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Annals of Oncology : Official Journal... 1995Lung cancer presenting with ipsilateral pleural effusion is considered to have a poor prognosis. Thoracoscopy has been invoked as a useful tool for staging those cases... (Review)
Review
Lung cancer presenting with ipsilateral pleural effusion is considered to have a poor prognosis. Thoracoscopy has been invoked as a useful tool for staging those cases before proceeding to thoracotomy, especially in patients with large pleural effusions. In cases where there is only a small effusion or no effusion at all, direct thoracotomy would be the choice, with pleural lavage during the operation and immediate cytology investigation. We performed thoracoscopy in 76 patients with lung cancer and ipsilateral pleural effusion (55 cytologically positive and the remaining negative), and we found only five cases with potentially resectable tumor. They were submitted to thoracotomy and resection could be accomplished in none of them, due to direct mediastinal tumor invasion. On the other hand, we found visceral pleura involvement without effusion in 31 out of 167 patients submitted to thoracotomy for lung cancer in our Institution. The tumor could be resected in all but one of these cases. Talc pleurodesis was performed in all patients who were found to have pleural effusion and non-resectable tumor at thoracoscopy, and we obtained a 68% success rate in cases with no trapped lung, as opposed to 56% in patients with trapped lung (massively covered by fibrin and/or tumor). Pleural fluid glucose and pH are good predictors of the outcome of pleurodesis.
Topics: Cytodiagnosis; Humans; Lung Neoplasms; Neoplasm Staging; Pleural Effusion, Malignant; Pleural Neoplasms; Thoracoscopy
PubMed: 8616109
DOI: 10.1093/annonc/6.suppl_3.s25 -
PloS One 2013The diagnosis of pleural tuberculosis (TB) remains to be difficult. Interferon-gamma release assay (IGRA) is a promising method for diagnosing TB in low TB burden...
BACKGROUND
The diagnosis of pleural tuberculosis (TB) remains to be difficult. Interferon-gamma release assay (IGRA) is a promising method for diagnosing TB in low TB burden countries. The release of interferon-gamma (IFN-γ) by T lymphocytes increases at a localized site of infection with Mycobacterium tuberculosis antigen. This study aimed to examine the clinical accuracy of T-SPOT.TB on pleural fluid and peripheral blood for the diagnosis of pleural TB in high TB burden country.
METHODS
168 subjects with pleural effusion were enrolled prospectively and examined with T-SPOT.TB on pleural fluid and peripheral blood samples simultaneously.
RESULTS
The receiver operating characteristic (ROC) curve and cut-off value of pleural fluid T-SPOT.TB was established according to spot forming cells (SFC) between culture/biopsy-confirmed pleural TB group and no pleural TB group. The sensitivity of pleural fluid T-SPOT.TB and peripheral blood T-SPOT.TB was similar (96.3% and 92.7%, respectively) (P= 0.691). In contrast, the specificity of pleural fluid T-SPOT.TB (94.5%) was significantly higher than that of peripheral blood T-SPOT.TB (76.1%) (P=0.002). 2% (2/98) of pleural fluid T-SPOT.TB results were indeterminate.
CONCLUSION
The diagnostic accuracy of peripheral blood T-SPOT.TB is low in high TB burden countries due to latent tuberculosis infection. Pleural fluid T-SPOT.TB is a relatively useful and supplementary test to explore pleural TB in high TB burden countries, but its diagnostic accuracy needs to be validated in further large scale research.
Topics: Adenosine Deaminase; Adult; Aged; Body Fluids; Female; Humans; Interferon-gamma Release Tests; Male; Middle Aged; Pleura; ROC Curve; Tuberculosis, Pleural
PubMed: 24386296
DOI: 10.1371/journal.pone.0083857 -
BMC Pulmonary Medicine Mar 2021Pleural effusion (PE) is a common clinical manifestation, and millions of people suffer from pleural disease. Herein, this retrospective study was performed to evaluate... (Comparative Study)
Comparative Study
PURPOSE
Pleural effusion (PE) is a common clinical manifestation, and millions of people suffer from pleural disease. Herein, this retrospective study was performed to evaluate the biomarkers and ratios in serum and pleural fluid (PF) for the differential diagnosis of the multiple types of PE and search for a new diagnostic strategy for PE.
METHODS
In-patients, who developed tuberculous PE (TPE), malignant PE (MPE), complicated parapneumonic effusion (CPPE), uncomplicated PPE (UPPE), or PE caused by connective tissue diseases (CTDs) and underwent thoracentesis at Peking University People's Hospital from November 2016 to April 2019, were included in this study. Eleven biomarkers and their ratios in serum and PF were investigated and compared between pairs of the different PE groups, and a decision-tree was developed.
RESULTS
Totally 112 PE cases, including 25 MPE, 33 TPE, 19 CPPE, 27 UPPE, and 8 PE caused by CTDs, were reviewed. Biomarkers and ratios showed good diagnostic performance with high area under the curve values, sensitivities, and specificities for the differential diagnosis of the multiple types of PE. According to the decision-tree analysis, the combination of adenosine deaminase (ADA), serum albumin, serum lactate dehydrogenase, total protein, PF-LDH/ADA, and PF-LDH/TP provided the best predictive capacity with an overall accuracy of 84.8%; the sensitivity and specificity for TPE diagnosis were 100% and 98.7%, respectively.
CONCLUSION
The biomarkers and ratios showed good diagnostic performance, and a decision-tree with an overall accuracy of 84.8% was developed to differentiate the five types of PE in clinical settings.
Topics: Adenosine Deaminase; Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Diagnosis, Differential; Exudates and Transudates; Female; Humans; L-Lactate Dehydrogenase; Male; Middle Aged; Pleura; Pleural Effusion; Pleural Effusion, Malignant; Retrospective Studies; Sensitivity and Specificity; Serum Albumin; Thoracentesis; Tuberculosis, Pleural; Young Adult
PubMed: 33740937
DOI: 10.1186/s12890-021-01459-w -
Cureus Apr 2023Empyema is a severe complication of pneumonia with high morbidity and mortality rates. Rapid diagnosis and tailoring of antibiotic therapy are crucial to treatment...
Empyema is a severe complication of pneumonia with high morbidity and mortality rates. Rapid diagnosis and tailoring of antibiotic therapy are crucial to treatment success for these severe bacterial lung infections. A Streptococcus pneumoniae ( antigen test drawn from the pleural fluid rather than a urine sample has been found to have equivalent diagnostic utility to the urinary antigen test. Discordance between these tests is rare. We report a case of a 69-year-old female with CT imaging findings consistent with empyema and a bronchopulmonary fistula. A rapid antigen test was negative from the urinary sample but positive when drawn from a patient's pleural fluid sample. Final pleural fluid cultures resulted in (S. constellatus). This case demonstrates discordance between the results of urinary and pleural fluid antigen tests, representing a potential pitfall in using rapid antigen testing on pleural fluid samples. False positives for the antigen in patients with viridans streptococci infections have been documented due to the cross-reactivity of cell wall proteins in different streptococcal species. Physicians encountering bacterial pneumonia of unknown etiology complicated by empyema should understand the potential for discordance and false positives using this diagnostic method.
PubMed: 37187652
DOI: 10.7759/cureus.37458 -
Radiology Case Reports Dec 2021We describe a 78-year-old initially presenting with left breast cancer, status post mastectomy and bilateral dual-lumen breast implant placement, subsequently developed...
We describe a 78-year-old initially presenting with left breast cancer, status post mastectomy and bilateral dual-lumen breast implant placement, subsequently developed lung cancer years later status post lobectomy, who later developed FDG-avid pleural nodularity and thickening. The differential diagnosis of pleural thickening and nodularity can be broad, including metastatic cancer, asbestos-related pleural disease, loculated fluid (including simple pleural effusion, hemothorax, or chylothorax), and pleural infection. However, in the setting of two different primary malignancies, our patient's FGD-avid pleural thickening was concerning for metastatic disease. Further workup with a core-needle biopsy of the pleural nodule revealed "droplets of foreign material and foreign body giant cell reaction consistent with contents of ruptured medical device", without evidence of malignancy. Prior imaging did not indicate breast implant compromise. A subsequent mammogram suggested findings of bilateral implant rupture, however, no further clinical workup was performed. A screening mammogram a decade later indicated possible extracapsular silicone within the right breast and left mastectomy site and an MRI was recommended for further workup. Subsequent MRI showed bilateral extracapsular silicone implant rupture with a thick layer of silicone signal within the left pleura in a similar distribution to her pleural thickening and nodularity. Her breast MRI findings, in conjunction with her pleural biopsy result, are concordant with pleural silicone granulomas from extracapsular breast implant rupture via radio-occult tract from prior left lobectomy procedure.
PubMed: 34745399
DOI: 10.1016/j.radcr.2021.08.060 -
International Journal of Molecular... Oct 2022Mesothelial cells (MCs) play a classic role in maintaining homeostasis in pleural, peritoneal, and pericardial cavities. MCs work as lubricants to reduce friction... (Review)
Review
Mesothelial cells (MCs) play a classic role in maintaining homeostasis in pleural, peritoneal, and pericardial cavities. MCs work as lubricants to reduce friction between organs, as regulators of fluid transport, and as regulators of defense mechanisms in inflammation. MCs can differentiate into various cells, exhibiting epithelial and mesenchymal characteristics. MCs have a high potential for differentiation during the embryonic period when tissue development is active, and this potential decreases through adulthood. The expression of the Wilms' tumor suppressor gene (), one of the MC markers, decreased uniformly and significantly from the embryonic period to adulthood, suggesting that it plays a major role in the differentiation potential of MCs. deletion from the embryonic period results in embryonic lethality in mice, and even knockout in adulthood leads to death with rapid organ atrophy. These findings suggest that MCs expressing have high differentiation potential and contribute to the formation and maintenance of various tissues from the embryonic period to adulthood. Because of these properties, MCs dynamically transform their characteristics in the tumor microenvironment as cancer-associated MCs. This review focuses on the relationship between the differentiation potential of MCs and , including recent reports using lineage tracing using the Cre-loxP system.
Topics: Adult; Animals; Cell Differentiation; Humans; Lubricants; Mice; Pleura
PubMed: 36233262
DOI: 10.3390/ijms231911960 -
Heart & Lung : the Journal of Critical... 2021COVID-19-related pleural effusions are frequently described during the ongoing pandemic.
BACKGROUND
COVID-19-related pleural effusions are frequently described during the ongoing pandemic.
OBJECTIVES
We described the incidence, characteristics, and outcomes of COVID-19-related pleural effusions based on the current evidence available in the literature.
METHODS
We searched MEDLINE, Pubmed, and Google Scholar databases using keywords of "coronavirus disease 2019 (COVID-19)," "severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)," "pleural effusion," "pleural fluid," and "pleura" from January 1st, 2020 to January 31st, 2021.
RESULTS
The incidence of pleural effusions was low at 7.3% among the 47 observational studies. Pleural effusions were commonly observed in critically ill patients and had Multisystem Inflammatory Syndrome (MIS). COVID-19-related pleural effusions were identified 5-7 days and 11 days, after hospital admission and onset of COVD-19 symptoms. The characteristic findings of pleural fluid were exudative, lymphocytic or neutrophilic-predominant pleural fluid with markedly elevated lactate dehydrogenase (LDH) levels and pleural fluid to serum LDH ratio.
CONCLUSION
A well-designed study is required to assess the significance of COVID-19-related pleural effusions during this current pandemic.
Topics: COVID-19; Humans; Incidence; Pleural Effusion; Pneumonia; SARS-CoV-2
PubMed: 33831700
DOI: 10.1016/j.hrtlng.2021.02.015 -
Journal of the Mechanical Behavior of... Jan 2019Pleural effusion manifests as compression of pleural fluid on the lung parenchyma contributing to hypoxemia. Medical procedures such as drainage of plural fluid releases...
Pleural effusion manifests as compression of pleural fluid on the lung parenchyma contributing to hypoxemia. Medical procedures such as drainage of plural fluid releases this compression and increases oxygenation. However, the effect of pleural effusion on the elasticity of lung parenchyma is unknown. By using lung ultrasound surface wave elastography (LUSWE) and finite element method (FEM), the effect of pleural effusion on the elasticity of superficial lung parenchyma in terms of surface wave speed measurement was evaluated in a sponge phantom study. Different thicknesses of ultrasound transmission gel used to simulated pleural fluid were inserted into a condom, which was placed between the sponge and standoff pad. A mechanical shaker was used to generate vibration on the sponge phantom at different frequencies ranging from 100 to 300 Hz while the ultrasound transducer was used to capture the motion for measurement of surface wave speed of the sponge. FEM was conducted based on the experimental setup and numerically assessed the influence of pleural effusion on the surface wave speed of the sponge. We found from FEM experiments that the influence of thickness of ultrasound transmission gel was statistically insignificant on the surface wave speed of the sponge at 100 and 150 Hz.
Topics: Biomechanical Phenomena; Body Fluids; Elasticity; Elasticity Imaging Techniques; Finite Element Analysis; Lung; Phantoms, Imaging; Pleural Effusion
PubMed: 30236977
DOI: 10.1016/j.jmbbm.2018.09.007 -
Respiratory Research Nov 2019Chemical pleurodesis is a therapeutic procedure applied to create the symphysis between the parietal and visceral pleura by intrapleural administration of various... (Review)
Review
Chemical pleurodesis is a therapeutic procedure applied to create the symphysis between the parietal and visceral pleura by intrapleural administration of various chemical agents (e.g. talk, tetracycline, iodopovidone, etc.). The two major clinical conditions treated with chemical pleurodesis are recurrent pleural effusion (PE) and recurrent spontaneous pneumothorax. Although the history of chemical pleurodesis began over a century ago, detailed data on the mechanisms of action of sclerosing agents are highly incomplete. The following article aims to present the state of knowledge on this subject.It is believed that mesothelial cells are the main structural axis of pleurodesis. In response to sclerosing agents they secrete a variety of mediators including chemokines such as interleukin 8 (IL-8) and monocyte chemoattractant protein (MCP-1), as well as growth factors - vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF) and transforming growth factor- β (TGF-β). Numerous data suggest that intact mesothelial cells and the above cytokines play a crucial role in the initiation and maintenance of different pathways of pleural inflammation and pleural space obliteration.It seems that the process of pleurodesis is largely nonspecific to the sclerosant and involves the same ultimate pathways including activation of pleural cells, coagulation cascade, fibrin chain formation, fibroblast proliferation and production of collagen and extracellular matrix components. Of these processes, the coagulation cascade with decreased fibrinolytic activity and increased fibrinogenesis probably plays a pivotal role, at least during the early response to sclerosant administration.A better understanding of various pathways involved in pleurodesis may be a prerequisite for more effective and safe use of various sclerosants and for the development of new, perhaps more personalized therapeutic approaches.
Topics: Animals; Fibrinolysis; Fibrosis; Humans; Pleura; Pleurodesis; Sclerosing Solutions; Signal Transduction; Talc; Treatment Outcome
PubMed: 31699094
DOI: 10.1186/s12931-019-1204-x -
European Journal of Radiology Jul 2024This study investigated strategies to reduce pneumothorax risk in CT-guided lung biopsy. The approach involved administering 10 ml of 1 % lidocaine fluid in the...
Pneumothorax risk reduction during CT-guided lung biopsy - Effect of fluid application to the pleura before lung puncture and the gravitational effect of pleural pressure.
PURPOSE
This study investigated strategies to reduce pneumothorax risk in CT-guided lung biopsy. The approach involved administering 10 ml of 1 % lidocaine fluid in the subpleural or pleural space before lung puncture and utilizing the gravitational effect of pleural pressure with specific patient positioning.
METHOD
We retrospectively analyzed 72 percutaneous CT-guided lung biopsies performed at a single center between January 2020 and April 2023. These were grouped based on fluid administration during the biopsy and whether the biopsies were conducted in dependent or non-dependent lung regions. Confounding factors like patient demographics, lesion characteristics, and procedural details were assessed. Patient characteristics and the occurrence of pneumothoraces were compared using a Kurskal-Wallis test for continuous variables and a Fisher's exact test for categorical variables. Multivariable logistic regression was used to identify potential confounders.
RESULTS
Subpleural or pleural fluid administration and performing biopsies in dependent lung areas were significantly linked to lower peri-interventional pneumothorax incidence (n = 15; 65 % without fluid in non-dependent areas, n = 5; 42 % without fluid in dependent areas, n = 5; 36 % with fluid in non-dependent areas,n = 0; 0 % with fluid in dependent areas; p = .001). Even after adjusting for various factors, biopsy in dependent areas and fluid administration remained independently associated with reduced pneumothorax risk (OR 0.071, p<=.01 for lesions with fluid administration; OR 0.077, p = .016 for lesions in dependent areas).
CONCLUSIONS
Pre-puncture fluid administration to the pleura and consideration of gravitational effects during patient positioning can effectively decrease pneumothorax occurrences in CT-guided lung biopsy.
Topics: Humans; Female; Male; Tomography, X-Ray Computed; Pneumothorax; Image-Guided Biopsy; Retrospective Studies; Middle Aged; Pleura; Aged; Lung; Radiography, Interventional; Gravitation; Lidocaine; Patient Positioning; Adult; Pressure; Punctures
PubMed: 38810440
DOI: 10.1016/j.ejrad.2024.111529