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Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

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Open Journal of Anesthesiology 2024年第3期14卷 41-50页

作者： Kunal Tewari Sumanth Pelluru Deepak Mishra Nitin Pahuja Akash Ray Mohapatra Jyotsna Sharma Om Bahadur Thapa Manjot Multani Department of Anesthesiology and Critical Care Armed Forces Medical College Pune India Department of Anesthesiology and Critical Care Military Hospital Bhopal India

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

关键词： Chest X ray (CXR) Consolidation Pulmonary edema pleural effusion Lung ultrasound (LUS) Pneumothorax

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pleural effusion in critically ill patients and intensive care setting

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World Journal of Clinical Cases 2023年第5期11卷 989-999页

作者： Adel Salah Bediwy Mohammed Al-Biltagi Nermin Kamal Saeed Hosameldin A Bediwy Reem Elbeltagi Department of Chest Diseases Faculty of MedicineTanta UniversityTanta 31527AlgharbiaEgypt Department of Chest Diseases University Medical CenterArabian Gulf UniversityDr.Sulaiman Al Habib Medical GroupManama 26671Bahrain Department of Pediatric Faculty of MedicineTanta UniversityTanta 31527AlgharbiaEgypt Department of Pediatric University Medical CenterKing Abdulla Medical CityArabian Gulf UniversityDr.Sulaiman Al Habib Medical GroupManama 26671Bahrain Medical Microbiology Section Chairperson of the Pathology DepartmentSalmaniya Medical ComplexMinistry of HealthKingdom of BahrainManama 26671Bahrain Microbiology Section Pathology DepartmentRoyal College of Surgeons in Ireland-BahrainBusiateen 15503MuharraqBahrain Faculty of Medicine Tanta UniversityTanta 31527AlgharbiaEgypt Department of Medicine Royal College of Surgeons in Ireland-BahrainBusaiteen 15503MuharraqBahrain

pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a wide range of variable prevalence rates of up to 50%-60%in some studies.This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit(ICU).The original disease that caused pleural effusion can be the exact cause of ICU admission.There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients.There are also many difficulties in diagnosing pleural effusion in the ICU,including clinical,radiological,and even laboratory difficulties.These difficulties are due to unusual presentation,inability to undergo some diagnostic procedures,and heterogenous results of some of the performed tests.pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients,who usually have frequent comorbidities.Similarly,pleural effusion drainage can modify the ICUadmitted patient’s outcome.Finally,pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.

关键词： pleural effusion Intensive care unit Mechanical ventilation Diagnosis Drainage Pigtail catheters

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Diagnostic value and safety of medical thoracoscopy for pleural effusion of different causes

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World Journal of Clinical Cases 2022年第10期10卷 3088-3100页

作者： Xiao-Ting Liu Xi-Lin Dong Yu Zhang Ping Fang Hong-Yang Shi Zong-Juan Ming Department of Respiratory Medicine The Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'an 710004Shaanxi ProvinceChina Department of Respiratory The Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'an 710004Shaanxi ProvinceChina

BACKGROUND pleural effusions occur for various reasons,and their diagnosis remains challenging despite the availability of different diagnostic modalities.Medical thoracoscopy(MT)can be used for both diagnostic and therapeutic purposes,especially in patients with undiagnosed pleural effusion.AIM To assess the diagnostic efficacy and safety of MT in patients with pleural effusion of different causes.METHODS Between January 1,2012 and April 30,2021,patients with pleural effusion underwent MT in the Department of Respiratory Medicine,The Second Affiliated Hospital of Xi’an Jiaotong University(Shaanxi,China).According to the discharge diagnosis,patients were divided into malignant pleural effusion(MPE),tuberculous pleural effusion(TBPE),and inflammatory pleural effusion(IPE)groups.General information,and tuberculosis-and effusion-related indices of the three groups were analyzed.The diagnostic yield,diagnostic accuracy,performance under thoracoscopy,and complications of patients were compared among the three groups.Then,the significant predictive factors for diagnosis between the MPE and TBPE groups were analyzed.RESULTS Of the 106 patients enrolled in this 10-year study,67 were male and 39 female,with mean age of 57.1±14.184 years.Among the 74 thoracoscopy-confirmed patients,41(38.7%)had MPE,21 had(19.8%)TBPE,and 32(30.2%)were undiagnosed.Overall diagnostic yield of MT was 69.8%(MPE:75.9%,TBPE:48.8%,and IPE:75.0%,with diagnostic accuracies of 100%,87.5%,and 75.0%,respectively).Under thoracoscopy,single or multiple pleural nodules were observed in 81.1%and pleural adhesions in 34.0%with pleural effusions.The most common complication was chest pain(41.5%),followed by chest tightness(11.3%)and fever(10.4%).Multivariate logistic regression analyses showed effusion appearance[odds ratio(OR):0.001,95%CI:0.000-0.204;P=0.010]and carcinoembryonic antigen(OR:0.243,95%CI:0.081-0.728;P=0.011)as significant for differentiating MPE and TBPE,with area under the receiver operating characteristic curve of 0.977(95%CI:0.953-1.000;P<0

关键词： Medical thoracoscopy pleural effusion Diagnostic value Safety Thoracoscopic performance Differential diagnosis

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3D spiral channels combined with flexible micro-sieve for high-throughput rare tumor cell enrichment and assay from clinical pleural effusion samples

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Bio-Design and Manufacturing 2022年第2期5卷 358-370页

作者： Jie Cheng Lina Zhang Yiran Zhang Yifei Ye Wenjie Zhao Lingqian Zhang Yuang Li Yang Liu Wenchang Zhang Hongyan Guo Mingxiao Li Yang Zhao Chengjun Huang Institute of Microelectronics Chinese Academy of SciencesBeijing 100029China School of Future Technology University of Chinese Academy of SciencesBeijing 100049China Department of Cellular and Molecular Biology Beijing Chest HospitalCapital Medical UniversityBeijing Tuberculosis and Thoracic Tumor Research InstituteBeijing 101149China National Engineering Research Center for Beijing Biochip Technology Beijing 102206China

The sieving and enrichment of rare tumor cells from large-volume pleural effusion(PE)samples is a promising technique for cell-based lung tumor diagnosis and drug tests,which features high throughput and recovery,purification,as well as viability rates of rare target cells as the prerequisites for high sensitivity,specificity,and accuracy of tumor cell analysis.In this paper,we propose a three-dimensional(3 D)sieving method for rare tumor cell enrichment,which effectively eliminates the"dead zones"in traditional two-dimensional(2 D)cell filters with a dimension-raising strategy to satisfy the requirements mentioned above.The prototype device was combined with a funnel-shaped holder,a flexible micropore membrane in the middle,and a3 D spiral fluid channel covered on the membrane as a three-layer ice-creaming cone composite structure.Driven by gravity alone,the device performed as follows:(1)20-fold throughput compared with the 2 D commercial planee hich was up to 20 mL/min for a threefold dilution of whole blood sample;(2)high recovery rates of 84.5%±21%,86%±25%,83%±14%for 100,1000,and 10000 cells/mL,respectively,in 30 mL phosphate buffer saline(PBS)sample,and a 100%positive detection rate in the case of≤5 A549 cells in 1 mL PBS;(3)a typical purification rate of 85.5%±9.1%;and(4)a viability rate of>93%.In the demonstration application,this device effectively enriched rare target cells from large volumes(>25 mL)of clinical pleural effusions.The following results indicated that tumor cells were easy-to-discover in the enriched PE samples,and the proliferation capability of purified cells was(>4.6 times)significantly stronger than that of unprocessed cells in the subsequent 6-day culture.The above evaluation indicates that the proposed easily reproducible method for the effective execution of rare cell enrichments and assays is expected to become a practical technique for clinical cell-based tumor diagnosis.

关键词： Cell enrichment High throughput pleural effusion Liquid biopsy 3D printing

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Unilateral pleural effusion secondary to Takayasu arteritis: a case report and literature review

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The Journal of Biomedical Research 2022年第2期36卷 141-144页

作者： Ling Chen Ting Ma Liang Wang Lixin Wang Minmin Li Rong Zhu The Huai'an Clinical College of Xuzhou Medical University Huai'anJiangsu 223300China Department of Respiratory Medicine Huai'an First People's HospitalHuai'anJiangsu 223300China

Takayasu arteritis (TA) is a chronic, nonspecific inflammatory disease of large and medium-sized vessels that primarily involves the aorta and its branches. TA involving the pulmonary arteries has a prevalence ranging from 14% to 86%, which can lead to pulmonary hypertension, a progressive increase in pulmonary artery pressure, and eventually death from right heart failure. The presentation of pulmonary arteritis (PA) is very nonspecific, with a reported misdiagnosis rate of up to 60% and a diagnosis time ranging from 1 month to more than 10 years. The clinical manifestation of pleural effusion is very rare in both TA and PA cases. Based on our literature review, this is the 6th reported case of TA with pleural effusion, and the specific mechanism of TA with pleural effusion is still unclear. The characteristics of this case and the previously reported cases are summarized in this article to improve the understanding of TA and PA and reduce the misdiagnosis rate.

关键词： Takayasu arteritis pulmonary arteritis pleural effusion case report literature review

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pleural effusion and ascites in extrarenal lymphangiectasia causedby post-biopsy hematoma: A case report

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World Journal of Clinical Cases 2020年第24期8卷 6330-6336页

作者： Qiong-Zhen Lin Hui-En Wang Dong Wei Yun-Feng Bao Hang Li Tao Wang Department of Nephrology The Third Hospital of Hebei Medical UniversityShijiazhuang 050051Hebei ProvinceChina Department of Thoracic Surgery Hebei Provincial General HospitalShijiazhuang 050051Hebei ProvinceChina Department of Urology Hebei Provincial General HospitalShijiazhuang 050051Hebei ProvinceChina Department of Medical Imaging Hebei General HospitalShijiazhuang 050051Hebei ProvinceChina Department of Nephrology Peking Union Medical College HospitalBeijing 100045China Department of Nephrology The First Hospital of Hebei Medical UniversityShijiazhuang 050000Hebei ProvinceChina

BACKGROUNDThe renal system has a specific pleural effusion associated with it in the form of“urothorax”, a condition where obstructive uropathy or occlusion of thelymphatic ducts leads to extravasated fluids (urine or lymph) crossing thediaphragm via innate perforations or lymphatic channels. As a rare disorder thatmay cause pleural effusion, renal lymphangiectasia is a congenital or acquiredabnormality of the lymphatic system of the kidneys. As vaguely mentioned in areport from the American Journal of Kidney Diseases, this disorder can be causedby extrinsic compression of the kidney secondary to hemorrhage.CASE SUMMARYA 54-year-old man with biopsy-proven acute tubulointerstitial nephropathyexperienced bleeding 3 d post hoc, which, upon clinical detection, manifested as amassive perirenal hematoma on computed tomography (CT) scan withoutconcurrent pleural effusion. His situation was eventually stabilized byexpeditious management, including selective renal arterial embolization. Despite good hemodialysis adequacy and stringent volume control, a CT scan 1 mo laterfound further enlargement of the perirenal hematoma with heterogeneoushypodense fluid, left side pleural effusion and a small amount of ascites. Thesefluid collections showed a CT density of 3 Hounsfield units, and drained fluid ofthe pleural effusion revealed a dubiously light-colored transudate withlymphocytic predominance (> 80%). Similar results were found 3 mo later, duringwhich time the patient was free of pulmonary infection, cardiac dysfunction andovert hypoalbuminemia. After careful consideration and exclusion of otherpossible causative etiologies, we believed that the pleural effusion was due to theocclusion of renal lymphatic ducts by the compression of kidney parenchymaand, in the absence of typical dilation of the related ducts, considered our case asextrarenal lymphangiectasia in a broad sense.CONCLUSIONAs such, our case highlighted a morbific passage between the kidney and thoraxunder an extraordinarily rare condition. Given the paucity of p

关键词： Urothorax pleural effusion Perirenal hematoma Renal lymphangiectasia Lymphatic drainage Case report

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Expression of soluble triggering receptor expression on myeloid cells-1 in pleural effusion

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Chinese Medical Journal 2008年第17期121卷 1656-1661页

作者： HUANG Lu-ying SHI Huan-zhong LIANG Qiu-li WU Yan-bin QIN Xue-jun CHEN Yi-qiang Institute of Respiratory Diseases First Affiliated Hospital Guangxi Medical University Nanning Guangxi 530021 China

Background Triggering receptors expressed on myeloid cells （TREM） proteins are a family of cell surface receptors expressed broadly by cells of the myeloid lineage. The aim of this study was to investigate the clinical significance of soluble TREM-1 （sTREM-1） in pleural effusions, and to determine the effects of pneumonia on pleural sTREM-1 concentrations. Methods pleural fluid was collected from 109 patients who presented to the respiratory institute （35 with malignant pleural effusion, 31 with tuberculous pleural effusion, 21 with bacterial pleural effusion, and 22 with transudate）. The concentrations of sTREM-1, tumor necrosis factor-a （TNF-a） and interleukin-113 （IL-113） were determined in effusion and serum samples by enzyme linked immunosorbent assay （ELISA）. Results The concentrations of sTREM-1 in bacterial pleural effusion were significantly higher than those in malignant, tuberculous, and transudative groups （all P 〈0.001）. An sTREM-1 cutoff value of 768.1 ng/L had a sensitivity of 86% and a specificity of 93%. pleural sTREM-1 levels were positively correlated with levels of TNF-a and IL-113. Patients with complicating bacterial pneumonia did not have elevated concentration of sTREM-1 in pleural effusion when compared with patients without pneumonia. Conclusions Determination of pleural sTREM-1 may improve the ability of clinicians to differentiate pleural effusion patients of bacterial origin from those with other etiologies. The occurrence of bacterial pneumonia did not affect pleural sTREM-1 concentrations.

关键词： pleural effusion empyema infection

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ALK gene expression status in pleural effusion predicts tumor responsiveness to crizotinib in Chinese patients with lung adenocarcinoma

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Chinese Journal of Cancer Research 2016年第6期28卷 606-616页

作者： Zheng Wang Xiaonan Wu Xiaohong Han Gang Cheng Xinlin Mu Yuhui Zhang Di Cui Chang Liu Dongge Liu Yuankai Shi Department of Pathology Beijing HospitalNational Center of Gerontology Department of Medical Oncology Beijing HospitalNational Center of Gerontology Department of Medical Oncology National Cancer Center/Cancer Institute &Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Department of Respiratory and Critical Care Medicine Peking University People's Hospital Beijing Institute of Respiratory Medicine Beijing Chao-Yang Hospital Capital Medical University Department of Medical Oncology PLA Army General Hospital

Objective： The relationship between anaplastic lymphoma kinase（ALK） expression in malignant pleural effusion（MPE） samples detected only by Ventana immunohistochemistry（IHC） ALK（D5F3） and the efficacy of ALKtyrosine kinase inhibitor therapy is uncertain.Methods： Ventana anti-ALK（D5F3） rabbit monoclonal primary antibody testing was performed on 313 cell blocks of MPE samples from Chinese patients with advanced lung adenocarcinoma, and fluorescence in situ hybridization（FISH） was used to verify the ALK gene status in Ventana IHC ALK（D5F3）-positive samples. The follow-up clinical data on patients who received crizotinib treatment were recorded.Results： Of the 313 MPE samples, 27（8.6%） were confirmed as ALK expression-positive, and the Ventana IHC ALK（D5F3）-positive rate was 17.3%（27/156） in wild-type epidermal growth factor receptor（EGFR） MPE samples. Twenty-three of the 27 IHC ALK（D5F3）-positive samples were positive by FISH. Of the 11 Ventana IHC ALK（D5F3）-positive patients who received crizotinib therapy, 2 patients had complete response（CR）, 5 had partial response（PR） and 3 had stable disease（SD）.Conclusions： The ALK gene expression status detected by the Ventana IHC ALK（D5F3） platform in MPE samples may predict tumor responsiveness to crizotinib in Chinese patients with advanced lung adenocarcinoma.

关键词： Anaplastic lymphoma kinase fluorescence in situ hybridization immunohistochemistry lung adenocarcinoma pleural effusion crizotinib

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Delayed internal pancreatic fistula with pancreatic pleural effusion postsplenectomy

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World Journal of Gastroenterology 2010年第35期16卷 4494-4496页

作者： Shu-Guang Jin Zhe-Yu Chen Lu-Nan Yan Yong Zeng Departmentof Hepato-Bilio-Pancreatic Surgery West China Hospital of Sichuan UniversityChengdu 610041Sichuan ProvinceChina

The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment of this case,we conclude that the symptoms and signs of a subphrenic effusion are often obscure;abdominal computed tomography may be required to look for occult,intra-abdominal infection;and active conservative treatment should be carried out in the early period of this complication to reduce the need for endoscopy or surgery.

关键词： Pancreatic fistula pleural effusion Splenectomy Subphrenic effusion Postoperative complications

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Intrahepatic biliary cystadenoma presenting with pleural effusion

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Chinese Medical Journal 2012年第7期125卷 1355-1357页

作者： YU Yuan-quan LOU Bing-hong YAN Hai-chao MA Rui XU Yuan-liang XU Jing-hong Naamrata Bhugowar JIN Yun PENG Shu-you LI Jiang-tao Department of Surgery Second Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouZhejiang 310009China

Hepatobiliary cystadenomas are rare cystic neoplasms that often occur in middle aged women. The exact etiology of these tumors is unknown. Diagnosis is often delayed in these cases. However, misdiagnosis and inappropriate treatment may result in unfavorable outcome. We report a case of hepatobiliary cystadenoma with pleural effusion. We also review the literature and discuss the current diAnnctic And ttmnt mnrtlitiHepatobiliary cystadenomas are rare cystic neoplasms that often occur in middle aged women. The exact etiology of these tumors is unknown. Diagnosis is often delayed in these cases. However, misdiagnosis and inappropriate treatment may result in unfavorable outcome. We report a case of hepatobiliary cystadenoma with pleural effusion. We also review the literature and discuss the current diagnostic and treatment modalities.

关键词： cystadenoma complications pleural effusion

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