scholarly journals URINOTHORAX: AN UNUSUAL CAUSE OF MASSIVE PLEURAL EFFUSION

2019 ◽  
Vol 2 (1) ◽  
pp. 18-19
Author(s):  
Jose Luis Bauza Quetglas ◽  
Maria Isabel Fullana ◽  
Javier Asensio ◽  
Manuel Díaz ◽  
A.M. Pinheiro ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diffuse Abdominal Pain ◽  
Thoracic Drainage ◽  
History Of ◽  
Chest X Ray ◽  
Blood Leukocyte ◽  
Diagnostic Criterion ◽  
Serum Ratio

A 74 year-old male with a history of high blood pressure and hyperuricemia was admitted to the hospital with asthenia, unquantified weight loss, dyspnea on moderate exertion for 2 weeks, and diffuse abdominal pain. Blood leukocyte count was 12400/uL, creatinine 0.98 mg/dL, CRP 19 mg/dL, and LDH 318 U/L. The chest X-ray showed a right pleural effusion and the pleural fluid was suggestive of an exudate. Thorax and abdominal CT scan revealed a polycystic right kidney with grade IV hydronephrosis and suggested the presence of a nephropleural fistula. The thoracocentesis was repeated and the pleural fluid / serum ratio of creatinine obtained was higher than 1 (1.35 mg/dL), which is a diagnostic criterion for urinothorax. Finally, a retrograde pyelography was carried out, and confirmed the passage of urinary tract fluid into the pleural cavity. A thoracic drainage tube and a nephrostomy through the superior calyx were placed, both draining purulent material. One month later, the control CT shows a right atrophic kidney and a reduction of the size of the fistulous path. Urinothorax is an infrequent and underdiagnosed pathology, with few cases reported. It is usually presented as a transudative pleural effusion. Currently, no test is available to confirm the diagnosis, although the ratio of serum creatinine/pleural creatinine could suggest the presence of urinothorax. Radiographic imaging is useful to support the diagnosis. Management of a urinothorax requires a multidisciplinary approach with an emphasis on the correction of the underlying urinary tract pathology, and once corrected, this often leads to a rapid resolution of the pleural effusion.

scholarly journals URINOTHORAX: AN UNUSUAL CAUSE OF MASSIVE PLEURAL EFFUSION

2019 ◽  
Vol 2 (1) ◽  
pp. 18-19
Author(s):  
Jose Luis Bauza Quetglas ◽  
Maria Isabel Fullana ◽  
Javier Asensio ◽  
Manuel Díaz ◽  
A.M. Pinheiro ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diffuse Abdominal Pain ◽  
Thoracic Drainage ◽  
History Of ◽  
Chest X Ray ◽  
Blood Leukocyte ◽  
Diagnostic Criterion ◽  
Serum Ratio

A 74 year-old male with a history of high blood pressure and hyperuricemia was admitted to the hospital with asthenia, unquantified weight loss, dyspnea on moderate exertion for 2 weeks, and diffuse abdominal pain. Blood leukocyte count was 12400/uL, creatinine 0.98 mg/dL, CRP 19 mg/dL, and LDH 318 U/L. The chest X-ray showed a right pleural effusion and the pleural fluid was suggestive of an exudate. Thorax and abdominal CT scan revealed a polycystic right kidney with grade IV hydronephrosis and suggested the presence of a nephropleural fistula. The thoracocentesis was repeated and the pleural fluid / serum ratio of creatinine obtained was higher than 1 (1.35 mg/dL), which is a diagnostic criterion for urinothorax. Finally, a retrograde pyelography was carried out, and confirmed the passage of urinary tract fluid into the pleural cavity. A thoracic drainage tube and a nephrostomy through the superior calyx were placed, both draining purulent material. One month later, the control CT shows a right atrophic kidney and a reduction of the size of the fistulous path. Urinothorax is an infrequent and underdiagnosed pathology, with few cases reported. It is usually presented as a transudative pleural effusion. Currently, no test is available to confirm the diagnosis, although the ratio of serum creatinine/pleural creatinine could suggest the presence of urinothorax. Radiographic imaging is useful to support the diagnosis. Management of a urinothorax requires a multidisciplinary approach with an emphasis on the correction of the underlying urinary tract pathology, and once corrected, this often leads to a rapid resolution of the pleural effusion.

scholarly journals Management of Pleural Brucellosis: Case Report

2009 ◽  
Vol 2 ◽  
pp. IDRT.S2235 ◽  
Author(s):  
Adel Alothman ◽  
Salih Bin Salih ◽  
Salwa Alothman ◽  
Ghassan Al Johani
Keyword(s):  
Case Report ◽  
Pleural Effusion ◽  
Incidence Rate ◽  
Pleural Fluid ◽  
Middle Eastern ◽  
Developed Countries ◽  
History Of ◽  
Chest X Ray ◽  
Low Incidence ◽  
The Right

Background Brucellosis is a zoonotic disease, with low incidence rate in developed countries, however the incidence rate in Middle Eastern countries remains high. Chest symptoms in brucellosis cases account for about 15% of the cases, but dealing with respiratory system involvement is rare particularly pleural involvement. Case Report We report a case of a 60-year-old Saudi woman who was admitted with two months history of fever, productive cough anorexia and weight loss, contact with sheep. She was ill looking, underweight and febrile while she was on treatment. Examination of the chest showed signs of pleural effusion on the right side with right infrascapular crepitations. Chest X-ray: showed pleural effusion and right LL infiltrates. CT chest: showed right loculated, pleural effusion. Pleural fluid examination showed exudative changes, on culture of pleural fluid, Brucella species grew. AFB in pleural fluid was negative. She was treated with Streptomycin, Doxycyclin and Ciprofloxacin. She improved within one week of treatment and was discharged, after 14 days on antibrucella therapy. Discussion Pulmonary brucellosis is reported in medical literature occasionally but only few reports are available about pleural brucellosis. The challenge with pleural brucellosis and the association of loculated abscesses lies in therapy. Due to lack of previous information with such cases, we suggest that a period of more than six weeks is needed to treat this condition. We recommend that pleural brucellosis needs to be treated with at least two therapeutic agents for nine weeks.

Mesalamine-induced eosinophilic pleural effusion

2020 ◽  
Vol 13 (4) ◽  
pp. e233886 ◽  
Author(s):  
Abdullah Al-abcha ◽  
Fazal Raziq ◽  
Shouq Kherallah ◽  
Ahmad Alratroot
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Symptomatic Improvement ◽  
X Ray ◽  
Fluid Analysis ◽  
Ct Angiogram ◽  
History Of ◽  
Chest X Ray ◽  
Eosinophilic Pleural Effusion

A 45-year-old woman with a medical history of ulcerative colitis (UC) presented with difficulty in breathing. The patient was diagnosed with UC a month prior to presentation and was started on mesalamine suppository. Chest x-ray (CXR) on presentation showed bilateral pleural effusion, which was confirmed on CT angiogram of the chest. Diagnostic and therapeutic thoracentesis was performed and 0.7 L of pleural fluid was removed from the left side. The pleural fluid analysis was consistent with exudative pleural effusion with eosinophilia. Symptomatic improvement was noted after thoracentesis. Mesalamine was stopped and repeat CXR was obtained on the follow-up visit, which showed no pleural effusion. The Naranjo score was calculated to be 7, indicating that the eosinophilic pleural effusion was most probably secondary to adverse reaction from mesalamine.

scholarly journals Urinothorax Caused by Xanthogranulomatous Pyelonephritis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Waiel Abusnina ◽  
Hazim Bukamur ◽  
Zeynep Koc ◽  
Fauzi Najar ◽  
Nancy Munn ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Obstructive Uropathy ◽  
Xanthogranulomatous Pyelonephritis ◽  
Robot Assisted ◽  
Rare Form ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
Tract Infections

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis that generally afflicts middle-aged women with a history of recurrent urinary tract infections. Its pathogenesis generally involves calculus obstructive uropathy and its histopathology is characterized by replacement of the renal parenchyma with lipid filled macrophages. This often manifests as an enlarged, nonfunctioning kidney that may be complicated by abscess or fistula. This case details the first reported case of xanthogranulomatous pyelonephritis complicated by urinothorax, which resolved on follow-up chest X-ray after robot-assisted nephrectomy.

scholarly journals Release of growth factors after mechanical and chemical pleurodesis for treatment of malignant pleural effusion: a randomized control study

2015 ◽  
Vol 49 (4) ◽  
pp. 386-394 ◽  
Author(s):  
Aljaz Hojski ◽  
Maja Leitgeb ◽  
Anton Crnjac
Keyword(s):  
Quality Of Life ◽  
Growth Factors ◽  
Growth Factor ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Malignant Pleural Effusion ◽  
Transforming Growth Factor ◽  
Chemical Pleurodesis ◽  
Thoracic Drainage

Abstract Background. Growth factors are key inducers of fibrosis but can also mediate inflammatory responses resulting in increasing pleural effusion and acute respiratory distress syndrome. The primary aim of the study was to analyse growth factors release after performing chemical and mechanical pleurodesis in the first 48 hours at the patients with malignant pleural effusion. The secondary endpoints were to evaluate the effectiveness of the both pleurodeses, symptoms release and the quality of life of patients after the treatment. Patients and methods. A prospective randomized study included 36 consecutive female patients with breast carcinoma and malignant pleural effusion in an intention-to-treat analysis. We treated 18 patients by means of thoracoscopic mechanical pleurodesis and 18 patients by chemical pleurodesis with talcum applied over a chest tube. We gathered the pleural fluid and serum samples in the following 48 hours under a dedicated protocol and tested them for growth factors levels. A quality of life and visual analogue pain score surveys were also performed. Results. Median measured serum vascular endothelial growth factor (VEGF) level after chemical pleurodesis was 930.68 pg/ml (95% CI: 388.22–4656.65) and after mechanical pleurodesis 808.54 pg/ml. (95% CI: 463.20-1235.13) (p = 0.103). Median pleural levels of transforming growth factor (TGF) β1 were higher after performing mechanical pleurodesis (4814.00 pg/ml [95% CI: 2726.51–7292.94]) when compared to those after performing chemical pleurodesis (1976.50 pg/ml [95% CI: 1659.82–5136.26]) (p = 0.078). We observed similar results for fibroblast growth factor (FGF) β; the serum level was higher after mechanical pleurodesis (30.45 pg/ml [95% CI: 20.40–59.42]), compared to those after chemical pleurodesis (13.39 pg/ml [95% CI: 5.04 – 74.60]) (p = 0.076). Mechanical pleurodesis was equally effective as chemical pleurodesis in terms of hospital stay, pleural effusion re-accumulation, requiring of additional thoracentesis, median overall survival, but, it shortened the mean thoracic drainage duration (p = 0.030) and resulted in a higher symptoms release and in a better quality of life (p = 0.047). Conclusions. We recorded an increase in serum VEGF levels after chemical pleurodesis, however on the contrary, an increase in the pleural fluid level of TGFβ1 and FGFβ] after mechanical pleurodesis with respect to compared group. Although the differences did not reach statistical significance, VEGF, TGFβ1 and FGFβ remain the most interesting parameters for future research. Considering the mechanisms of growth factors action, we conclude that in our study group mechanical pleurodesis might be more efficient in terms of growth factors release, thoracic drainage duration and resulted in a higher symptoms release and in a better quality of life than chemical pleurodesis.

scholarly journals Clinical profile of patients with pleural effusion admitted to KMCTH

1970 ◽  
Vol 7 (4) ◽  
pp. 438-444 ◽  
Author(s):  
KR Dhital ◽  
R Acharya ◽  
R Bhandari ◽  
P Kharel ◽  
KP Giri ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Clinical Presentation ◽  
Lateral View ◽  
Parapneumonic Effusion ◽  
Age Group ◽  
Common Cause ◽  
Fluid Analysis ◽  
Blood Haemoglobin ◽  
Chest X Ray

Background: pleural effusion is the common findings in patients presenting with cardiopulmonary symptoms but specific studies are lacking in Nepal. Objective: The main objective of this study is to find out the various causes of pleural effusion, their mode of clinical presentation and laboratory analysis of blood and pleural fluid to aid diagnosis of patients with pleural effusion. Materials and methods: Retrospective data from July 2009 to July 2007 from all the cases diagnosed with pleural effusion were taken. Altogether 100 cases diagnosed with pleural effusion by chest X-ray (Posterior- Anterior and Lateral view) and Ultrasonogram of the chest were studied. The following parameters were analysed: Patients demographic profile, causes, location (Unilateral, Bilateral), Blood haemoglobin and count, sputum profile, Monteux test, chest Xray and USG findings and pleural fluid analysis[Biochemical, Haematological, Microbiological(culture and stain) and cytological]. This study was analysed by using SPSS 16. Results: The mean age of the patient was 44.89 ± 21.59 and must patients with pleural effusion belong to age group 21- 30. Most common cause of pleural effusion was found to be tubercular effusion followed by parapneumonic effusion. Right sided effusion was seen in most cases of tubercular parapneumonic and malignant effusion whereas bilateral effusion was seen in 87.5% of the patient (7 out of 8) having congestive heart failure and all cases of renal disease (4 out of 4). Shortness of breath (83%), cough (67%) and fever (66%) are the most common mode of clinical presentation. Conclusion: Our study concluded that the most common cause of unilateral pleural effusion is tuberculosis followed by parapneumonic effusion and most cases of those belong to younger age group (21 -30yrs) and most common cause of bilateral pleural effusion is congestive cardiac failure. Key words: Pleural effusion; Tuberculosis; pneumonia; malignancy; protein; ADA DOI: 10.3126/kumj.v7i4.2772 Kathmandu University Medical Journal (2009) Vol.7, No.4 Issue 28, 438-444

scholarly journals Malignant melanoma presenting as an isolated pleural effusion

2015 ◽  
Vol 75 (2) ◽  
Author(s):  
M. Shameem ◽  
J. Akhtar ◽  
U. Baneen ◽  
N. Ahmad Khan ◽  
R. Bhargava ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Melanoma ◽  
Pleural Fluid ◽  
Past History ◽  
Mediastinal Lymphadenopathy ◽  
Rare Presentation ◽  
Pigmented Lesion ◽  
S 100 ◽  
History Of ◽  
Enhanced Computed Tomography

Isolated pleural effusion is a very rare presentation of malignant melanoma. A 46 year-old male patient presented to us with complaints of shortness of breath during the previous month. A contrast enhanced computed tomography (CECT) imaging scan of his thorax showed right-sided pleural effusion with the absence of any mass lesion or mediastinal lymphadenopathy. Cytology of his pleural fluid showed pigmented cells suggestive of malignant melanoma. Staining of the pleural fluid cells with immunohistological markers for melanoma (HMB 45 and S 100) were positive. An examination of his skin did not reveal any pigmented lesion, nor was there a past history of malignant melanoma for this patient. The patient responded well to therapy for malignant melanoma and has remained asymptomatic for the last year. This patient was diagnosed with a rare case of primary malignant melanoma of the pleura presenting as isolated pleural effusion.

scholarly journals GeneXpert: a game changer in the detection and diagnosis of childhood tuberculosis

2017 ◽  
Vol 5 (1) ◽  
pp. 35 ◽  
Author(s):  
Nayantara Rao Gandra ◽  
Jayasri Helen Gali
Keyword(s):  
Pleural Effusion ◽  
Elbow Joint ◽  
Mantoux Test ◽  
Gastric Aspirate ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
The Government ◽  
Detection And Diagnosis ◽  
Game Changer

Background: Battling against tuberculosis (TB) is still a major challenge in India, despite measures undertaken by the government and medical fraternity. Delay in diagnosing tuberculosis is a challenge, causing hurdle in the prevention of spread of the disease.Methods: This retrospective study analysed the samples by geneXpert assay. Samples (n=403, from 359 children) included pulmonary (sputum and gastric aspirate, 359), extrapulmonary (lymph node aspirate (LNA), 41) cerebrospinal fluid (CSF, 03) pus from the lesion at the elbow joint (01).  Only sputum was analysed for 315 children, both sputum and LNA for 41.Results: Mean age of patients was 9.08±2.85 years, range 3-15 years. There were 221 (61.56%) males and 138 (38.44%) females. Fever (71, 19.78%), fever with cough (87, 24.23%), fever with weight loss (41,11.42%) were the main symptoms.  There were three patients with high fever, headache and seizures with neck rigidity, clinically diagnosed as Tuberculous meningitis. There was history of contact with Tuberculosis in 15 (4.18%) patients. Mean ESR was 112.09mm/1st Hr±56.05 (range 54 -750 mm/1st Hr). Mantoux test was positive in 270 (75.42%). Chest X-ray was normal in 33 (9.19%); consolidation in 189 (52.65%), mild pleural effusion in 94 (26.18%) mild pleural effusion associated with consolidation in 43 (11.98%) were reported. Positive GeneXpert assay (106 samples, 27.39%; sputum (87, 24.23% %), pus (01), CSF (03), LNA (15, 57.69%) was reported in 87 patients.  Results were obtained ≤36 hours, mean 2 hours± 2.34 (range 6- 36 hours).Conclusions: GeneXpert is an effective tool for rapid detection of tuberculosis. Present study supports its inclusion in the battery of routine investigations. It can revolutionise the scenario in prevention and management of tuberculosis. 

scholarly journals Additive effect of dabigatran and high-dose aspirin in the development of haemorrhagic pleural effusion in a patient with tuberculous pleuritis

2020 ◽  
Vol 32 (3) ◽  
pp. 176-179
Author(s):  
Duygu Karagül
Keyword(s):  
Pleural Effusion ◽  
Dabigatran Etexilate ◽  
Chronic Atrial Fibrillation ◽  
The Elderly ◽  
Additive Effect ◽  
High Dose ◽  
History Of ◽  
Chest X Ray ◽  
Polymerase Chain ◽  
High Doses

Tuberculous pleuritis can rarely cause haemorrhagic pleural effusion. Dabigatran etexilate can have an additive effect on increasing the risk of haemorrhage. Aspirin cannot cause major haemorrhage, but in the elderly it can cause gastrointestinal bleeding via ulceration of the gastrointestinal mucosa. We report here the case of a 77-year-old male who presented to the hospital with a 2-month history of progressive dyspnoea. He had been taking dabigatran etexilate (220 mg) and high-dose acetylsalicylic acid (aspirin; 300 mg) daily for chronic atrial fibrillation. A chest X-ray revealed a moderately sized right pleural effusion confirmed by a computed tomography scan, which also showed bronchiectasis of both lungs. Dabigatran was discontinued and aspirin was decreased to the minimal therapeutic dose of 100 mg before thoracentesis was performed. Lymphocyte-predominant (50%) haemorrhagic fluid of 500 ml was drained, positive for acid-fast bacilli smear and polymerase chain reaction of Mycobacterium tuberculosis. A chest tube was placed and an additional 1250 ml of haemorrhagic exudate drained out. We treated the patient with a routine regimen of antituberculous medication and the infection resolved without complications other than the bronchiectasis present before treatment. We think that the combination of dabigatran etexilate and high doses of aspirin increased the risk of pleural haemorrhage in this patient with tuberculous pleuritis

scholarly journals A rare complication of ventriculoperitoneal shunt: Pleural effusion without intrathoracic ventriculoperitoneal shunt catheter

2020 ◽  
Vol 11 ◽  
pp. 291
Author(s):  
Said Hilmani ◽  
Tarek Mesbahi ◽  
Abderrahman Bouaggad ◽  
Abdelhakim Lakhdar
Keyword(s):  
Pleural Effusion ◽  
Ventriculoperitoneal Shunt ◽  
Rare Complication ◽  
Peritoneal Catheter ◽  
X Ray ◽  
Thoracic Drainage ◽  
Repeat Chest ◽  
Chest X Ray ◽  
The Right ◽  
Catheter Replacement

Background: Symptomatic pleural effusion following ventriculoperitoneal shunt (VPS) insertion is very rare and poorly understood in the literature in contrary to other mechanical complications. Case Description: We report a case of 15 month-year-old girl who had VP shunt for congenital hydrocephalus. Twelve months after surgery, she was diagnosed with massive hydrothorax. Chest X-ray and thoracoabdominal CT scan confirmed the right pleurisy and showed the tip of the peritoneal catheter in the general peritoneal cavity. We made thoracic drainage of the transudative pleural effusion. When we released the chest tube, 24 h after, the girl showed a respiratory distress again and the effusion resumed at the X-ray control. Her symptoms abated after the realization of a ventriculoatrial shunt “VAS.” Repeat chest X-ray confirmed the resolution of the hydrothorax. Conclusion: Despite the not yet well-understood mechanism of this rare and important VPS complication, management is simple based on X-ray confirmation, thoracentesis with biological analysis, and catheter replacement, especially in atrium “VAS.”

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