Osteophytes may be a rare cause of recurrent pleural effusions

We report a rare case of a 59 year-old female, who was admitted to the hospital because of a recurrent right-sided pleural effusion. The initial work-up was non-diagnostic. The diagnosis was finally confirmed following medical thoracoscopy, where an osteophyte of a rib was found to protrude sharply into the thoracic cavity. Chronic inflammatory changes of the pleura suggested mechanical irritation due to long lasting friction between this bony structure and the underlying lung. This is the first report where an osteophyte seems to be implicated in pleural pathology. A brief review of the available data from the literature is presented to further support our results.

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Ultrasound-Guided Retrieval and Position Replacement of a Dislodged Fetal Pleuro-Amniotic Shunt: A Novel Approach for a Known Complication of Feto-Amniotic Shunting

Fetal Diagnosis and Therapy ◽

10.1159/000371576 ◽

2015 ◽

Vol 39 (1) ◽

pp. 78-80 ◽

Cited By ~ 1

Author(s):

Tracy M. Adams ◽

Nadia B. Kunzier ◽

Martin R. Chavez ◽

Anthony M. Vintzileos

Keyword(s):

Pleural Effusion ◽

Preterm Labor ◽

Neonatal Surgery ◽

Thoracic Cavity ◽

Perinatal Morbidity ◽

Pleural Effusions ◽

Perinatal Complications ◽

Ultrasound Guided ◽

Amniotic Cavity ◽

Novel Approach

Untreated fetal pleural effusion can cause significant perinatal morbidity and mortality. Treatment of pleural effusions with pleuro-amniotic shunting has been shown to improve outcomes. Pleuro-amniotic shunting is associated with complications including ruptured membranes, preterm labor and shunt dislodgement into either the amniotic cavity or the fetal thorax. Shunt dislodgement into the thoracic cavity can cause prenatal complications from the shunt itself or may necessitate neonatal surgery for removal. We present a case where a novel ultrasound-guided technique was used to replace the dislodged pleural shunt in utero, thereby effectively draining the effusion while simultaneously obviating the need for neonatal surgery and decreasing possible perinatal complications.

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Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion

Proceedings of Singapore Healthcare ◽

10.1177/2010105820978998 ◽

2020 ◽

pp. 201010582097899

Author(s):

Nai-Chien Huan ◽

Inn Shih Khor ◽

Hema Yamini Ramarmuty ◽

Ming Yao Lim ◽

Kai Choon Ng ◽

...

Keyword(s):

Pleural Effusion ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Surrogate Marker ◽

Queen Elizabeth Hospital ◽

Tuberculous Pleural Effusion ◽

Initial Work ◽

The Mean ◽

N 93 ◽

Work Up

Introduction: Pleural fluid adenosine deaminase (pfADA) is a simple, rapid and inexpensive surrogate marker for tuberculous pleural effusion (TPE). A nationwide cut-off of 40 U/L is currently used based on overseas data. There is a need to optimise the diagnostic utility of pfADA by establishing a local cut-off value. In this study, we aimed to describe the demographics and clinical characteristics of patients with TPE and non-TPE; determine the sensitivity and specificity of current pfADA of 40 U/L; and establish a new local pfADA cut-off for TPE. Methods: We conducted a single-centre, observational, prospective study of patients with exudative pleural effusion and pfADA measured from 1 October 2019 to 30 April 2020 at Queen Elizabeth Hospital, Malaysia. Results: The diagnosis of analysed patients ( n = 93) included TPE ( n = 41), malignancy ( n = 28), parapneumonic effusion ( n = 12) and other causes ( n = 12). The mean pfADA was 51.15 U/L (standard deviation (SD) = 13.77) among TPE group and 18.86 U/L (SD = 12.33) among non-TPE. When analysis was restricted to TPE patients, the local pfADA cut-off is 29.6 U/L, with a sensitivity of 97.6% and specificity of 90.4%. The current pfADA of 40 U/L has a sensitivity of 87.8% and specificity of 92.3%. Conclusion: We established a local pfADA cut-off of 29.6 U/L for TPE. Optimising the utility of pfADA helps to enhance clinicians’ treatment confidence of TPE when initial work-up is inconclusive.

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Congenital chylothorax: a rare entity

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20201665 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1162

Author(s):

Prachi Gandhi ◽

Sushma Malik ◽

Nilesh N. Jamkar ◽

Vinaya A. Singh ◽

Poonam Wade

Keyword(s):

Pleural Effusion ◽

Rare Case ◽

Medium Chain Triglyceride ◽

Rare Entity ◽

Pleural Effusions ◽

Female Ratio ◽

Common Cause ◽

Medium Chain ◽

Congenital Chylothorax ◽

Male To Female

Pleural effusions in a neonate are generally congenital in about one third of the cases and acquired in the remaining two thirds. Congenital isolated pleural effusion is rare. It has an incidence of approximately 1 in 12000 to 1 in 15000 pregnancies. Chylothorax is the most common cause of neonatal congenital pleural effusion. Incidence of congenital chylothorax is 1 in 8600 to 1 in 10000 deliveries with a male to female ratio of 2:1. It poses both a diagnostic as well as therapeutic challenge to the neonatologist. Authors hereby present a rare case of congenital chylothorax which was medically managed and discharged. The neonate responded well to octreotide and medium chain triglyceride (MCT)-diet and was discharged without any complications.

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Co-existing Tubercular Pleural Effusion and Visceral Larva Migrans in a Patient with Hypereosinophilia: A Rare Case

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/45881.14354 ◽

2020 ◽

Author(s):

Taranpreet Kaur ◽

Nitin Kumar Bansal ◽

Kuldeep Goyal ◽

Jaykrat Chaudhary

Keyword(s):

Chest Pain ◽

Pleural Effusion ◽

Rare Case ◽

Larva Migrans ◽

Pleural Effusions ◽

Visceral Larva Migrans ◽

Blood Eosinophilia ◽

Causative Factors ◽

Peripheral Blood Eosinophilia ◽

Eosinophilic Pleural Effusion

Eosinophilic pleural effusions accounts for 5-16% of all the cases of pleural effusion. Here the authors present a case of 21 years old male patient, with right-sided chest pain in whom peripheral blood eosinophilia along with eosinophilic pleural effusion were found after a series of relevant investigations and two causative factors were found for same i.e., Visceral Larva Migrans (VLM) and tubercular pleural effusion. Both of them individually can cause hypereosinophilia, but presence of them together makes this case rare and interesting.

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A Substitutional Clinical Nomogram Model for Medical Thoracoscopy to Identify Tuberculous Pleural Effusion

10.21203/rs.3.rs-227634/v1 ◽

2021 ◽

Author(s):

Jie-Ru Guo ◽

Jing Zhang ◽

Xian-Li Wu ◽

Zan-Sheng Huang ◽

Ming-Zhou Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Pleural Effusion ◽

Standard Model ◽

Univariate Analysis ◽

Cost Effective ◽

Pleural Effusions ◽

Multivariate Logistic Regression ◽

Training Cohort ◽

Tuberculous Pleural Effusion ◽

Medical Thoracoscopy

Abstract Background: Tuberculous pleural effusion (TPE) is one of the most prevalent causes of exudative pleural effusion. As it is curable, early diagnosis is essential. Nevertheless, direct examination is not so sensitive while thoracoscopy is invasive and resource-demanding.Objective: To seek a less-invasive but also cost-effective substitute for medical thoracoscopy to identify TPE. Methods: We retrospectively collected 662 patients with pleural effusions who have undergone thoracoscopy as the training cohort, developed a predictive model and then validated it in another independent cohort. Independent predictor was screened by univariate analysis, feature selection and multivariate logistic regression. A predictive nomogram model was then established and evaluated by calibration, discrimination and clinical values. A standard model with a pleural adenosine deaminase (plADA) cut-off value at 40 IU/L was applied for comparison.Results: A lower plADA threshold at 24.5 IU/L was identified to discriminate TPE from other etiologies. Furthermore, serum tumor marker CA153 and Cyfra21.1, pleural lactic acid dehydrogenase and pleural interstitial cells were also identified as independent predictors (p<0.05) in multivariate logistic regression. The multivariate nomogram model presented good calibration, discrimination and clinical values, superior to the standard model. Excellent discrimination was demonstrated by the Harrell’s concordance index of 0.993 in the training cohort and 0.968 in the validation cohort. Furthermore, decision curve analysis demonstrated that the multivariate nomogram model added more benefit to patients with TPE.Conclusion: A multivariate nomogram model involved biochemical examinations and thoracentesis performed well in TPE clinical diagnosis among undetermined pleural effusions with approximate efficacy to medical thoracoscopy.

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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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A Case of Haemorrhagic Constrictive Pericarditis with Bilateral Pleural Effusions

Case Reports in Cardiology ◽

10.1155/2016/8142134 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3

Author(s):

Hans A. Reyes ◽

Julie Islam ◽

Soheila Talebi ◽

Eder Cativo ◽

Savi Mushiyev ◽

...

Keyword(s):

Pericardial Effusion ◽

Thoracoscopic Surgery ◽

Young Female ◽

Pleural Effusions ◽

Pericardial Window ◽

Pericardial Disease ◽

Diffuse Abdominal Pain ◽

Viral Aetiology ◽

Initial Work ◽

Work Up

Presentation of pericardial disease is diverse, with the viral aetiology being the most common cause; however, when haemorrhagic pericardial effusion is present, these causes are narrowed to few aetiologies. We present a case of a young female of African descent who presented with diffuse abdominal pain and vomiting. Initial work-up showed pericardial effusion with impending echocardiographic findings of cardiac tamponade and bilateral pleural effusions. Procedures included a left video-assisted thoracoscopic surgery (VATS) with pericardial window. We consider that it is important for all physicians to be aware of not only typical presentation but also atypical and unusual clinical picture of pericardial disease.

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Diagnostic Value And Safety of Medical Thoracoscopy In The Pleural Effusion of Different Causes

10.21203/rs.3.rs-668793/v1 ◽

2021 ◽

Author(s):

Xiaoting Liu ◽

Xilin Dong ◽

Yu Zhang ◽

Ping Fang ◽

Hongyang Shi ◽

...

Keyword(s):

Pleural Effusion ◽

Diagnostic Yield ◽

Multivariate Logistic Regression Analysis ◽

Invasive Procedure ◽

Diagnostic Value ◽

General Information ◽

Pleural Effusions ◽

Predictive Diagnosis ◽

Diagnostic Efficacy ◽

Medical Thoracoscopy

Abstract Background: Pleural effusions are caused by various reasons, whose diagnosis remains challenging in spite of various means of diagnosis. Medical thoracoscopy, greatly improves the diagnostic efficacy and gets preference for managements, especially undiagnosed pleural effusions. This study aimed to assess the diagnostic efficacy and safety of medical thoracoscopy in patients with pleural effusion of different causes. Methods: Between January 1st 2012 and April 30th 2021, patients with pleural effusion underwent medical thoracoscopy in the Department of Respiratory Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University. According to the discharge diagnosis, patients were grouped into three, including malignant, tuberculous and inflammatory group. General information, tuberculosis-related and effusion-related indices of three groups were analyzed. The diagnostic yield, diagnostic accuracy, performance under thoracoscopy and complications of patients were compared in three groups. Then, the significant factors for predictive diagnosis between the malignant and tuberculous group were analyzed. Results: During this 10-year study, 106 patients were included, with 67 males and 39 females, mean age 57.1±14.184 years. In 74 patients confirmed under thoracoscopy, 41 patients (38.7%) were malignant, 21 patients (19.8%) tuberculous and 32 patients (30.2%) undiagnostic. The diagnostic yield of medical thoracoscopy is 69.8%, and 75.9% in the malignant, 48.8% in the tuberculous, and 75.0% in the inflammatory. The diagnostic accuracies are 100%, 87.5%, and 75.0%, respectively. Under thoracoscopy, we observed single or multiple pleural nodules in 81.1%, pleural adhesions in 34.0% of patients with pleural effusions. The most common complication was chest pain (41.5%), following by chest tightness (11.3%), fever (10.4%). Multivariate logistic regression analysis showed that effusion appearance (OR=0.001, 95%CI: 0.000-0.204, P=0.010), CEA (OR=0.243, 95%CI: 0.081-0.728, P=0.011) were significant in the differentiation of malignant and tuberculous pleural effusion. Conclusion: Medical thoracoscopy is an effective, safe, less invasive procedure with high diagnostic yield for the pleural effusion of different causes. Medical thoracoscopy has a promising prospect.

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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20170014 ◽

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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Case Report: A rare case of a vanishing unilateral effusion

F1000Research ◽

10.12688/f1000research.24711.1 ◽

2020 ◽

Vol 9 ◽

pp. 669

Author(s):

Emily Hoodless ◽

Arvind Arumainathan ◽

Dennis Wat

Keyword(s):

Pleural Effusion ◽

Rare Case ◽

Cell Lymphoma ◽

Haematological Malignancy ◽

B Cell Lymphoma ◽

Spontaneous Remission ◽

Pleural Effusions ◽

Large B Cell Lymphoma ◽

First Case ◽

Large B Cell

Pleural effusions rarely spontaneously resolve, and we document an instance where this phenomenon occurred. Here, we report a case of a 95-year old female who presented with a unilateral pleural effusion, diagnosed as secondary to a haematological malignancy [diffuse large B-cell lymphoma (DLBCL)] which resolved spontaneously. This is the first case to describe spontaneous remission in a primary cavitary DLBCL complicated by pleural effusion.

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