Diagnostic Utility of Pleural Fluid Soluble Triggering Receptor Expressed on Myeloid Cells 1 Protein in Patients with Exudative Pleural Effusion

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

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

Tropical Doctor ◽

10.1177/0049475520964399 ◽

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.

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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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