scholarly journals Pleuroperitoneal Leak as an Uncommon Cause of Pleural Effusion in Peritoneal Dialysis: A Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Minh Huan Dang ◽  
Mathew Mathew ◽  
Rajesh Raj
Keyword(s):  
Peritoneal Dialysis ◽  
Case Report ◽  
Pleural Effusion ◽  
Gold Standard ◽  
Pleural Effusions ◽  
Biochemical Tests ◽  
Talc Pleurodesis ◽  
Advantages And Disadvantages ◽  
Fluid Analysis ◽  
Important Complication

Pleural effusions are frequently seen in patients on dialysis. A pleuroperitoneal leak or communication is a rare but important cause of pleural effusion in patients on peritoneal dialysis. This diagnosis can be made with a combination of biochemical tests and radiological modalities, in the absence of a gold standard diagnostic test. In addition to thoracocentesis, treatment often involves cessation of peritoneal dialysis and transition to hemodialysis. We describe a case of an 80-year-old man who presented with unilateral right-sided pleural effusion. He underwent therapeutic thoracocentesis and was subsequently diagnosed with a pleuroperitoneal leak through pleural fluid analysis. Peritoneal dialysis was ceased, and he transitioned temporarily to hemodialysis. He was subsequently treated with talc pleurodesis and successfully recommenced on peritoneal dialysis at six weeks after operation. In our report, we also review diagnostic imaging modalities, as well as advantages and disadvantages of each modality. A pleuroperitoneal leak is a rare but important complication of peritoneal dialysis and needs consideration in any patient on peritoneal dialysis presenting with unilateral pleural effusion.

scholarly journals Pleural fluid cholesterol level is an important parameter in differentiating exudative from transudative pleural effusions

2018 ◽  
Vol 5 (3) ◽  
pp. 520
Author(s):  
Chakradhar Majhi ◽  
Butungeshwar Pradhan ◽  
Bikash C. Nanda ◽  
Sagnika Tripathy
Keyword(s):  
Pleural Effusion ◽  
Cholesterol Level ◽  
Pleural Fluid ◽  
Sensitivity And Specificity ◽  
Pleural Effusions ◽  
Biochemical Tests ◽  
Etiological Diagnosis ◽  
Multiple Parameters ◽  
Fluid Analysis ◽  
Cholesterol Levels

Background: The first important step is to decide whether the pleural effusion is transudate or exudates by Light’s criteria. Light’s criteria can misclassify 25% of pleural transudates as exudates. Pleural fluid cholesterol level can differentiate transudates from exudates as a single parameter instead of multiple parameters used in Light’s criteria. Measurement of pleural fluid cholesterol levels to differentiate transudative effusions from exudative effusions.Methods: Consecutive 60 cases of pleural effusion were taken in the study. Pleural fluid analysis was done for parameters of Light’s criteria along with pleural fluid cholesterol levels. First exudative and transudative effusion was classified by Light’s criteria. Other  clinical and relevant  biochemical tests were done to arrive in  the final etiological diagnosis  and data were collected and analysed .Pleural fluid cholesterol levels was  correlated to Light’s criteria.Results: Total 60 cases of pleural effusion were there in the study. There were 43 exudative and 17 transudative effusions. Mean cholesterol level was 64.2± 7.5mg/dl in exudative effusions and 26.05±8.01 mg/dl in transudates. Pleural fluid cholesterol was ≥55mg /dl in 43 cases of exudates and <55mg/dl in 17 cases of transudates.Conclusions: Pleural fluid cholesterol level of ≥ 55mg/dl had similar sensitivity and specificity to Light’s criteria and as a single important parameter to differentiate exudative from transudative pleural effusion

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

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.

scholarly journals Rapidly Progressive Lung Cysts and Pleural Effusion: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Diana Olsen ◽  
Charlene Molloy ◽  
P. S. Sriram
Keyword(s):  
Endothelial Cells ◽  
Case Report ◽  
Pleural Effusion ◽  
Vascular Endothelial Cells ◽  
Vascular Endothelial ◽  
Review Of The Literature ◽  
Pleural Effusions ◽  
Lung Cysts ◽  
Pulmonary Cysts ◽  
Thin Walled

Angiosarcoma is a rare but highly malignant tumor arising from vascular endothelial cells. Angiosarcoma commonly arises from the heart, liver, breast, and skin including the scalp. Angiosarcoma metastasizing to the lungs can present as either pneumothorax, hemothorax, or pleural effusions. They can rarely present as rapidly enlarging thin-walled pulmonary cysts. A review of the literature is included.

scholarly journals Pancreaticopleural fistula: An insidious cause of pleural effusion –case report

2021 ◽  
Author(s):  
Fábio Murteira ◽  
Tiago Costa ◽  
Sara Barbosa Pinto ◽  
Elsa Francisco ◽  
Ana Catarina Gomes
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Case Report ◽  
Pleural Effusion ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pancreatic Amylase ◽  
Pleural Effusions ◽  
Primary Event ◽  
Endoscopic Retrograde ◽  
Left Chest

Pancreaticopleural fistulas (PPF) are a rare etiology of pleural effusions. We describe a case of a 61-year-old man, with left chest pain with six months of progression who presented with a large volume unilateral pleural effusion. A thoracentesis was performed, which showed a dark reddish fluid(exudate) and high content of pancreatic amylase. After that an abdominal computed tomography (CT)and magnetic resonance cholangiopancreatography (MRCP) was done, revealing fistulous pathways that originated in the pancreas. The patient was admitted for conservative and endoscopic treatment by Endoscopic Retrograde Cholangiopancreatography (ERCP) and a prosthesis was placed on a fistulous path. He was discharged without complications, with the resolution of the pleural effusion and fistula.The interest of this case lies in the rarity of the event and absence of symptoms of the probable primary event (acute pancreatitis). The possible iatrogenic association with several drugs of his usual medication makes it even more complex.

scholarly journals Pacemaker-Associated Post-cardiac Injury Syndrome Presenting with Tamponade and Recurrent Pleural Effusion

2020 ◽  
Vol 13 ◽  
pp. 117954762096555
Author(s):  
Young Ju Lee ◽  
Mahmood Mubasher ◽  
Abir Zainal ◽  
Tausif Syed ◽  
Mouhand F.H. Mohamed ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Cardiac Tamponade ◽  
Cardiac Injury ◽  
Pleural Effusions ◽  
Talc Pleurodesis ◽  
Immune Mediated ◽  
Pacemaker Insertion ◽  
Recurrent Pleural Effusion

Post-cardiac injury syndrome (PCIS) is presumed to be an immune-mediated process. It affects the pericardium and, to a lesser extent, the epicardium, myocardium, and pleura. It has been rarely reported following pacemaker insertion with an estimated incidence of 1% to 2%. We present the case of a 62-year-old female who developed PCIS 8 weeks following pacemaker insertion. She presented with impending cardiac tamponade requiring pericardiocentesis; recurrent pleural effusions subsequently complicated her condition. The pleural effusion recurred despite trials of steroids, eventually requiring talc pleurodesis. This case highlights the need to consider PCIS as a possible etiology of recurrent pleural effusion following pacemaker insertion.

scholarly journals Application of Computed Tomography (CT) Attenuation Values in Diagnosis of Transudate and Exudate in Patients with Pleural Effusion

2018 ◽  
Vol 11 (02) ◽  
pp. 19-25
Author(s):  
Keshab Sharma ◽  
PS Lamichhane ◽  
BK Sharma
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Ct Scan ◽  
Pleural Fluid ◽  
Pleural Effusions ◽  
Hounsfield Units ◽  
Fluid Analysis ◽  
Ct Attenuation ◽  
The Mean ◽  
Attenuation Values

Background: Pleural effusion is the pathologic accumulation of fluid in the pleural space. The fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Analysis of pleural fluid by thoracentesis with imaging guidance helps to determine the cause of pleural effusion. The purpose of this study was to assess the accuracy of computed tomography (CT) in characterizing pleural fluid based on attenuation values and CT appearance. Materials and Methods: This prospective study included 100 patients admitted to Gandaki Medical College and Teaching Hospital, Pokhara, Nepal between January 1, 2017 and February 28, 2018. Patients who were diagnosed with pleural effusion and had a chest CT followed by diagnostic thoracentesis within 48 hours were included in the study. Effusions were classified as exudates or transudates using laboratory biochemistry markers on the basis of Light’s criteria. The mean attenuation values of the pleural effusions were measured in Hounsfield units in all patients using a region of interest with the greatest quantity of fluid. Each CT scan was also reviewed for the presence of additional pleural features. Results: According to Light’s criteria, 26 of 100 patients with pleural effusions had transudates, and the remaining patients had exudates. The mean attenuation of the exudates (16.5 ±1.7 HU; 95% CI, range, -33.4 – 44 HU) was significantly higher than the mean attenuation of the transudates (11.6 ±0.57 HU; 95% CI, range, 5 - 16 HU), (P = 0.0001). None of the additional CT features accurately differentiated exudates from transudates (P = 0.70). Fluid loculation was found in 35.13% of exudates and in 19.23% of transudates. Pleural thickening was found in 29.7% of exudates and in 15.3% of transudates. Pleural nodule was found in 10.8% of exudates which all were related to the malignancy. Conclusion: CT attenuation values may be useful in differentiating exudates from transudates. Exudates had significantly higher Hounsfield units in CT scan. Additional signs, such as fluid loculation, pleural thickness, and pleural nodules were more commonly found in patients with exudative effusions and could be considered and may provide further information for the differentiation.

Pleurodesis with Iodized Talc for Malignant Effusions Using Pigtail Catheters

1998 ◽  
Vol 32 (7-8) ◽  
pp. 739-742 ◽  
Author(s):  
Robert L Thompson ◽  
Jonathan C Yau ◽  
Ronald F Donnelly ◽  
Debra J Gowan ◽  
Frederick RK Matzinger
Keyword(s):  
Pleural Effusion ◽  
Tertiary Care ◽  
Pleural Space ◽  
Pigtail Catheter ◽  
Pleural Effusions ◽  
Talc Pleurodesis ◽  
Malignant Pleural Effusions ◽  
Kaplan Meier ◽  
A Prospective Study ◽  
The Cost

OBJECTIVE: To assess the efficacy of using an iodized talc slurry as a sclerosing agent instilled into the pleural space via a 12-French pigtail catheter for controlling malignant pleural effusions. DESIGN: A prospective study in which patients were followed until their death. SETTING: A university-affiliated tertiary-care teaching hospital. PATIENTS: Medical oncology patients admitted with symptomatic malignant pleural effusions were considered for iodized talc pleurodesis. MAIN OUTCOME MEASURES: The control of pleural effusion. Treatment failure was defined as any reaccumulation of fluid in the pleural space. RESULTS: Fifteen patients were treated for a total of 17 instillations. The median follow-up on all patients until death was 6 months (range 1–20). The most frequent adverse effect in the study group was pleuritic chest pain (60%). The probability of control of effusion, as determined by the method of Kaplan–Meier, was 81% (SEM 9.7%). The cost of preparing 5 g of iodized talc was $4.32 (US). CONCLUSIONS: Iodized talc slurry instilled through a small-bore pigtail catheter is a safe, economical, and effective treatment for malignant pleural effusion.

scholarly journals The Use of Thoracic Ultrasound to Predict Transudative and Exudative Pleural Effusion

POCUS Journal ◽  
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.

Pleural Effusion

2015 ◽  
Author(s):  
Rafael S. Andrade ◽  
Eitan Podgaetz
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Tube Placement ◽  
Pleural Effusions ◽  
Computed Tomographic ◽  
Fluid Analysis ◽  
Management Algorithm ◽  
Practical Guidelines ◽  
Basic Facts ◽  
Subcutaneous Tunneling

Pleural effusions can occur in a wide variety of clinical situations. The most important test for the initial diagnosis and evaluation of a pleural effusion is the chest radiograph. Further investigation, such as imaging, pleural fluid analysis, pleural biopsy, and thoracoscopy, may be required to determine the etiology of the pleural effusion. This review covers the clinical evaluation, investigative studies, and management of pleural effusion, as well as basic facts of the pleura. An algorithm shows the approach to the patient with a pleural effusion. Figures show chest radiographs of patients with pleural effusion; six computed tomographic scans (showing right-side empyema showing a loculated effusion; a free-flowing, sickle-shaped, right-side effusion; parapneumonic effusion [PPE] at diagnosis, after initial chest tube placement, and after fibrinolytics; and left-side chylothorax secondary to lymphoma); an algorithm to manage known malignant pleural effusions; and a photograph of a PleurX catheter after placement and subcutaneous tunneling. Tables list the pathophysiologic mechanisms of pleural effusion, differential diagnosis for pleural effusions, relationship between pleural fluid appearance and causes, pleural fluid tests for causative assessment, practical guidelines for definitive management of malignant pleural effusion, and categorization of PPE by risk of poor outcome. Techniques for bedside thoracentesis and tube thoracostomy as well as for bedside fibrinolytic use are also presented. This review contains 1 management algorithm, 8 figures, 6 tables, and 92 references.

scholarly journals Chylothorax in a patient with HIV-related Kaposi’s sarcoma

2019 ◽  
Vol 12 (1) ◽  
pp. e227641 ◽  
Author(s):  
Sonia Cherian ◽  
Onyeka Maureen Umerah ◽  
Muhammad Tufail ◽  
Rakesh K Panchal
Keyword(s):  
Case Report ◽  
Antiretroviral Therapy ◽  
Pleural Effusion ◽  
Kaposi's Sarcoma ◽  
Kaposi’S Sarcoma ◽  
Hiv Patients ◽  
Chest Drainage ◽  
Talc Pleurodesis ◽  
Clinical Control

We present a case of a 33-year-old man with a background of HIV and Kaposi’s sarcoma (KS), who presented with a right sided chylothorax. He was managed with percutaneous chest drainage and talc pleurodesis, in addition to his chemotherapy and antiretroviral therapy for KS and HIV, respectively. Good clinical control of the chylothorax remained 4 months post drainage. This case report summarises the approach to investigating and managing pleural effusion, and in particular chylothorax, in HIV patients.

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