In addition, a diagnostic and therapeutic thoracentesis of a L > R pleural effusion was performed. Pleural fluid studies were suggestive of a transudative process, though with some abnormal characteristics (including lymphocyte predominance, as well as presence of signet cells) Differential Diagnosis of Pleural Effusions Carcinoembryonic antigen (CEA), orosomucoid beta 2 microglobulin, and alpha fetoprotein were quantified in the pleural fluid and serum of 58 hospitalized consecutive patients in order to differentiate malignant from nonmalignant effusions. Cytologic examination of the effusions was also performed Differential Diagnosis of Pleural Effusions JMAJ 49(9•10): 315-319, 2006 Tetsuo Sato*1 Abstract A variety of disease states are associated with the development of pleural effusions, which sometimes makes the differential diagnosis problematic. Pleural effusions can be classified into two categories, transudative an
Several primary tumors can metastasize to the pleura, and pleural effusions are often associated with carcinoma of breast, lung, or stomach. On the other hand, pleural effusion is a common sign of decompensation in heart failure, and this latter syndrome can occur superimposed on various malignancies Transudative pleural effusion. Considerations in the differential diagnosis of transudative pleural effusion include the following: Congestive heart failure (most common) Cirrhosis with hepatic hydrothorax. Nephrotic syndrome. Peritoneal dialysis/continuous ambulatory peritoneal dialysis. Hypoproteinemia Many pleural fluid tests are useful in the differential diagnosis of exudative effusions. Other tests helpful for diagnosis include helical computed tomography and thoracoscopy. Pleural effusion.. Cell differential A high lymphocyte count is most commonly associated with a tuberculous pleural effusion (TPE), but chronic effusions can often have a high lymphocyte ratio of 50% or more. The most common aetiologies which produce lymphocytic effusions are tuberculosis (TB), malignancy and CCF The differential diagnosis of pleural effusion can be daunting, but an organized approach that begins with the patient's history and focuses on identification of conditions that require urgent evaluation can guide appropriate care
Detection of pleural effusion(s) and the creation of an initial differential diagnosis are highly dependent upon imaging of the pleural space. Conventional chest radiography and computed tomography (CT) scanning are the primary imaging modalities that are used for evaluation of all types of pleural disease, but ultrasound and magnetic resonance. DIFFERENTIAL DIAGNOSIS OF PLEURAL EFFUSIONS 297. sions. An attempt was made to evaluate the clinical value of combined assays of several markers in pleuralfluids. METHODSAND MATERIALS Sampling Pleural effusions were obtained from 58 consecutive hos. A systematic approach to analysis of the fluid in conjunction with the clinical presentation allows clinicians to diagnose the cause of an effusion, narrow the differential diagnoses, and design a management plan in a majority of patients who undergo pleural fluid analysis. An approach to pleural fluid analysis will be presented here Purpose: To investigate the value of spectral CT in the differential diagnosis of benign from malignant pleural effusion. Method and materials: 14 patients with benign pleural effusion and 15 patients with malignant pleural effusion underwent non-contrast spectral CT imaging. These patients were later verified by the combination of disease history, clinical signs and other information with the.
Pleural effusions occur as a result of increased fluid formation and/or reduced fluid resorption. The precise pathophysiology of fluid accumulation varies according to underlying aetiologies. As the differential diagnosis for a unilateral pleural effu-sion is wide, a systematic approach to investigation is necessary. The aim is to establish. Pleural effusions are a common medical problem with more than 50 recognised causes including disease local to the pleura or underlying lung, systemic conditions, organ dysfunction and drugs.1 Pleural effusions occur as a result of increased fluid formation and/or reduced fluid resorption. The precise pathophysiology of fluid accumulation varies according to underlying aetiologies The differential diagnosis is presented in Table 1.9, 10 Often consolidation, lymphadenopathy, and/or unilateral pleural effusion; cavitation common. Acid-fast bacilli Gram stain, sputum. Pleural aspirate can narrow the differential diagnosis significantly. First, appearance is important ( Table 2 ). While straw coloured fluid is associated with multiple aetiologies, blood stained fluid tends to point towards malignancy, trauma (haemothorax), PE, TB or benign asbestos‐related effusion ( 4 ) Differential Diagnosis Pleural Effusion. On upright views, the opacification is particularly marked in the laterobasal hemithorax with blunting of the costophrenic angles. The effusion may be mobile with changes in patient position. Pleural Thickening and Fibrothorax
Cell count with differential. Hematocrit. Cytology if there is concern about pleural malignancy. What imaging studies will be helpful in making or excluding the diagnosis of hemorrhagic pleural effusions or hemothorax? A chest radiograph is useful, although it may miss a small hemothorax in 21 percent of patients following chest trauma, as at. A case study of a patient with a pleural effusion is presented, as well as a brief description of the signs and symptoms, pathophysiology, and management of this disease process. A brief review of the signs and symptoms, differential diagnosis, and pathophysiology of pleural effusions is presented along with a case study Pleural effusions are characterized on CT by attenuation values between those of water (0 Hounsfield units [HU]) and soft tissue (approximately 100 HU), typically in the order of 10 to 20 HU. CT density measurements alone are considered unreliable in differentiating transudates from exudates or in the diagnosis of chylous pleural effusions
Pleural Effusions. Pleural effusions are produced by a wide variety of causes. Infectious processes including bacteria, viruses, tuberculosis, atypical mycobacterium, fungus, as well as parasites account for a substantial percentage of these effusions. This chapter will help to elucidate the broad differential diagnosis that must be entertained. Pleural effusion in which a high proportion of the cells are eosinophils is not a widely recognized phenomenon. One purpose of this paper is to report that the cause of such an effusion may be a fungus infection. Two patients with eosinophilic effusion are described in detail, and several others of which we have knowledge are mentioned briefly Pleural fluids from 182 patients were studied prospectively. Although red blood cell (RBC) counts of greater than 10,000/cu mm were common with all types of effusions, an RBC count greater than 100,000/cu mm strongly suggested malignant neoplasm, pulmonary infarction, or trauma. Of 31 exudative..
5. Specific differential diagnosis problems generated by pleural nodules, where the main concern is establishing if the complementary CT scan is needed. B. Differential diagnosis discussion: B.1. Very small or complex/multiple loculated pleural effusions: Very small loculated pleural effusions (below 300ml) are difficult to see on plai A pleural effusion is accumulation of excessive fluid in the pleural space, the potential space that surrounds each lung.Under normal conditions, pleural fluid is secreted by the parietal pleural capillaries at a rate of 0.01 millilitre per kilogram weight per hour, and is cleared by lymphatic absorption leaving behind only 5-15 millilitres of fluid, which helps to maintain a functional.
Pleural effusions may be classified as being either a transudate or exudate according to the protein concentration. Transudate (< 30g/L protein) Heart failure (most common transudate cause) Hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption) Hypothyroidism. Meigs' syndrome Summary. Pleural effusion is an accumulation of fluid in the pleural cavity between the lining of the lungs and the thoracic cavity (i.e., the visceral and parietal pleurae).The pleural fluid is called a transudate if it permeates (transudes) into the pleural cavity through the walls of intact pulmonary vessels. It is called an exudate if it escapes (exudes) into the pleural cavity through.
Original Articles Clinical and laboratory parameters in the differential diagnosis of pleural effusion secondary to tuberculosis or cancer. Leila Antonangelo, Francisco Suso Vargas, Marcia Seiscento, Sidney Bombarda, Lisete Teixera, Roberta Karla Barbosa de Sales. DOI: 10.1590/S1807-59322007000500009 PURPOSE: To evaluate the clinical and laboratory characteristics of pleural effusions. Most (82%) of malignant effusions were exudative. The primary site could be assessed by cytological examination in 57.14% of malignant effusions. Conclusions: The most useful test in establishing the diagnosis of pleural effusion is pleural fluid cytology and pleural fluid cell count Considerations in the differential diagnosis of transudative pleural effusion include the following: Congestive heart failure (most common) Cirrhosis with hepatic hydrothorax Nephrotic syndrome Pe. Some imaging findings may help narrow the list of potential causes of the pleural effusion. Bilateral pleural effusions: Most commonly seen in volume overload states (e.g., CHF) Differential diagnosis should also include malignancy, lupus, and constrictive pericarditis. Massive effusions may occur in: Malignanc
DIFFERENTIAL DIAGNOSIS. Pleural effusions are quite common, diagnosed in over 1 million patients each year in the United States (5). Over 50 etiologies are known, and in the United States the most common causes are heart failure, pneumonia, malignancy, and pulmonary embolism (6). In children, pneumonia is the most common cause of pulmonary. The differential diagnosis of pleural fluids is wide and may indicate the presence of pleural, pulmonary or extrapulmonary disease. When we attempt to identify the cause of the pleural effusion, most patients undergo various diagnostic procedures Objective and background: Determining the aetiology of an effusion involves assessing if it is an exudate or a transudate. However, a reliable test for determining the aetiology of a pleural effusion is lacking. Pleural viscosity has a high sensitivity and specificity and a high positive and negative predictive value for discriminating exudative and transudative pleural effusions
Pleural effusion: diagnosis, treatment, and management Vinaya S Karkhanis, Jyotsna M JoshiDepartment of Respiratory Medicine, TN Medical College and BYL Nair Hospital, Mumbai, IndiaAbstract: A pleural effusion is an excessive accumulation of fluid in the pleural space. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to. Most (82%) of malignant effusions were exudative. The primary site could be assessed by cytological examination in 57.14% of malignant effusions. Conclusions: The most useful test in establishing the diagnosis of pleural effusion is pleural fluid cytology and pleural fluid cell count
differential diagnosis of these entities. The pleural effusion cytologies from 40 cases of malignant mesothelioma, 40 cases of adenocarcinoma and 30 cases of reactive mesothelial proliferation diagnosed between 1997 and 2007 were reviewed. Twenty-seven cytologic features which are regarded as useful in the differential diagnosis of mesothe There is a wide differential for an exudative lymphocyte-rich pleural effusion, with the most common causes listed in the BTS pleural disease guidelines,1 including malignancy, lymphoma, tuberculosis, cardiac failure, postcoronary artery bypass graft and rheumatological disease. It should be noted that most effusions related to cardiac failure.
Porcel JM, Vives M, Cao G, et al. Biomarkers of infection for the differential diagnosis of pleural effusions. Eur Respir J 2009; 34:1383. Porcel JM, Bielsa S, Esquerda A, et al. Pleural fluid C-reactive protein contributes to the diagnosis and assessment of severity of parapneumonic effusions An important step in differential diagnosis of pleural effusion is to determine the nature of serous fluid, exudate or transudate, which significantly reduces the diagnostic search. Relative density transudate is less than 1,015, and protein content - less than 20.0 g / dL. while the relative density of more than 1,018 of fluid and protein content - more than 30.0 g / dL Cholesterol pleural effusions are rare and primarily need to be distinguished from chylothorax (the presence of chyle in a pleural effusion). The etiology, clinical presentation, diagnosis, and management of cholesterol pleural effusions will be reviewed here
ROENTGEN-RAY DIAGNOSIS OF PLEURAL EFFUSIONS, GENERAL AND LOCAL THEIR RECOGNITION, LOCALIZATION AND DIFFERENTIAL DIAGNOSIS L. R. SANTE, M.D. Associate Professor of Radiology, St. Louis University School of Medicine ST. LOUIS In no branch in the field of chest radiography is roentgen-ray examination of more importance than in the diagnosis of pleural effusions. The diagnosis of. The diagnosis of generalized pleural effusions, especially when associated with consolidation, is naturally very difficult owing to the confusion of physical signs; the detection of localized collections of fluid and the determination of their extent and location is often impossible
Benign asbestos pleural effusion (BAPE). In patients who present with a pleural effusion in the context of previous asbestos exposure, benign asbestos pleural effusion is in the differential diagnosis. However, the effusion is usually small, and it tends to occur with a shorter time lag after asbestos exposure than mesothelioma does differential diagnosis of lymphocytic pleural effusions. Pleural fluid adenosine deaminase (ADA) is a well-known biomarker for the diagnosis of tuberculous pleural effusion (TPE) in patients with lymphocytic exudative pleural effusion (6-8). However, elevated pleural fluid ADA levels, a finding that is uncommon in solid tumors, is frequentl Clinical Features in the Diagnosis of Pleural Effusions and Identifying Etiology: 1,2 Pleural effusions can be easily identified on chest radiography, physical examination findings include dullness to percussion, decreased tactile fremitus and decreased (or absent) breath sounds
60046008 - Pleural effusion Look For. Subscription Required. Diagnostic Pearls. Subscription Required. Differential Diagnosis & Pitfalls The differential is vast and often requires a careful history and, ultimately, correlation with thoracentesis and fluid sampling. The differential includes: Malignancy; Mesothelioma; Congestive heart failur Cytological evaluation is the gold standard for diagnosis of neoplastic pericardial effusion, with a sensitivity of 71% to 92% and a specificity approaching 100%. Imazio M, Colopi M, De Ferrari GM. Pericardial diseases in patients with cancer: contemporary prevalence, management and outcomes
Chest radiography: small to moderate unilateral pleural effusion, often without associated infiltrate PFA: exudative effusion with elevated adenosine deaminase levels (> 40 to 60 U per L [670 to. Thus, in the differential diagnosis of pleural effusion, could we choose pleural fluid as the specimen type instead of serum? Wang et al .[3] reported that the medical thoracoscopy is an effective and safe method for diagnosing pleural effusions of undetermined causes. Medical thoracoscopy should be definitely helpful and useful in the.
There is no gold standard diagnostic technique for differential diagnosis of pleural effusion. The available traditional methods like cytology and microbiology are time-consuming. Depending on the laboratory consultant's expertise, there is a chance of subjective bias affecting the patients' management. Radiological investigations (USG/CT. The negative predictive value of a negative ANA in pleural fluid is so high that it eliminates lupus from the differential diagnosis. In lupus patients with effusions from causes other than lupus, the pleural-fluid ANA was low-positive (1:40 to 1:80) or negative. The majority of non-lupus pleural effusions with positive ANAs were malignant Pleural effusion is an extremely common problem; however, the diagnosis of pleural effusion remains challenging due to its diverse aetiologies. Malignant pleural effusion (MPE) is one of the leading causes of unilateral pleural effusion, and many clinical guidelines have recommended diagnostic strategies for MPE [1, 2]
