scholarly journals Pleural effusion in sarcoidosis patients

2020 ◽  
Vol 98 (9) ◽  
pp. 64-69
Author(s):  
N. A. Stogova
Keyword(s):  
Pulmonary Embolism ◽  
Pleural Effusion ◽  
Pulmonary Sarcoidosis ◽  
Parietal Pleura ◽  
Pleural Effusions ◽  
Pleural Biopsy ◽  
Etiological Diagnosis ◽  
Oncological Diseases

The article presents the review of 62 publications which demonstrated that 1.1-16.7% of patients with pulmonary sarcoidosis develop plural effusion. Data from thoracoscopic examinations with pleural biopsy in sarcoidosis revealed damage to both the visceral and parietal pleura which manifested through hydrothorax, chylothorax, and hemothorax. Among patients with pleural effusions of various etiology, pleural sarcoidosis is detected in 1.5-4.0% of cases. However, pleural effusion in patients with sarcoidosis can also be caused by concomitant diseases (tuberculosis, mycosis, cardiac, renal, and hepatic failures, pulmonary embolism, pneumonia, and oncological diseases). In this regard, it is advisable to perform morphological verification for the etiological diagnosis of pleural effusion in sarcoidosis patients.

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

CYTO-DIAGNOSIS OF PLEURAL EFFUSIONS: A COMBINED APPROACH TO MORPHOLOGICAL FEATURES IN ROUTINELY STAINED CYTOLOGY SMEARS AND CELL BLOCK TECHNIQUE

2021 ◽  
pp. 3-5
Author(s):  
Lubna Khan ◽  
Mahendra Singh ◽  
Anshul Pratap Singh ◽  
Mohd Faheemuddin
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Yield ◽  
Tertiary Care ◽  
North India ◽  
Parietal Pleura ◽  
Cell Block ◽  
Pleural Effusions ◽  
Tertiary Care Centre ◽  
Pathology Department ◽  
Smear Examination

Introduction: Pleural cavity is a potential space between the parietal pleura and visceral pleural. It consists of some amount of uid called pleural uid which is normally less than 25ml. Pleural uid is produced by parietal lining and absorbed by visceral lining. Fluid is produced by plasma ltration through capillary endothelial cells. Aims & Objectives:Acombined approach of cytology and cell block technique in diagnosing the cause of pleural effusion. To evaluate the utility of cell block preparation over the conventional smear in the cytodiagnosis of serous effusions. Material & Methods: The present study was conducted on patients having pleural effusions. The cases and specimens were selected from the outdoor as well as indoor patients admitted in a tertiary care centre of North India and also from those sent directly to Pathology department from other hospitals. The duration of study was from January 2019 to September 2020. The specimens obtained were processed in the biochemistry, cytopathology and histopathology laboratory in the Pathology department of GSVM Medical College, Kanpur. Result And Analysis: Out of 100 cases studied it was found that 83 (83%) cases were of reactive pleural effusion and 17 (17%) cases were of malignant pleural effusions.Out of 17 malignant effusion, 16 (94%) cases were exudative, while 1 (6%) case was transudative.Only 8 cases of adenocarcinoma were diagnosed on smear examination, while 11 cases were diagnosed on cell block examination. 3 cases of poorly differentiated carcinoma were diagnosed on conventional smear and 5 cases on cell block examination.Out of total 17 malignant pleural effusions diagnosed by cell block, only 12 cases were diagnosed by conventional smear examination. Hence diagnostic yield increased by 30% using cell block preparations. Conclusion: Thus it was concluded that routine centrifuge is not satisfactory in reporting uids with scant cellularity. Hence for uids with scant cellularity cell block preparation is a useful method. Also the morphology of the cells were well appreciated by cell block as compared to routine centrifuge, thus aiding in accurate diagnosis. In this study the diagnoses which were missed or incompletely diagnosed on conventional smear were diagnosed by cell block.

Pleural effusion

2007 ◽  
pp. 145-152
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Chest Radiograph ◽  
Pleural Space ◽  
Parietal Pleura ◽  
Clinical Approach ◽  
Clinical Scenario ◽  
Pleural Effusions ◽  
Wide Range

Introduction 146 Causes 146 Clinical approach 147 Pleural fluid 149 Management 151 Pleural effusions are a common clinical scenario with a wide range of causes. They are defined as an accumulation of fluid between the visceral and parietal pleura. There is normally around 20 ml of fluid present in the pleural space. Around 400 ml needs to be present before clinically apparent, whilst >200 ml is visible on the PA chest radiograph....

scholarly journals Role of pleural biopsy in etiological diagnosis of pleural effusion

Lung India ◽  
2010 ◽  
Vol 27 (4) ◽  
pp. 202 ◽  
Author(s):  
Sudipta Pandit ◽  
ArunabhaDatta Chaudhuri ◽  
SourinBhuniya Saikat Datta ◽  
Atin Dey ◽  
Pulakesh Bhanja
Keyword(s):  
Pleural Effusion ◽  
Pleural Biopsy ◽  
Etiological Diagnosis

Telomerase activity in pleural effusions: diagnostic significance.

1998 ◽  
Vol 16 (2) ◽  
pp. 567-573 ◽  
Author(s):  
C T Yang ◽  
M H Lee ◽  
R S Lan ◽  
J K Chen
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Telomerase Activity ◽  
Pleural Effusions ◽  
Pleural Biopsy ◽  
Diagnostic Significance ◽  
Group Iii ◽  
Malignant Pleural Effusions ◽  
Group I ◽  
Group Ii

PURPOSE To determine the diagnostic value of pleural fluid telomerase activity in distinguishing a malignant from a nonmalignant pleurol effusion in a cohort of patients undergoing thoracentesis. PATIENTS AND METHODS Using a polymerase chain reaction (PCR)-based assay, telomerase activity was examined in the pleural fluid cells obtained from 144 consecutive, unselected patients. According to the final diagnosis achieved, these patients were classified into three groups: group I consisted of 70 malignant pleural effusions diagnosed by either fluid cytology or pleural biopsy, group II consisted of 52 nonmalignant pleural effusions, and another 22 samples were categorized to be suspicious malignant pleural effusions (group III) due to inconclusive results in effusion cytology and percutaneous pleural biopsy, but were strongly suspicious in clinical settings. RESULTS The presence of telomerase activity was observed in 64 of 70 samples in group I (91.4%), three of 52 samples in group II (5.8%), and 20 of 22 samples in group III. All three nonmalignant, telomerase-positive pleural effusion samples in group II were obtained from patients with tuberculosis. As a diagnostic criterion for malignant pleural effusion in group I and group II patients, positive telomerase activity had a sensitivity of 91.4%, a specificity of 94.2%, and a positive and negative predictive value of 0.96 and 0.89, respectively. CONCLUSION Our results indicate that the detection of telomerase activity may be a useful adjunct to cytopathologic methods in the diagnosis of malignant pleural effusions.

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

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.

scholarly journals Pleural fluid cholesterol level is an important parameter in differentiating exudative from transudative pleural effusions

2018 ◽  
Vol 5 (3) ◽  
pp. 520
Author(s):  
Chakradhar Majhi ◽  
Butungeshwar Pradhan ◽  
Bikash C. Nanda ◽  
Sagnika Tripathy
Keyword(s):  
Pleural Effusion ◽  
Cholesterol Level ◽  
Pleural Fluid ◽  
Sensitivity And Specificity ◽  
Pleural Effusions ◽  
Biochemical Tests ◽  
Etiological Diagnosis ◽  
Multiple Parameters ◽  
Fluid Analysis ◽  
Cholesterol Levels

Background: The first important step is to decide whether the pleural effusion is transudate or exudates by Light’s criteria. Light’s criteria can misclassify 25% of pleural transudates as exudates. Pleural fluid cholesterol level can differentiate transudates from exudates as a single parameter instead of multiple parameters used in Light’s criteria. Measurement of pleural fluid cholesterol levels to differentiate transudative effusions from exudative effusions.Methods: Consecutive 60 cases of pleural effusion were taken in the study. Pleural fluid analysis was done for parameters of Light’s criteria along with pleural fluid cholesterol levels. First exudative and transudative effusion was classified by Light’s criteria. Other  clinical and relevant  biochemical tests were done to arrive in  the final etiological diagnosis  and data were collected and analysed .Pleural fluid cholesterol levels was  correlated to Light’s criteria.Results: Total 60 cases of pleural effusion were there in the study. There were 43 exudative and 17 transudative effusions. Mean cholesterol level was 64.2± 7.5mg/dl in exudative effusions and 26.05±8.01 mg/dl in transudates. Pleural fluid cholesterol was ≥55mg /dl in 43 cases of exudates and <55mg/dl in 17 cases of transudates.Conclusions: Pleural fluid cholesterol level of ≥ 55mg/dl had similar sensitivity and specificity to Light’s criteria and as a single important parameter to differentiate exudative from transudative pleural effusion

scholarly journals Role of Pleural Biopsy in the Etiological Diagnosis of Exudative Pleural Effusion

2017 ◽  
Vol 5 (1) ◽  
pp. 33-36
Author(s):  
Jamal Uddin Ahmed ◽  
Mohammad Delwar Hossain ◽  
Farhana Afroz ◽  
Muhammad Abdur Rahim ◽  
AKM Musa
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Granulomatous Inflammation ◽  
Mean Value ◽  
Total Leukocyte Count ◽  
Pleural Biopsy ◽  
Cross Sectional ◽  
Etiological Diagnosis ◽  
Almost All ◽  
Exudative Pleural Effusion

Purpose: Exudative pleural effusion usually indicates an underlying pulmonary pathology. Sometimes etiological diagnosis of exudative pleural effusion is difficult despite cytological, biochemical and microbiological tests. Aim of present study was to make an etiological diagnosis of exudative pleural effusion by pleural biopsy.Methods: This cross-sectional observational study was performed from January 2012 to December 2014 in the Department of Internal Medicine & Pulmonology of BIRDEM General Hospital, Dhaka, Bangladesh. A total of 51 patients with exudative pleural effusion in whom the diagnosis was uncertain after routine biochemical, cytological and microbiological evaluation of pleural fluid were included in the study. These patients underwent pleural biopsy by Abram’s needle and histopathology was done to determine the etiology of pleural effusion.Results: Majority (74.5%) of the patients were male. Mean age of the patients was 52.7±16.0 years. Most (52.9%) patients had right sided pleural effusion. Histopathology report of the pleural biopsy showed granulomatous inflammation compatible with tuberculosis (TB) in 15 (29.4%), metastatic malignancy in 10 (19.6%) and chronic inflammation in 9 (17.6%) cases. In 17 (33.3%) cases the histopathology did not reveal any abnormality. Among 10 cases of metastatic malignancy, most (7, 70%) were adenocarcinoma. Compared to malignancy cases, TB cases were younger in age (Mean age: TB - 45.0±17.9 vs malignancy - 61.8±13.0 years). Pleural fluid was straw color in all (100%) cases of TB and hemorrhagic in almost all (90%) cases of metastatic malignancy (p 0.000). Mean value of pleural fluid protein (59.1±4.8 vs 47.3±4.2 gm/L; p 0.003), lactate dehydrogenase (LDH) (917.3±219.3 vs 464.3±112.3 U/L; p 0.101), adenosine deaminase (ADA) (39.0±3.7 vs 15.615.6±2.3 U/L; p 0.016), total leukocyte count (1039.3±776.8 vs 439.2±138.2 cells/cmm; p 0.328) and lymphocyte percentage (94.4±4.3 vs 68.3±9.3; p 0.003) were all raised in TB compared to metastatic malignancyConclusions: Pleural biopsy was definitive diagnostic in almost half the patients with exudative pleural effusion. Tuberculosis was more common than malignancy particularly in young persons. Pleural fluid protein, LDH and ADA are significantly raised in TB compared to malignancy.Bangladesh Crit Care J March 2017; 5(1): 33-36

scholarly journals A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion

2016 ◽  
Vol 05 (01) ◽  
pp. 27-28 ◽  
Author(s):  
Ashwini Kumar Mishra ◽  
Sanjeev Kumar Verma ◽  
Surya Kant ◽  
Ram Awadh Kushwaha ◽  
Rajiv Garg ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Cavity ◽  
Single Port ◽  
Parietal Pleura ◽  
Viewing Angle ◽  
Interventional Study ◽  
Pleural Biopsy ◽  
Diagnostic Efficacy ◽  
Biopsy Needle ◽  
Exudative Pleural Effusion

Abstract Background: The diagnostic approach to exudative pleural effusion remains an underappreciated aspect of modern thoracic medicine. 15-20% of the pleural effusions remain undiagnosed. The most efficient approach to pleural exudates remains uncertain and controversial particularly if acquisition of pleural tissue is required. The clinician needs to consider various factors when confronted with the choice between closed pleural biopsy (CPB) and thoracoscopy. Hence this study was planned to compare the diagnostic efficacy of CPB and Thoracoscopic pleural biopsy (TPB). Materials and Methods: This was a prospective interventional study in patients of exudative pleural effusion. CPB was performed by Cope′s biopsy needle. Then inspection of the pleural cavity was performed by single port rigid thoracoscope (KARL, STORZ TELECAM DX II 20 2330 20) with viewing angle of zero (0) degrees and biopsy taken from the diseased or unhealthy parietal pleura. Accordingly we compared the results of CPB and TPB. Results: 46 Patients underwent this study. In all 46 patients both CPB and TPB were performed.TPB was diagnostic in 36 cases (78.2%) while CPB was diagnostic only in 10 cases i.e. 21.7%. 10 (21,7%) cases remained undiagnosed. On thoracoscopic examination 30 patients were having nodularity, 25 (54.3%) were having adhesions and 20 (43.5%) were having hyperemia. 79.3% of the patients with nodularity turned out to be malignant and 71.4% of patients with adhesions and hyperemia tubercular. Conclusions: TPB has much greater diagnostic efficacy than CPB.

scholarly journals Comparison of diagnostic yield and complications of bronchoscopy, closed pleural biopsy and medical thoracoscopic pleural biopsies in undiagnosed pleural effusions

2017 ◽  
Vol 5 (2) ◽  
pp. 388
Author(s):  
Kizhakkepeedika Davis Rennis ◽  
Jaboy Bibin ◽  
Vadakkan Thomas ◽  
Easwaramangalath Venugopal Krishnakumar
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Yield ◽  
Safe Procedure ◽  
Pleural Effusions ◽  
Pleural Biopsy ◽  
Predictive Values ◽  
Medical Thoracoscopy ◽  
Sensitivity Specificity ◽  
Blunt Trocar ◽  
Exudative Pleural Effusion

Background: Undiagnosed exudative pleural effusion is a commonly encountered clinical scenario, which requires further evaluation. This study was aimed to analyze the diagnostic yield and complications of three procedures- Bronchoscopy, closed (Abram’s) pleural biopsy and medical thoracoscopy. Further, this study assessed whether combining closed pleural biopsy with bronchoscopy can be a substitute for medical thoracoscopy.Methods: An observational study was conducted among people with undiagnosed exudative pleural effusion. Initially, closed pleural biopsies were performed with Abrams needle and multiple tissue fragments were taken through the incision and the samples were sent in formalin to the laboratory for histopathology examination. For thoracoscopy, a cannula of 10 mm diameter with blunt trocar was inserted into the pleural cavity and semi rigid thoracoscope was introduced through the trocar. Bronchoscopy was performed 48 hours after thoracoscopy. Sensitivity, specificity and positive and negative predictive values were calculated and compared.Results: Out of 25 people, 14 were diagnosed to have malignancy and 7 were diagnosed tuberculosis. The overall sensitivity of the three procedures were 28.5% for closed pleural biopsy, 14.2% for bronchoscopy, 95.2% for medical thoracoscopy, 42.8% for the combined pleural biopsy and bronchoscopy. The complication rate was lowest for bronchoscopy (4%), followed by medical thoracoscopy (8%) and closed pleural biopsy (16%).Conclusions: Medical thoracoscopy is a comparatively safe procedure which has got the highest sensitivity for the diagnosis of undiagnosed exudative pleural effusions. Bronchoscopy combined with closed pleural biopsy, the diagnostic yield was increased (than that of individual yield), but cannot be a substitute for medical thoracoscopy.

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