Pleural effusion in a COVID-19 patient

Introduction/Aim: Pleural effusions are rarely seen on computerized tomography (CT) or radiography (X-ray) images of the chest, in coronavirus disease of 2019 (COVID-19). When present, they usually occur late in the course of the disease; they are mostly unilateral but can also be bilateral, and are absorbed after two days. Studies have also shown that pleural effusions occur primarily in the elderly and individuals with underlying respiratory disease. The incidence of respiratory failure and acute respiratory distress syndrome, as well as the mortality rates are higher in patients with pleural effusion than in patients without it. Our aim is to report a case that is different from the most commonly described cases in available literature. Patient presentation: We present a 49-year-old, comorbidity-free COVID-19 patient, who developed pleural effusion on the 10th day of hospitalization. The pleural effusion was unilateral and did not appear on a repeat lung radiography after four days. Except an elevated platelet count, the blood count parameters were in the reference ranges, while the value of CRP was slightly elevated. The patient was discharged with a good general health status, after 16 days of hospitalization. Conclusion: This case provides insight into the course and prognosis of the COVID-19 disease that is different from what has been reported in previously published papers and shows that pleural effusions do not occur only in elderly patients with comorbidities and a severe clinical presentation of the COVID-19 infection.

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Diagnostic efficacy and suitability of trans-thoracic ultrasonography for pleural fluid detection – The future non-invasive gold-standard?

Journal of Fatima Jinnah Medical University ◽

10.37018/jfjmu.558 ◽

2020 ◽

Vol 13 (4) ◽

pp. 184-190

Author(s):

Muhammad Irfan ◽

Abdul Rasheed Qureshi ◽

Zeeshan Ashraf ◽

Muhammad Amjad Ramzan ◽

Tehmina Naeem ◽

...

Keyword(s):

Pleural Effusion ◽

Diagnostic Accuracy ◽

Pleural Fluid ◽

Gold Standard ◽

Pleural Effusions ◽

Diagnostic Efficacy ◽

Chest Sonography ◽

X Ray ◽

Non Invasive ◽

Fluid Detection

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard. Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

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Characteristics of Chest X-Ray in Patients with Cancer at the Dharmais Cancer Hospital Emergency Room during the COVID-19 Pandemic

Indonesian Journal of Cancer ◽

10.33371/ijoc.v15i4.835 ◽

2021 ◽

Vol 15 (4) ◽

pp. 195

Author(s):

Bima Taruna Sakti ◽

Rosalina Rosalina ◽

Jaka Pradipta

Keyword(s):

Breast Cancer ◽

Lung Cancer ◽

Pleural Effusion ◽

Pleural Effusions ◽

Hospital Emergency ◽

X Ray ◽

Patients With Cancer ◽

Cancer Hospital ◽

Hospital Emergency Room ◽

Chest X Ray

Background: Conventional chest X-ray (chest X-ray) in Dharmais Cancer Hospital emergency room (ER) is still the primary modality to diagnose patients with cancer with dyspnoea complaints. Chest X-ray was also carried out to screen inpatients at the Dharmais Cancer Hospital ER at the beginning of the COVID-19 pandemic in Indonesia. It was essential because patients in the Dharmais Cancer Hospital ER were patients with cancer, with low immunity and a high risk of being exposed to various infections. Thus, the purpose of this study was to determine the characteristics of chest X-rays in patients with cancer at the Dharmais Cancer Hospital ER during the COVID-19 pandemic in February-May 2020. Methods: This was a descriptive study. The population involved was all patients at the Dharmais Cancer Hospital ER who received chest X-ray support, with the inclusion criteria for diagnosing lung cancer, breast cancer, cervical cancer, colorectal cancer, and blood cancer (Leukemia) from February to May 2020. Data analysis employed univariate analysis by utilizing tables and graphs in presenting the data.Results: 289 samples met the research criteria. The highest visits were patients with breast cancer (41.2%). The most common thoracic images were pleural effusion (34.3%), followed by bronchopneumonia (31.1%), normal lung (16.6%), lung mass (7.6%), pneumonia (5.2%), and others (5.2%), consisting of atelectasis, bronchitis, fibrosis/chronic pulmonary process, pulmonary emphysema, cardiomegaly, and specific process. Besides, the chest x-ray bronchopneumonia was 31.1% (90 samples), accompanied by pleural effusion of 44.4%. From the chest X-ray, pleural effusions were 34.3% (99 samples), with lung cancer being the most common with pleural effusions (48.4%).Conclusions: More than 80% of chest x-ray performed in the ER are abnormal. Also, breast cancer is the highest in the Dharmais Cancer Hospital ER cases, with the highest chest x-ray of pleural effusion.

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Clinical and radiographic characteristics of pulmonary tuberculosis

Medicinski pregled ◽

10.2298/mpns1206196s ◽

2012 ◽

Vol 65 (5-6) ◽

pp. 196-199

Author(s):

Sonja Smiljic ◽

Blagica Radovic

Keyword(s):

Pulmonary Tuberculosis ◽

Older Patients ◽

Clinical Presentation ◽

Health Centre ◽

The Elderly ◽

Common Symptom ◽

Younger Patients ◽

X Ray ◽

Lower Lung ◽

Radiographic Changes

Pulmonary tuberculosis in the elderly shows a specific clinical presentation in relation to younger persons. The aim of this study was to examine the influence of age and possible risk factors on pulmonary tuberculosis, clinical features of disease and lung x-ray findings. The research included 151 patients who had been treated at the Pulmonary Department of the Health Centre in Kosovska Mitrovica in the period from 2005 to 2009. Younger patients often suffer from severe forms of tuberculosis with caverns (46.9%), a significantly higher number of their sputum is positive for bacillus Kohn and they show a greater tendency towards alcoholism. A common symptom in older patients is dyspnea and radiographic changes are the most intense in the lower lung fields. The number of younger people suffering from severe forms of cavernous tuberculosis is significantly higher. Sputum findings are often negative, the caverns are found less often and lower lung fields are affected more often in the elderly.

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Role of bronchoscopy in pleural effusion bacterial infection

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20200670 ◽

2020 ◽

Vol 7 (3) ◽

pp. 523

Author(s):

Gomathi R. G. ◽

Sindhura Koganti ◽

Dhanasekhar . ◽

Chandrasekar . ◽

Rajagopalan .

Keyword(s):

Pleural Effusion ◽

Bacterial Infection ◽

Bacterial Growth ◽

Ultrasound Examination ◽

Underlying Disease ◽

Pleural Effusions ◽

Etiological Diagnosis ◽

X Ray ◽

Definite Role

Background: In the present study was to investigate that the role of Bronchoscopy in pleural effusion in bacterial growth condition. Pleural effusion is one of the commonest problems with which patients present to the hospital. Pleural effusion is always abnormal and indicates the presence of an underlying disease. Despite the fact that there are many causes of pleural effusion, it is estimated that 90% of all pleural effusions are the result of only 5 disease processes: malignancy, pneumonia, pulmonary embolism viral infection, congestive heart failure.Methods: This is a Prospective and Observational Study. All patients diagnosed to have pleural effusion by x-ray, clinical examination and ultrasound examination of pleura if needed will undergo informed.Results: All 80 patients were included of whom 60(70%) were males and 20(30%) were females. Out of 80 patients, 5 patients are having bacterial growth (6.3%). All 5 patients who had exudative effusion, 4 were males and 1 female, 4 cases were right side effusion and 1 left sided effusion.Conclusions: Authors conclude that bronchoscopy has a definite role in the etiological diagnosis of pleural effusion in bacterial infection.

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Quantitative Analysis Of X-Ray Images From Geological Materials

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010013482x ◽

1990 ◽

Vol 48 (2) ◽

pp. 244-245

Author(s):

J. M. Paque ◽

R. Browning ◽

P. L. King ◽

P. Pianetta

Keyword(s):

Quantitative Analysis ◽

Bulk Composition ◽

Principal Component ◽

Analytical Description ◽

Bulk Sample ◽

Geological Samples ◽

X Ray ◽

Software And Hardware ◽

And Storage ◽

Insight Into

Geological samples typically contain many minerals (phases) with multiple element compositions. A complete analytical description should give the number of phases present, the volume occupied by each phase in the bulk sample, the average and range of composition of each phase, and the bulk composition of the sample. A practical approach to providing such a complete description is from quantitative analysis of multi-elemental x-ray images.With the advances in recent years in the speed and storage capabilities of laboratory computers, large quantities of data can be efficiently manipulated. Commercial software and hardware presently available allow simultaneous collection of multiple x-ray images from a sample (up to 16 for the Kevex Delta system). Thus, high resolution x-ray images of the majority of the detectable elements in a sample can be collected. The use of statistical techniques, including principal component analysis (PCA), can provide insight into mineral phase composition and the distribution of minerals within a sample.

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Copper–oxygen Dynamics in Tyrosinase

10.26434/chemrxiv.9255251 ◽

2019 ◽

Author(s):

Nobutaka Fujieda ◽

Sachiko Yanagisawa ◽

Minoru Kubo ◽

Genji Kurisu ◽

Shinobu Itoh

Keyword(s):

Catalytic Mechanism ◽

Substrate Binding ◽

Active Form ◽

Copper Ion ◽

Atomic Resolution ◽

Oxygen Species ◽

X Ray ◽

Oxygen Dynamics ◽

Insight Into ◽

Copper Centre

To unveil the activation of dioxygen on the copper centre (Cu2O2core) of tyrosinase, we performed X-ray crystallograpy with active-form tyrosinase at near atomic resolution. This study provided a novel insight into the catalytic mechanism of the tyrosinase, including the rearrangement of copper-oxygen species as well as the intramolecular migration of copper ion induced by substrate-binding.

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CLINICAL SYMPTOMS, BIOCHEMISTRY AND CYTOLOGY OF PLEURAL, PERITONEAL EFFUSIONS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2015.6.10 ◽

2016 ◽

pp. 66-71

Author(s):

Van Mao Nguyen ◽

Huyen Quynh Trang Pham

Keyword(s):

Pleural Effusion ◽

Clinical Symptoms ◽

Cross Sectional Study ◽

Malignant Cells ◽

Sectional Study ◽

Pleural Effusions ◽

Cross Sectional ◽

Breath Sounds ◽

Peritoneal Effusion ◽

Neutrophil Leukocytes

Background: The cytology and the support of clinical symptoms, biochemistry for diagnosis of the cases of effusions are very important. Objectives: - To describe some of clinical symptoms and biochemistry of effusions. - To compare the results between cytology and biochemistry by the causes of pleural, peritoneal fluids. Material & Method: A cross-sectional study to describe all of 47 patients with pleural, peritoneal effusions examinated by cytology in the Hospital of Hue University of Medicine and Pharmacy from April 2013 to January 2014. Results: In 47 cases with effusions, pleural effusion accounting for 55.32%, following peritoneal effusions 29.79% and 14.89% with both of them. The most common symptoms in patients with pleural effusions were diminished or absent tactile fremitus, dull percussion, diminished or absent breath sounds (100%), in patients with peritoneal effusions was ascites (95.24%). 100% cases with pleural effusions, 50% cases with peritoneal effusions and 80% cases with pleural and peritoneal effusions were exudates. The percentage of malignant cells in patients with pleural effusions was 26.92%, in peritoneal effusions was 28.57%, in pleural and peritoneal effusions was 42.86%. The percentage of detecting the malignant cells in patients with suspected cancer in the first test was 57.14%, in the second was 9.53% and 33.33% undetectable. Most of cases which had malignant cells and inflammatory were exudates, all of the cases which had a few cells were transudates. Besides, 7.5% cases which had high neutrophil leukocytes were transudates. Conclusion: Cytology should be carry out adding to the clinical examinations and biochemistry tests to have an exact diagnosis, especially for the malignant ones. For the case with suspected cancer, we should repeat cytology test one more time to increase the ability to detect malignant cells. Key words: Effusion, pleural effusion, peritoneal effusion, cytology, biochemistry

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A novel large animal model of smoke inhalation-induced acute respiratory distress syndrome

Respiratory Research ◽

10.1186/s12931-021-01788-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Premila D. Leiphrakpam ◽

Hannah R. Weber ◽

Andrea McCain ◽

Roser Romaguera Matas ◽

Ernesto Martinez Duarte ◽

...

Keyword(s):

Animal Model ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Inhalation Injury ◽

Smoke Inhalation ◽

Large Animal Model ◽

Large Animal ◽

X Ray ◽

Chest X Ray

Abstract Background Acute respiratory distress syndrome (ARDS) is multifactorial and can result from sepsis, trauma, or pneumonia, amongst other primary pathologies. It is one of the major causes of death in critically ill patients with a reported mortality rate up to 45%. The present study focuses on the development of a large animal model of smoke inhalation-induced ARDS in an effort to provide the scientific community with a reliable, reproducible large animal model of isolated toxic inhalation injury-induced ARDS. Methods Animals (n = 21) were exposed to smoke under general anesthesia for 1 to 2 h (median smoke exposure = 0.5 to 1 L of oak wood smoke) after the ultrasound-guided placement of carotid, pulmonary, and femoral artery catheters. Peripheral oxygen saturation (SpO2), vital signs, and ventilator parameters were monitored throughout the procedure. Chest x-ray, carotid, femoral and pulmonary artery blood samples were collected before, during, and after smoke exposure. Animals were euthanized and lung tissue collected for analysis 48 h after smoke inhalation. Results Animals developed ARDS 48 h after smoke inhalation as reflected by a decrease in SpO2 by approximately 31%, PaO2/FiO2 ratio by approximately 208 (50%), and development of bilateral, diffuse infiltrates on chest x-ray. Study animals also demonstrated a significant increase in IL-6 level, lung tissue injury score and wet/dry ratio, as well as changes in other arterial blood gas (ABG) parameters. Conclusions This study reports, for the first time, a novel large animal model of isolated smoke inhalation-induced ARDS without confounding variables such as cutaneous burn injury. Use of this unique model may be of benefit in studying the pathophysiology of inhalation injury or for development of novel therapeutics.

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The Use of Somatex Shunt for Fetal Pleural Effusion: A Cohort of 8 Procedures

Fetal Diagnosis and Therapy ◽

10.1159/000515849 ◽

2021 ◽

pp. 1-8

Author(s):

Man Yan Chung ◽

Wing Cheong Leung ◽

Wing Ting Tse ◽

Yuen Ha Ting ◽

Kwok Ming Law ◽

...

Keyword(s):

Pleural Effusion ◽

Gestational Age ◽

Single Case ◽

Perinatal Outcomes ◽

In Utero ◽

Good Survival ◽

Pleural Effusions ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Live Births

Introduction: Fetal pleural effusion may require in utero shunting which is associated with procedure-related complications. Objective: To evaluate the efficacy and complications of the newly designed Somatex shunt in treating fetal pleural effusion. Methods: Consecutive cases with primary fetal pleural effusion who were treated with the Somatex shunt between 2018 and 2019 were evaluated. Perinatal outcomes and complications were retrospectively analyzed. Results: There were 6 cases of unilateral and 1 case of bilateral pleural effusion, and hence a total of 8 pleuroamniotic shunting procedures were performed. The median gestational age at diagnosis and shunting was 20.7 and 22.6 weeks, respectively. All 8 procedures were successful, achieving complete in utero drainage. All but one were live births (85.7%) with a median gestational age of 38 weeks. The single case of in utero death occurred 4.7 weeks after successful shunting, and no cause could be identified after autopsy. The rates of preterm birth and premature rupture of membranes were 33.3% (2/6) and 16.7% (1/6), respectively. Four of the 8 procedures (50%) had minor shunt-related complications such as dislodgement and entrapment, occurring at a median of 7.7 weeks after shunting. None of the shunts became blocked. Conclusions: The Somatex shunt is effective in relieving fetal pleural effusions with good survival rate. Overall, it was a safe instrument, though minor shunt complications occurred.

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Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature

Open Medicine ◽

10.1515/med-2021-0243 ◽

2021 ◽

Vol 16 (1) ◽

pp. 387-396

Author(s):

Sing-Ting Wang ◽

Chieh-Lung Chen ◽

Shih-Hsin Liang ◽

Shih-Peng Yeh ◽

Wen-Chien Cheng

Keyword(s):

Acute Myeloid Leukemia ◽

Pleural Effusion ◽

Adenosine Deaminase ◽

Myeloid Leukemia ◽

Diagnostic Yield ◽

Leukemic Cells ◽

Pleural Effusions ◽

Diagnostic Dilemma ◽

True Incidence ◽

Acute Myeloid

Abstract Pleural effusions are rarely observed in association with acute myeloid leukemia (AML), and their true incidence remains unknown. Given the low diagnostic yield from cytopathologic analysis of malignant pleural effusions and the fact that patients with leukemia are often thrombocytopenic and unable to tolerate invasive procedures, the incidence of leukemic effusions may be underestimated. Here, we report a rare case of pleural effusion in a patient with newly diagnosed AML. Initial analysis revealed an exudative, lymphocyte-predominant effusion. High levels of adenosine deaminase (ADA) were detected in pleural fluid, consistent with a diagnosis of tuberculosis. However, the analysis of pleural cytology revealed leukemic cells, permitting the diagnosis of leukemic effusion to be made. The patient underwent induction chemotherapy and pleural effusion resolved without recurrence. This case emphasizes the diagnostic dilemma presented by high levels of ADA in a leukemic pleural effusion, as this association has not been previously considered in the literature.

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