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Annals of Diagnostic Pathology Apr 2023Primary effusion lymphoma (PEL) is a rare neoplasm that arises in the context of severe immunosuppression. Acquired immunodeficiency syndrome (AIDS) as a result of human... (Review)
Review
Primary effusion lymphoma (PEL) is a rare neoplasm that arises in the context of severe immunosuppression. Acquired immunodeficiency syndrome (AIDS) as a result of human immunodeficiency virus (HIV) infection is the most common cause of immunodeficiency in patients who develop PEL. These neoplasms usually involve one or more body cavities, so-called classic PEL. The pleural cavity is most often involved, followed by the peritoneal and pericardial cavities. Involvement of the cerebrospinal fluid (CSF) and meninges is rare. A subset of patients can present with a tissue-based mass, known as the extracavitary variant. We encountered a patient with HIV infection and severe immunosuppression who presented initially with mediastinal, retroperitoneal mass and bilateral pleural effusions. He subsequently developed CSF involvement. Despite therapy, the patient relapsed with chest wall disease 6 months later and died shortly thereafter. Our literature review yielded about 400 cases of PEL reported previously. About 65 % of PEL patients have had AIDS, but a subset of patients had immunosuppression attributable to organ transplantation or physiological immunosenescence. CSF involvement has been reported in ~2 % of patients, and about 10 % of patients had both body cavity and extracavitary disease. The pathologic findings in this case were typical of extracavitary PEL. The neoplastic cells had features of plasmablasts and were positive for HHV-8, Epstein-Barr virus encoded RNA (EBER) and plasma cell associated markers, and were negative for B-cell antigens. The prognosis of patients with PEL is usually poor with a median survival less than one year in most studies. We use this patient's case as an illustration of PEL and we review the clinicopathologic findings and differential diagnosis of PEL.
Topics: Male; Humans; Lymphoma, Primary Effusion; HIV Infections; Epstein-Barr Virus Infections; Pleural Cavity; Acquired Immunodeficiency Syndrome; Herpesvirus 4, Human; Herpesvirus 8, Human
PubMed: 36577188
DOI: 10.1016/j.anndiagpath.2022.152084 -
Khirurgiia 2021To analyze the anatomometric characteristics of post-pneumonectomy cavity and their changes at various times after surgery.
OBJECTIVE
To analyze the anatomometric characteristics of post-pneumonectomy cavity and their changes at various times after surgery.
MATERIAL AND METHODS
The study included 47 patients aged 39-75 years after pneumonectomy (right-sided - 23 cases, left-sided - 24 cases). Computed tomography was performed prior to surgery, in 10-12 days, 6 and 12 months after intervention. Transverse, anteroposterior dimensions, height and volume of pleural cavity were evaluated using CT scans and 3D models.
RESULTS
Post-pneumonectomy cavity decreases and changes own shape in postoperative period. Reduction is mainly caused by decrease in its height. The volume of post-pneumonectomy cavity was decreased in early postoperative period by 1.8 times compared to preoperative values (from 3351.5±150.0 cm to 2112.1±152.6 cm on the right side and from 2674.3±125.2 cm to 1460.1±84.1 cm on the left side). After 12 months, this value was reduced by 3.68 times compared to early postoperative period (714.3±100.7 cm on the right and 401.5±42.5 cm on the left). The shape changes consist of flattening and sinus depth reduction. Exudate density was similar throughout a year. The capsule was formed in 74.1% of patients after 12 months. There was no correlation between the cavity reduction and patient constitution.
CONCLUSION
Post-pneumonectomy cavity is a dynamically changing anatomical formation participating in the mechanisms of compensation for changes after pneumonectomy. The most significant collapse of post-pneumonectomy cavity occurs in early postoperative period. Cavity reduction degree does not depend on individual characteristics of patients.
Topics: Adult; Aged; Humans; Middle Aged; Pleural Cavity; Pneumonectomy; Postoperative Period; Tomography, X-Ray Computed
PubMed: 33977696
DOI: 10.17116/hirurgia202105132 -
Journal of Thoracic Imaging Jul 2016Routine posteroanterior chest radiographs and computed tomography scans are more sensitive for detecting pneumothoraces than anteroposterior chest radiographs. However,... (Review)
Review
Routine posteroanterior chest radiographs and computed tomography scans are more sensitive for detecting pneumothoraces than anteroposterior chest radiographs. However, supine chest radiographs are commonly performed as part of the initial and routine assessment of trauma and critically ill patients. Rates of occult pneumothorax can be as high as 50% and have a significant impact in the mortality of these patients; thus, a prompt diagnosis of this entity is important. This pictorial essay will illustrate the pleural anatomy, explain the distribution of air within the pleural space in the supine position, and review the radiologic findings that characterize this entity.
Topics: Humans; Pleural Cavity; Pneumothorax; Radiography, Thoracic; Supine Position; Tomography, X-Ray Computed
PubMed: 27105051
DOI: 10.1097/RTI.0000000000000216 -
American Journal of Respiratory Cell... Jul 2024Mechanical ventilation contributes to the morbidity and mortality of patients in intensive care, likely through the exacerbation and dissemination of inflammation....
Mechanical ventilation contributes to the morbidity and mortality of patients in intensive care, likely through the exacerbation and dissemination of inflammation. Despite the proximity of the pleural cavity to the lungs and exposure to physical forces, little attention has been paid to its potential as an inflammatory source during ventilation. Here, we investigate the pleural cavity as a novel site of inflammation during ventilator-induced lung injury. Mice were subjected to low or high tidal volume ventilation strategies for up to 3 hours. Ventilation with a high tidal volume significantly increased cytokine and total protein levels in BAL and pleural lavage fluid. In contrast, acid aspiration, explored as an alternative model of injury, only promoted intraalveolar inflammation, with no effect on the pleural space. Resident pleural macrophages demonstrated enhanced activation after injurious ventilation, including upregulated ICAM-1 and IL-1β expression, and the release of extracellular vesicles. ventilation and stretch of pleural mesothelial cells promoted ATP secretion, whereas purinergic receptor inhibition substantially attenuated extracellular vesicles and cytokine levels in the pleural space. Finally, labeled protein rapidly translocated from the pleural cavity into the circulation during high tidal volume ventilation, to a significantly greater extent than that of protein translocation from the alveolar space. Overall, we conclude that injurious ventilation induces pleural cavity inflammation mediated through purinergic pathway signaling and likely enhances the dissemination of mediators into the vasculature. This previously unidentified consequence of mechanical ventilation potentially implicates the pleural space as a focus of research and novel avenue for intervention in critical care.
Topics: Animals; Ventilator-Induced Lung Injury; Pleural Cavity; Mice, Inbred C57BL; Inflammation; Mice; Respiration, Artificial; Tidal Volume; Macrophages; Adenosine Triphosphate; Extracellular Vesicles; Male; Cytokines; Bronchoalveolar Lavage Fluid; Disease Models, Animal; Interleukin-1beta
PubMed: 38767348
DOI: 10.1165/rcmb.2023-0332OC -
Radiologia May 2021Pleural appendages (PA) are portions of extrapleural fat that hang from the chest wall. They have been described on videothoracoscopy, however their appearance,...
BACKGROUND AND AIMS
Pleural appendages (PA) are portions of extrapleural fat that hang from the chest wall. They have been described on videothoracoscopy, however their appearance, frequency and possible relationship with the amount of patient's fat remain unknown. Our aim is to describe their appearances and prevalence on CT, and determinate whether their size and number is higher in obese patients.
PATIENTS AND METHODS
Axial images of 226 patients with pneumothorax on CT chest were retrospectively reviewed. Exclusion criteria included known pleural disease, previous thoracic surgery and small pneumothorax. Patients were divided in obese (BMI > 30) and non-obese (BMI < 30) groups. Presence, position, size and number of PA were recorded. Chi square and Fisher's exact test were used to evaluate differences between the two groups, considering p<0.05 as significant.
RESULTS
Valid CT studies were available for 101 patients. Extrapleural fat was identified in 50 (49.5%) patients. Most were solitary (n=31). Most were located in the cardiophrenic angle (n=27), and most measured < 5cm (n=39). There was no significant difference between obese and non-obese patients regarding the presence or absence of PA (p=0.315), number (p=0.458) and size (p=0.458).
CONCLUSIONS
Pleural appendages were seen in 49.5% patients with pneumothorax on CT. There was no significant difference between obese and non-obese patients regarding presence, number and size of pleural appendages.
PubMed: 34034900
DOI: 10.1016/j.rx.2021.03.008 -
PloS One 2016Pleural tuberculosis (TB), a form of extrapulmonary TB, can be difficult to diagnose. High numbers of lymphocytes in pleural fluid have been considered part of the... (Comparative Study)
Comparative Study
Pleural tuberculosis (TB), a form of extrapulmonary TB, can be difficult to diagnose. High numbers of lymphocytes in pleural fluid have been considered part of the diagnostic criteria for pleural TB; however, in many cases, neutrophils rather than lymphocytes are the predominant cell type in pleural effusions, making diagnosis more complicated. Additionally, there is limited information on the clinical and laboratory characteristics of neutrophil-predominant pleural effusions caused by Mycobacterium tuberculosis (MTB). To investigate clinical and laboratory differences between lymphocyte- and neutrophil-predominant pleural TB, we retrospectively analyzed 200 patients with the two types of pleural TB. Of these patients, 9.5% had neutrophil-predominant pleural TB. Patients with lymphocyte-predominant and neutrophil-predominant pleural TB showed similar clinical signs and symptoms. However, neutrophil-predominant pleural TB was associated with significantly higher inflammatory serum markers, such as white blood cell count (P = 0.001) and C-reactive protein (P = 0.001). Moreover, MTB was more frequently detected in the pleural fluid from patients in the neutrophil-predominant group than the lymphocyte-predominant group, with the former group exhibiting significantly higher rates of positive results for acid-fast bacilli in sputum (36.8 versus 9.4%, P = 0.003), diagnostic yield of MTB culture (78.9% versus 22.7%, P < 0.001) and MTB detected by polymerase chain reaction (31.6% versus 5.0%, P = 0.001). Four of seven patients with repeated pleural fluid analyses revealed persistent neutrophil-predominant features, which does not support the traditional viewpoint that neutrophil-predominant pleural TB is a temporary form that rapidly develops into lymphocyte-predominant pleural TB. In conclusion, neutrophil-predominant pleural TB showed a more intense inflammatory response and a higher positive rate in microbiological testing compared to lymphocyte-predominant pleural TB. Pleural TB should be considered in neutrophil-predominant pleural effusions, and microbiological tests are warranted.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Laboratories; Lymphocytes; Male; Middle Aged; Neutrophils; Pleural Cavity; Sputum; Tuberculosis, Pleural
PubMed: 27788218
DOI: 10.1371/journal.pone.0165428 -
Ultrasound in Medicine & Biology May 2021We aimed to explore the value of contrast-enhanced ultrasound (CEUS) of the pleural cavity in locating catheters and identifying fibrous septa and to compare CEUS with... (Comparative Study)
Comparative Study Randomized Controlled Trial
We aimed to explore the value of contrast-enhanced ultrasound (CEUS) of the pleural cavity in locating catheters and identifying fibrous septa and to compare CEUS with multiple existing methods. We included 304 participants whose pleural effusion could not continue to be drained and compared the catheter-localization capabilities of empirical diagnosis, B-mode ultrasound with normal saline and CEUS, with computed tomography as the reference standard. CEUS performed the best (accuracy, 100%; sensitivity, 100%; specificity, 100%), followed by B-mode ultrasound with normal saline (accuracy, 77.78%; sensitivity, 62.5%; specificity, 100%), and finally empirical diagnosis (accuracy, 54.17%; sensitivity, 66.67%; specificity, 33.33%). The capabilities of CEUS and computed tomography to identify fibrous septa were evaluated, with B-mode ultrasound as the reference, and CEUS (accuracy, 100%; sensitivity, 100%; specificity, 100%) was superior to computed tomography (accuracy, 82.41%; sensitivity, 26.09%; specificity, 97.65%). Overall, CEUS can accurately locate catheters and identify fibrous septa, with performance superior to existing methods.
Topics: Adult; Aged; Catheters; Contrast Media; Double-Blind Method; Female; Humans; Male; Middle Aged; Pleural Cavity; Prospective Studies; Ultrasonography
PubMed: 33541751
DOI: 10.1016/j.ultrasmedbio.2021.01.011 -
Journal of Applied Physiology... Jan 2020Esophageal pressure has been suggested as adequate surrogate of the pleural pressure. We investigate after lung surgery the determinants of the esophageal and...
Esophageal pressure has been suggested as adequate surrogate of the pleural pressure. We investigate after lung surgery the determinants of the esophageal and intrathoracic pressures and their differences. The esophageal pressure (through esophageal balloon) and the intrathoracic/pleural pressure (through the chest tube on the surgery side) were measured after surgery in 28 patients immediately after lobectomy or wedge resection. Measurements were made in the nondependent lateral position (without or with ventilation of the operated lung) and in the supine position. In the lateral position with the nondependent lung, collapsed or ventilated, the differences between esophageal and pleural pressure amounted to 4.4 ± 1.6 and 5.1 ± 1.7 cmHO. In the supine position, the difference amounted to 7.3 ± 2.8 cmHO. In the supine position, the estimated compressive forces on the mediastinum were 10.5 ± 3.1 cmHO and on the iso-gravitational pleural plane 3.2 ± 1.8 cmHO. A simple model describing the roles of chest, lung, and pneumothorax volume matching on the pleural pressure genesis was developed; modeled pleural pressure = 1.0057 × measured pleural pressure + 0.6592 ( = 0.8). Whatever the position and the ventilator settings, the esophageal pressure changed in a 1:1 ratio with the changes in pleural pressure. Consequently, chest wall elastance (E) measured by intrathoracic (E = ΔPpl/tidal volume) or esophageal pressure (E = ΔPes/tidal volume) was identical in all the positions we tested. We conclude that esophageal and pleural pressures may be largely different depending on body position (gravitational forces) and lung-chest wall volume matching. Their changes, however, are identical. Esophageal and pleural pressure changes occur at a 1:1 ratio, fully justifying the use of esophageal pressure to compute the chest wall elastance and the changes in pleural pressure and in lung stress. The absolute value of esophageal and pleural pressures may be largely different, depending on the body position (gravitational forces) and the lung-chest wall volume matching. Therefore, the absolute value of esophageal pressure should not be used as a surrogate of pleural pressure.
Topics: Aged; Esophagus; Female; Humans; Lung; Lung Compliance; Lung Volume Measurements; Male; Pleural Cavity; Positive-Pressure Respiration; Posture; Pressure; Respiratory Mechanics
PubMed: 31774352
DOI: 10.1152/japplphysiol.00587.2019 -
Monaldi Archives For Chest Disease =... Sep 2023Chylothorax indicates the accumulation of chyle in the pleural cavity. It is a rare cause of pleural effusion, especially bilaterally. In clinical practice, the presence...
Chylothorax indicates the accumulation of chyle in the pleural cavity. It is a rare cause of pleural effusion, especially bilaterally. In clinical practice, the presence of milky fluid in the pleural cavity raises the suspicion of chylothorax. The most common cause is trauma, iatrogenic or non, owing to thoracic duct injury, which transports chyle from the lymphatic system into the bloodstream. The case we describe is of a 53-year-old female who was referred to our hospital with bilateral pleural effusions and a left supraclavicular mass. From the diagnostic studies, the nontraumatic causes of chylothorax were excluded. The potential diagnosis was traumatic chylothorax, a diagnosis of exclusion, as it appeared after muscle stretch and receded with a fat-free diet and repose without any relapse.
PubMed: 37768210
DOI: 10.4081/monaldi.2023.2684 -
International Journal of Nanomedicine 2020Malignant pleural effusion (MPE) is the accumulation of fluid in the pleural cavity as a result of malignancies affecting the lung, pleura and mediastinal lymph nodes....
BACKGROUND
Malignant pleural effusion (MPE) is the accumulation of fluid in the pleural cavity as a result of malignancies affecting the lung, pleura and mediastinal lymph nodes. Curcumin, a compound found in turmeric, has anti-cancer properties that could not only treat MPE accumulation but also reduce cancer burden. To our knowledge, direct administration of curcumin into the pleural cavity has never been reported, neither in animals nor in humans.
PURPOSE
To explore the compartmental distribution, targeted pharmacokinetics and the safety profile of liposomal curcumin following intrapleural and intravenous administration.
METHODS
Liposomal curcumin (16 mg/kg) was administered into Fischer 344 rats by either intrapleural injection or intravenous infusion. The concentration of curcumin in plasma and tissues (lung, liver and diaphragm) were measured using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Blood and tissues were examined for pathological changes.
RESULTS
No pleural or lung pathologies were observed following intrapleural liposomal curcumin administration. Total curcumin concentration peaked 1.5 hrs after the administration of intrapleural liposomal curcumin and red blood cell morphology appeared normal. A red blood cells abnormality (echinocytosis) was observed immediately and at 1.5 hrs after intravenous infusion of liposomal curcumin.
CONCLUSION
These results indicate that liposomal curcumin is safe when administered directly into the pleural cavity and may represent a viable alternative to intravenous infusion in patients with pleural-based tumors.
Topics: Administration, Intravenous; Animals; Chromatography, Liquid; Curcumin; Female; Liposomes; Lung; Male; Pleural Cavity; Pleural Neoplasms; Rats, Inbred F344; Tandem Mass Spectrometry; Tissue Distribution
PubMed: 32103948
DOI: 10.2147/IJN.S237536