽

Exudative Pleural Effusion

Empyema discusses the clinical features, evolution, differential diagnosis, complications, and imaging manifestations of this disease process. There are three distinct stages in the evolution of empyema: exudative stage, fibropurulent stage, and organizing stage. The majority of patients with empyema are symptomatic and present with cough, fever, chest pain, and dyspnea. A simple parapneumonic effusion manifests as a free small to moderate pleural effusion of variable size and is usually associated with adjacent consolidation. Empyema manifests as a loculated pleural effusion which may or may not be associated with adjacent consolidation. Empyema typically exhibits smooth parietal pleural thickening and enhancement indicative of an exudative pleural effusion. Approximately 50% exhibit the split pleural sign with thickening and enhancement of the visceral and parietal pleura. Complications of empyema include bronchopleural fistula, empyema necessitans, “trapped” lung, and malignant transformation. The treatment of empyema is drainage via thoracostomy tubes or surgical decortication in complicated cases.

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STUDY OF THE CLINNICAL CHARACTERISTICS AND OUTCOMES OF EXUDATIVE PLEURAL EFFUSION: IMPROVING CLINICAL DECISION MAKING IN RESOURCE LIMITED SETTING

SAARC Journal of Tuberculosis Lung Diseases and HIV/AIDS ◽

10.3126/saarctb.v14i1.17727 ◽

2017 ◽

Vol 14 (1) ◽

pp. 33-39

Author(s):

Deebya Raj Mishra ◽

N Bhatta ◽

P Koirala ◽

RH Ghimire ◽

B Bista ◽

...

Keyword(s):

Decision Making ◽

Pleural Effusion ◽

Malignant Pleural Effusion ◽

Clinical Decision Making ◽

Clinical Decision ◽

Resource Limited Setting ◽

Pleural Effusions ◽

Resource Limited ◽

Limited Setting ◽

Exudative Pleural Effusion

Introduction: In the background of resource limited setting like Nepal, we set out to identify if specific clinical characteristics and basic lab parameters would guide differentiation of Tuberculous from other causes of exudative pleural effusion.Methodology: Retrospective study of 109 consecutive patients with exudative pleural effusion.Results: Compared to Tubercular pleural effusions (41.3%), increased age, increased duration of symptom and increased pack years statistically favoured a diagnosis of Malignant pleural effusion(21.1%), whereas presence of fever, cough and increased pleural ADA levels favoured Tubercular pleural effusions. With regards to Parapneumonic effusions (26.6%), a shorter duration of symptom, smaller effusions, higher pleural Neutrophils, lower pleural lymphocyte neutrophil ratio and lower ADA favoured the diagnosis as compared to Tubercular pleural effusions.Conclusions: The appreciation of important clinical and pleural biochemical differences between Tubercular and other major causes of exudative pleural effusions aids in improved clinical decision making with minimal resources in resource limited settings like ours.SAARC J TUBER LUNG DIS HIV/AIDS, 2017; XIV(1), page: 33-39

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Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated?

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01461-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Mertol Gokce ◽

Bulent Altinsoy ◽

Ozcan Piskin ◽

Burak Bahadir

Keyword(s):

Pleural Effusion ◽

Predictive Value ◽

Length Of Hospital Stay ◽

Efficacy And Safety ◽

Pleural Effusions ◽

Pleural Biopsy ◽

Diagnostic Efficacy ◽

Sensitivity Specificity ◽

Time Of Operation ◽

Exudative Pleural Effusion

Abstract Background The aim of this study is to compare the diagnostic efficacy and safety of video-assisted thoracoscopic surgery (VATS) with awake VATS (AVATS) pleural biopsy in undiagnosed exudative pleural effusions. Methods The diagnostic efficacy of pleural biopsy by uniportal VATS under general anesthesia or AVATS under local anesthesia and sedation performed by the same surgeon in patients with undiagnosed exudative pleural effusion between 2007 and 2020 were retrospectively evaluated. Test sensitivity, specificity, positive predictive value and negative predictive value were compared as well as age, gender, comorbidities, procedure safety, additional pleural-based interventions, duration time of operation and length of hospital stay. Results Of 154 patients with undiagnosed exudative pleural effusion, 113 (73.37%) underwent pleural biopsy and drainage with VATS, while 41 (26.62%) underwent AVATS pleural biopsy. Sensitivity, specificity, positive predictive value and negative predictive value were 92, 100, 100, and 85.71% for VATS, and 83.3, 100, 100, and 78.9% for AVATS, respectively. There was no significant difference in diagnostic test performance between the groups, (p = 0.219). There was no difference in the rate of complications [15 VATS (13.3) versus 4 AVATS (9.8%), p = 0.557]. Considering additional pleural-based interventions, while pleural decortication was performed in 13 (11.5%) cases in the VATS group, no pleural decortication was performed in AVATS group, (p = 0.021). AVATS group was associated with shorter duration time of operation than VATS (22.17 + 6.57 min. Versus 51.93 + 8.85 min., p < 0.001). Length of hospital stay was relatively shorter in AVATS but this was not statistically significant different (p = 0.063). Conclusions Our study revealed that uniportal AVATS pleural biopsy has a similar diagnostic efficacy and safety profile with VATS in the diagnosis and treatment of patients with undiagnosed pleural effusion who have a high risk of general anesthesia due to advanced age and comorbidities. Accordingly, uniportal AVATS pleural biopsy may be considered in the diagnosis and treatment of all exudative undiagnosed pleural effusions.

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Diagnostic accuracy of semirigid thoracoscopy in exudative pleural effusions and relationship of thoracoscopic findings with probability of malignant diagnosis

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1554 ◽

2021 ◽

Author(s):

Ashok Kuwal ◽

Manish Advani ◽

Naveen Dutt ◽

Seemant Saini ◽

Surjit Singh

Keyword(s):

Pleural Effusion ◽

Diagnostic Accuracy ◽

Pleural Fluid ◽

Laboratory Data ◽

Unknown Etiology ◽

Histopathological Diagnosis ◽

Pleural Effusions ◽

Related Complication ◽

Relationship Of ◽

Exudative Pleural Effusion

Semirigid thoracoscopy is increasingly becoming the procedure of choice for evaluation of undiagnosed exudative pleural effusions. Few studies have reported relationship of thoracoscopic appearances of pleural abnormalities and etiological diagnoses. We aimed our study to assess the diagnostic utility and safety of semirigid thoracoscopy for evaluation of patients with undiagnosed exudative pleural effusion. Further, we also pursued to find any relation of various thoracoscopic findings with the final diagnosis. We prospectively enrolled hospitalized patients with undiagnosed exudative pleural effusion who underwent semirigid thoracoscopy. Demographic, clinical and laboratory data along with data on thoracoscopic appearance of various pleural abnormalities and histopathological diagnosis of pleural biopsy specimens were collected and analysed. Semirigid thoracoscopy was diagnostic in 46 (N=55) patients (83.64%). Malignancy was diagnosed in 31 patients (56.36%), of which adenocarcinoma was the most common histopathological diagnosis (45.16%). Sensitivity, specificity, PPV, NPV LR+ and LR- of thoracoscopy were 93.87%, 100%, 100%, 66.67%, 40.30 and 0.06, respectively. Pleural nodules, masses and hemorrhagic pleural fluid significantly increased the diagnosis yield of malignancy [OR= 37.16 (95%CI = 3.61-382.65), =0.002]. The procedure related complications were mild and transient. Post- procedural pain (20%) was most commonly reported followed by dry cough (18.18%), sub-cutaneous emphysema (7.27%) and anaesthesia related complication (1.82%). Semirigid thoracoscopy is simple, safe and effective procedure in diagnosing exudative pleural effusion of unknown etiology with high diagnostic accuracy and minor procedure related complications. The likelihood of diagnosing malignancy is high if combination of pleural nodules, masses and hemorrhagic pleural fluid is present.

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