Pleural thickening, trapped lung, and chronic empyema as sequelae of tuberculous pleural effusion: don't sweat the pleural thickening [Editorial]

Background: Tuberculosis is the most common cause of exudative lymphocytic pleural effusion in India. Residual pleural thickening (RPT) is observed in about 50 percent of patients even after proper treatment with ATT. Pleural fluid drainage either with simple aspiration or with intercostal drainage and addition of corticosteroids along with antitubercular drugs have not shown to influence the incidence of RPT. The present study was undertaken to study the complications and residual effects of tubercular pleural effusion on the patients during the follow up period following intrapleural streptokinase instillation.Methods: Clinical profile, hospital course and outcome of tuberculous pleural effusion patients at the end of six months of anti-tubercular treatment of 50 patients from January 2009 to June 2010 were analyzed. These patients were randomly divided into two groups. One group (n=25) received intrapleural streptokinase via pigtail catheter and the other group (n=25) received intercostal drainage without intrapleural streptokinase instillation. All the patients received standard daily anti TB regimen of 2HERZ/4HR for a total duration of six months. All the patients were followed up for a total duration of 1 year for evidence of any residual pleural thickening.Results: Majority of the patients were above 40 years of age (60%). The male to female ratio was 2.3:1. The major symptoms of the patients were, fever in 44 patients (88%), cough in 42 patients (84%), breathlessness in 33 patients (66%), loss of appetite in 25 patients (50%) and chest pain in 25 patients (50%). Most of the patients had ADA levels between 40-70IU/L (48%) and only 6% had ADA levels below 40IU/L. The incidence of residual pleural thickening in the study group was less as compared to the control group (2.36±0.49mm vs 9.28±1.50mm) (p <0.0001).Conclusion: Intrapleural streptokinase instillation with pigtail catheter drainage less number of complications associated with study group and is successful with the decreased incidence of residual pleural thickening during the follow up period.

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Tuberculous Pleural Effusion- Residual Pleural Thickening

Pediatric Oncall ◽

10.7199/ped.oncall.2019.5 ◽

2019 ◽

Vol 16 (1) ◽

Author(s):

Lavina Desai ◽

Ira Shah

Keyword(s):

Pleural Effusion ◽

Tuberculous Pleural Effusion ◽

Pleural Thickening

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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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VEGF Correlates with Inflammation and Fibrosis in Tuberculous Pleural Effusion

The Scientific World JOURNAL ◽

10.1155/2015/417124 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Mauo-Ying Bien ◽

Ming-Ping Wu ◽

Wei-Lin Chen ◽

Chi-Li Chung

Keyword(s):

Pleural Effusion ◽

Plasminogen Activator ◽

Odds Ratio ◽

Ph Value ◽

Characteristic Curve ◽

Tissue Type ◽

Chest Ultrasonography ◽

Tuberculous Pleural Effusion ◽

Pleural Thickening ◽

Pai 1

Objective. To investigate the relationship among angiogenic cytokines, inflammatory markers, and fibrinolytic activity in tuberculous pleural effusion (TBPE) and their clinical importance.Methods. Forty-two patients diagnosed with TBPE were studied. Based on chest ultrasonography, there were 26 loculated and 16 nonloculated TBPE patients. The effusion size radiological scores and effusion vascular endothelial growth factor (VEGF), interleukin- (IL-) 8, plasminogen activator inhibitor type-1 (PAI-1), and tissue type plasminogen activator (tPA) were measured. Treatment outcome and pleural fibrosis, defined as radiological residual pleural thickening (RPT), were assessed at 6-month follow-up.Results. The effusion size and effusion lactate dehydrogenase (LDH), VEGF, IL-8, PAI-1, and PAI-1/tPA ratio were significantly higher, while effusion glucose, pH value, and tPA were significantly lower, in loculated than in nonloculated TBPE. VEGF and IL-8 correlated positively with LDH and PAI-1/tPA ratio and negatively with tPA in both loculated and nonloculated TBPE. Patients with higher VEGF or greater effusion size were prone to develop RPT (n=14; VEGF, odds ratio 1.28,P=0.01; effusion size, odds ratio 1.01,P=0.02), and VEGF was an independent predictor of RPT in TBPE (receiver operating characteristic curveAUC=0.985,P<0.001).Conclusions. Effusion VEGF correlates with pleural inflammation and fibrosis and may be targeted for adjunct therapy for TBPE.

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Serial pulmonary function test abnormality in tuberculous pleural effusion

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195508 ◽

2019 ◽

Vol 7 (12) ◽

pp. 4505

Author(s):

Ayush Bansal ◽

Shekhar Trimbak Nabar

Keyword(s):

Pleural Effusion ◽

Pulmonary Function ◽

Large Scale ◽

Clinical Problem ◽

X Rays ◽

Ventilatory Function ◽

Tuberculous Pleural Effusion ◽

Pleural Thickening ◽

Hemodynamic Improvement ◽

The Impact

Background: Pleural effusion is a common clinical problem that frequently causes dyspnoea and poor ventilatory function. In addition to fluid, pleural thickening, septations and calcifications can add to the functional deterioration of lungs. The drainage of pleural effusion is very effective in improving the functionality of lungs. Large volume pleural fluid tapping results in immediate hemodynamic improvement and relief from dyspnoea.Methods: The aim of the present study was to estimate the impact of tubercular pleural effusion on the ventilatory function of the lungs and to find out the correlation between the effect of pleural tapping and functional effect on the lungs. The study comprised of thirty tubercular pleural effusion cases. They were observed for six months by doing serial chest X-rays and pulmonary function test.Results: It was observed that tuberculous pleural effusion causes a restrictive abnormality and small airway obstruction. These abnormalities improve gradually over a period of six months when the patient is on anti-tubercular treatment. The role of any therapeutic intervention towards decreasing these lung function abnormalities will be subject of separate large-scale prospective study.Conclusions: Functional defects and residual pleural thickening has no correlation with the initial severity of pleural effusion.

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