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undiagnosed pleural effusion

Sachin S Dole, Gauri P Godbole, Himanshu S Pophale
BACKGROUND: Medical thoracoscopy has received interest in recent past for diagnostic as well as therapeutic uses. In this study we describe our experience with diagnostic medical thoracoscopy in pleural effusions of undiagnosed etiology. OBJECTIVE: 1.To detect diagnostic yield of medical thoracoscopy in pleural effusions of unknown etiology. 2.To find complication rate in these patients. METHODOLOGY: In a retrospective analysis of thoracoscopic procedures performed between March 2011 and December 2014, diagnostic yield and complications of thoracoscopic pleural biopsy for achieving a diagnosis in undiagnosed pleural effusions were evaluated...
October 2016: Journal of the Association of Physicians of India
Ilknur Erdem, Senay Elbasan Omar, Ridvan Kara Ali, Hayati Gunes, Aynur Eren Topkaya
OBJECTIVE: Infections are among the most important causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE) but are rare initial presentation of the disease. Therefore, in this study, we describe a case of Streptococcus pneumoniae sepsis in a young woman with previously undiagnosed SLE. CASE REPORT: A 23-year-old female patient was admitted to our outpatient clinic complaining of high fever (40°C), chills, fatigue, generalized myalgia, and cough with brown sputum for 5 days...
2016: International Journal of General Medicine
Chetan Basavaraj Patil, Ramakant Dixit, Rakesh Gupta, Neeraj Gupta, Varna Indushekar
BACKGROUND: Medical thoracoscopy is a minimally invasive procedure used in diagnostic and therapeutic applications for pleural diseases. In this study, we describe our experience in the outcome and analysis of thoracoscopy in undiagnosed pleural effusion presenting to our center. MATERIALS AND METHODS: This is a prospective study conducted over last 2 years. We performed thoracoscopy in 129 cases of undiagnosed exudative pleural effusions using rigid thoracoscope...
September 2016: Lung India: Official Organ of Indian Chest Society
Yun Su Sim, Dong Gyu Kim, Tae Rim Shin
BACKGROUND: The soluble receptor for advanced glycation end products (sRAGE) may have an inflammatory or homeostatic function in lung tissue. The aim of this study was to assess the usefulness of sRAGE as a diagnostic marker for exudative pleural effusions, which are common manifestations of a variety of diseases. METHODS: Patients with an undiagnosed pleural effusion were prospectively enrolled between January 2013 and January 2015. Samples of blood and pleural fluid were centrifuged and the supernatant stored at -70 °C...
July 2016: Journal of Thoracic Disease
Aggeliki Psatha, Demosthenes Makris, Theodora Kerenidi, Zoe Daniil, Theodoros Kiropoulos, Konstantinos Gourgoulianis
BACKGROUND: Vascular endothelial growth factor (VEGF) may play a role in pleural fluid formation, as it represents a potent inducer of capillary permeability. We aimed to investigate the diagnostic utility of VEGF levels in pleural fluid and serum in patients with pleural effusions with initially negative diagnostic work up. METHODS: Seventy-one patients with exudative lymphocytic pleural effusions undiagnosed after initial diagnostic work up were enrolled in this prospective study and their clinical course was followed up to 24 months...
July 2016: Journal of Thoracic Disease
Dominik Domanski, Anna Perzanowska, Michal Kistowski, Grzegorz Wojtas, Agata Michalak, Grzegorz Krasowski, Michal Dadlez
Pleural effusion (PE), excess fluid in the pleural space, is often observed in lung cancer patients and also forms due to many benign ailments. Classifying it quickly is critical, but this remains an analytical challenge often lengthening the diagnosis process or exposing patients to unnecessary risky invasive procedures. We tested the analysis of PE using a multiplexed cytokeratin (CK) panel with targeted mass spectrometry-based quantitation for its rapid classification. CK markers are often assessed in pathological examinations for cancer diagnosis and guiding treatment course...
July 2016: Neoplasia: An International Journal for Oncology Research
Srujana Mohanty, Gourahari Pradhan, Manoj Kumar Panigrahi, Prasanta Raghab Mohapatra, Baijayantimala Mishra
Melioidosis, caused by the environmental saprophyte, Burkholderia pseudomallei, is an important public health problem in Southeast Asia and Northern Australia. It is being increasingly reported from other parts, including India, China, and North and South America expanding the endemic zone of the disease. We report a case of systemic melioidosis in a 58-year-old diabetic, occupationally-unexposed male patient, who presented with chronic fever, sepsis, pneumonia, pleural effusion and subcutaneous abscess, was undiagnosed for long, misidentified as Pseudomonas aeruginosa infection elsewhere, but was saved due to correct identification of the etiologic agent and timely institution of appropriate therapy at our institute...
2016: Pneumonologia i Alergologia Polska
Ashwini Kumar Mishra, Sanjeev Kumar Verma, Surya Kant, Ram Awadh Kushwaha, Rajiv Garg, Santosh Kumar, Ved Prakash, Ajay Verma, Mala Sagar
BACKGROUND: The diagnostic approach to exudative pleural effusion remains an underappreciated aspect of modern thoracic medicine. 15-20% of the pleural effusions remain undiagnosed. The most efficient approach to pleural exudates remains uncertain and controversial particularly if acquisition of pleural tissue is required. The clinician needs to consider various factors when confronted with the choice between closed pleural biopsy (CPB) and thoracoscopy. Hence this study was planned to compare the diagnostic efficacy of CPB and Thoracoscopic pleural biopsy (TPB)...
January 2016: South Asian Journal of Cancer
Kenichi Okuda, Satoshi Noguchi, Osamu Narumoto, Masako Ikemura, Yasuhiro Yamauchi, Goh Tanaka, Daiya Takai, Masashi Fukayama, Takahide Nagase
BACKGROUND: Meigs' syndrome is defined as the presence of a benign ovarian tumor with pleural effusion and ascites that resolve after removal of the tumor. The pathogenesis of the production of ascites and pleural effusion in this syndrome remains unknown. Aside from pleural effusion and ascites, pericardial effusion is rarely observed in Meigs' syndrome. Here, we report the first case of Meigs' syndrome with preceding pericardial effusion in advance of pleural effusion. CASE PRESENTATION: An 84-year-old Japanese non-smoking woman with a history of lung cancer, treated by surgery, was admitted due to gradual worsening of dyspnea that had occurred over the previous month...
2016: BMC Pulmonary Medicine
Oliver J Bintcliffe, Clare E Hooper, Iain J Rider, Rhian S Finn, Anna J Morley, Natalie Zahan-Evans, John E Harvey, Andrew P Skyrme-Jones, Nick A Maskell
RATIONALE: Evaluation of a pleural effusion has historically focused on establishing a single etiology. Pleural fluid may accumulate through multiple pathophysiological processes. The prevalence of multiple causes for pleural effusions has not been established. The identification of contributing processes may improve clinical outcomes. OBJECTIVES: The objective of this prospectively collected case series was to establish the prevalence and nature of multiple etiologies for a unilateral pleural effusion...
July 2016: Annals of the American Thoracic Society
Anna C Bibby, Nick A Maskell
PURPOSE OF REVIEW: Pleural biopsies are often necessary if a pleural effusion remains undiagnosed after radiological imaging and pleural fluid analysis. There are many methods of obtaining pleural biopsies, including blind or image-guided procedures, closed-bevel or cutting-edge needles, and percutaneous or thoracoscopic approaches. This article will review recent research relating to these methods, aiming to provide an overview of the strengths and limitations of each technique. RECENT FINDINGS: Historically pleural biopsies were undertaken using a blind closed 'Abrams' needle method...
July 2016: Current Opinion in Pulmonary Medicine
Soheila Aminimoghaddam, Narmin Karisani, Maryam Mazloomi, Maryam Rahimi
Hypothyroidism is a common health issue worldwide with varying clinical manifestations. We report a woman who experienced an incomplete abortion and undiagnosed hypothyroidism who was referred to the oncologist with the suspicion of metastatic gestational trophoblastic neoplasm (GTN). A 29-year-old woman with incomplete abortion was referred to an oncologist for possible GTN due to persistent active vaginal bleeding, an elevated beta human chorionic gonadotropin (hCG), abnormal cervical inspection exam, abnormal liver function tests, ovarian enlargement, ascites, and a pleural effusion...
2016: Case Reports in Oncological Medicine
Balamugesh Thangakunam
Closed pleural biopsy used to be a popular method of evaluation of pleural effusion. With the advent of thoracoscopy, this valuable method is being neglected. Studies have shown that closed pleural biopsy especially done with image guidance has high yield and low complication rate as compared to thoracoscopy. Given the ease of the procedure and the less cost involved, imaged guided closed pleural biopsy should be considered as the initial diagnostic step in undiagnosed pleural biopsy especially in developing countries with high prevalence of tuberculosis...
November 2015: Lung India: Official Organ of Indian Chest Society
Dharmesh Patel
In the modern management of pleural diseases, thoracoscopy has a clear advantage over closed pleural biopsy. By way of its high yield, both in malignant pleural disease and pleural Tuberculosis - the two commonest cause of undiagnosed pleural effusion, thoracoscopy has the added advantage of faster symptom relief and offering effective pleurodesis. This makes it an attractive diagnostic and therapeutic procedure of choice and features high in the algorithms of many international guidelines on the approach to pleural diseases...
November 2015: Lung India: Official Organ of Indian Chest Society
Fangyuan Cheng, Qian Wang, Diansheng Zhong
Malignant pleural effusion (MPE ) is due tumor which arises from the mesothelium or metastases from tumor origniating other sites. In large, for undiagnosed unilateral pleural effusions, the most frequent and important diagnosis to be established or excluded is malignancy. Cell block is prepared from residual fluid which is centrifuged or is naturally sedimenting to obtain clots at the bottom of the container. The cell block technique is simple, relatively non-invasive, reproducible and has a high yield for malignant plerual effusion...
October 20, 2015: Zhongguo Fei Ai za Zhi, Chinese Journal of Lung Cancer
José M Porcel, M Azzopardi, C F Koegelenberg, F Maldonado, N M Rahman, Y C G Lee
Pleural effusions arise from a variety of systemic, inflammatory, infectious and malignant conditions. Their precise etiological diagnosis depends on a combination of medical history, physical examination, imaging tests and pertinent pleural fluid analyses; including specific biomarkers (e.g., natriuretic peptides for heart failure, adenosine deaminase for tuberculosis, or mesothelin for mesothelioma). Invasive procedures, such as pleuroscopic biopsies, may be required for persistently symptomatic effusions which remain undiagnosed after the analysis of one or more pleural fluid samples...
2015: Expert Review of Respiratory Medicine
Xiao-Juan Wang, Yuan Yang, Zhen Wang, Li-Li Xu, Yan-Bing Wu, Jun Zhang, Zhao-Hui Tong, Huan-Zhong Shi
BACKGROUND: The differential diagnosis of pleural effusions can present a considerable challenge, and the etiology of pleural effusions varies depending on the population studied. OBJECTIVE: This study aimed to assess the efficacy and safety of medical thoracoscopy in the diagnosis of patients with undiagnosed pleural effusions in a Chinese population. METHODS: Between July 2005 and June 2014, medical thoracoscopy (MT) using the semirigid instrument was performed in 833 patients with pleural effusions of unknown etiology in our Institute, where diagnostic thoracocentesis or/and blind pleural biopsy had failed to yield an answer...
2015: Respiration; International Review of Thoracic Diseases
Gulsah Gunluoglu, Aysun Olcmen, Mehmet Zeki Gunluoglu, Ibrahim Dincer, Adnan Sayar, Gungor Camsari, Veysel Yilmaz, Sedat Altin
INTRODUCTION: The cause of exudative pleural effusion cannot be determined in some patients. The longterm outcomes of patients with undiagnosed pleural effusion were analyzed. METHODS: Patients with exudative pleural effusion whose diagnostic procedures included pleural biopsy using video-assisted thoracoscopic surgery carried out between 2008 and 2012 were evaluated retrospectively. Patients diagnosed with non-specific pleuritis were included. Fifty-three patients with available follow-up data were included in the study...
December 2015: Archivos de Bronconeumología
Anurag Agrawal, Rajeev Tandon, Lalit Singh, Aakanksha Chawla
BACKGROUND: Malignant pleural effusion is a major clinical problem associated with primary and metastatic pleural malignancies. Pleural effusions from an unknown primary are responsible for 7-15% of all malignant pleural effusions. Presence of malignant pleural effusion puts the patient in advanced stage and renders the prognosis as poor. AIM: In this study we intend to find out the incidence of malignant pleural effusion, its aetiology and clinical course in patients attending a tertiary care teaching hospital...
July 2015: Lung India: Official Organ of Indian Chest Society
Giles Dixon, Duneesha de Fonseka, Nick Maskell
Undiagnosed pleural effusions present an increasing diagnostic burden upon healthcare providers internationally. The investigation of pleural effusions often requires the acquisition of tissue for histological analysis and diagnosis. Historically there were two options for tissue biopsy: a 'gold standard' surgical biopsy or a "blind" closed pleural biopsy. Over the last decade however, image-guided Tru-cut biopsies and local anaesthetic thoracoscopic (local anaesthetic thoracoscopy) biopsies have become more widespread...
June 2015: Journal of Thoracic Disease
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