Physiotherapy management in patients with pleural effusion: a systematic review

Pleural effusion is the accumulation of fluid in between the parietal and visceral pleura, which is called the pleural cavity. It can occur by itself or can be the result of surrounding parenchymal disease like infection, malignancy, or inflammatory conditions. Pleural effusion is one of the major causes of pulmonary mortality and morbidity. With the aim to review the physiotherapy management in pleural effusion till date A Systematic review was done according to PRISMA guidelines was conducted on 15 articles through different databases like PubMed, google scholar which were identified, sorted, and screened according to the inclusion criteria and exclusion criteria post which the studies were assessed for quality. In this review the result data from the selected studies were extracted under the headings of title/author, type of study design, intervention /device /technique elaborated in the study, and key highlights of the study and was tabulated systematically. Following the discussion of results about the methods, effects of the protocols along with the biases in research it was concluded that Physiotherapy management increases pulmonary function, chest expansion and oxygenation in patients with pleural effusion.

Acute postpartum pleural effusion causing distress for patient and obstetrician

A 31-year-old Gravida 5 Para 2 Live 2 Abortion 2, without comorbidities, underwent spontaneous vaginal delivery at term. She was asymptomatic in postpartum and had puerperal sterilization under low risk on postnatal day 4. After fourteen hours of surgery, she experienced an acute onset of breathlessness, tachypnea, and orthopnoea. Workup revealed right-sided pleural effusion filling three-fourths of the cavity with consolidation on chest X- ray. Therapeutic thoracocentesis was performed draining 600 ml of straw-coloured fluid. She was started on the Piperacillin tazobactam combination. Due to the repeated collection and persistent symptoms, a continuous intercostal drain was placed after 4 days. Due to persistent fever spikes, antibiotics were stepped up to Linezolid and Meropenem. A negative result on the Mantoux test, CBNAAT, and IGRA test was obtained. ANA profiling revealed the presence of non-specific KU antibodies. Symptomatic improvement was noted, and the ICD was subsequently removed after 6 days of insertion. Pregnancy is an immunosuppressive state. Rapid reversal of this state in postpartum results in a flare-up of quiescent infection. Even auto-immune diseases flare up in postpartum. Understanding this phenomenon of immune reconstitution syndrome and its impact will help in the management planning of postpartum women without dilemmas.

Pleural effusion in a pediatric ward: clinical feature, etiology and outcome

Background: Pleural effusion is a common respiratory complication in children. We aimed to document clinical feature, etiology, biochemical parameters and outcome of the admitted children with pleural effusion.Methods: This cross-sectional study was conducted from January 2022 to June 2023 at pediatric ward of ICMH. All children from 6 months to 14 years presented with clinical features suggestive of pleural effusion and later supported by radiology and ultrasonography of chest either at presentation or owing to other systemic illness were enrolled. Children aged below 6 months, associated chronic illness and parental denial of giving consent were excluded. In indicated cases pleural fluid was tapped and sent to laboratory for physical, biochemical examination, staining, culture, GeneXpert, LDH and ADA assay. Results: Out of 43 children, 19 underwent pleural tap and rest were managed conservatively. Most of the children were in between 2 to 6 years. There were 22 male and 21 female. Unilateral effusion was found in 25 children and 18 children developed bilateral effusion. All the children had documented fever. Other symptoms were cough, respiratory distress, chest pain, weight loss, abdominal pain, jaundice and blood mixed sputum. Physical signs correlated classical effusion features. The etiologies included DF, TB, para-pneumonic effusion, empyema, nephrotic syndrome, malignancy, acute viral hepatitis, heart failure and acute pancreatitis. There was no mortality and long-term complication in non-malignant cases.Conclusions: DF outnumbered other causes of pleural effusion in recent times owing to recent Dengue outbreak. Tubercular effusion was leading cause among cases undergoing pleural tap.

Pharmaceutical care for rare ADR in a patient with ALK-positive non-small cell lung cancer induced by alectinib / 中国药房

OBJECTIVE To provide reference for safe drug use in patients with anaplastic lymphoma kinase （ALK）-positive non-small cell lung cancer （NSCLC）. METHODS Clinical pharmacists participated in the diagnosis and treatment of a patient with ALK-positive NSCLC who developed bilateral pleural effusion and hemolytic anemia after taking alectinib； regarding symptoms such as pleural effusion and hemolytic anemia in the patient， clinical pharmacists investigated the patient’s history of medication and disease， as well as potential drug interaction； to consider the correlation between the patient’s use of alectinib and the duration of pleural effusion and hemolytic anemia， clinical pharmacists suggested that clinical doctors discontinued alectinib and used reduced dose treatment after the pleural effusion improved， but the patient suffered from bilateral pleural effusion and hemolytic anemia again； after evaluating the correlation between alectinib and bilateral pleural effusion and hemolytic anemia using the Naranjo’s assessment scale， clinical pharmacists recommend permanent discontinuation of alectinib and jointly recommend replacement with ensartinib with clinical physicians. RESULTS Physicians adopted the suggestions of clinical pharmacists. The pleural effusion subsequently regressed and hemolytic anemia improved after replacing the drug. The correlation between alectinib and bilateral pleural effusion and hemolytic anemia was confirmed. CONCLUSIONS Clinical pharmacists participate in pharmaceutical monitoring of ALK-positive NSCLC patients， assist clinical doctors in developing personalized medication recommendations， and ensure the safety of patient medication.

An analysis on clinical characteristics in patients with lung adenocarcinomas tested positive for EGFR muta-tion in pleural effusion / 实用医学杂志

Objective To analyze the clinical characteristics of lung adenocarcinoma patients with positive EGFR mutations detected in pleural effusion.Methods We retrospectively analyzed the clinical characteristics including gender,age,smoking history,presence of other underlying diseases(such as COPD,cardiovascular disease,and diabetes),site of pleural fluid,feature of pleural fluid,and TNM stage in patients with lung adenocar-cinoma who had been admitted to the first Affiliated Hospital of Bengbu Medical College from 2020.01 to 2022.12 for the first time by the detection of EGFR mutation positive in pleural effusion.The data were statistically analyzed using the SPSS 26.0 software.Results A total of 126 patients were screened for enrollment,including 61 patients(48.41%)with EGFR exon 19 deletion mutation(19del),56 patients(44.44%)with exon 21 L858R mutation(21L858R),and 9 patients(7.14%)with non-classical mutations.Univariate analysis showed that the three muta-tion subtypes were statistically significant in terms of gender,age,smoking history,and presence of COPD(P<0.05 for all comparisons),but not in terms of pleural fluid site,feature of pleural fluid,tumor size,and presence of cardiovascular disease,diabetes mellitus,presence of distant metastases,and mediastinal lymph node metastases(P>0.05 for all comparisons);Multivariate analysis showed that 21 L858R mutation was more likely to be found in male,older age,non-smoking,and presence of COPD than 19del mutation;non-classical mutation was more likely to be found in male than 19del mutation.Conclusions There are significant differences among the three mutation subtypes in sex,age,smoking history,and presence of COPD,but not in pleural fluid location,feature of pleural fluid,tumor size,presence of cardiovascular disease or diabetes mellitus,presence of distant metastases,or medias-tinal lymph node metastases;Among lung adenocarcinoma patients with positive EGFR mutations in pleural fluid,21 L858R mutation mostly occurs in male,older age,non-smokers,and those complicated with COPD,while non-classical mutation mainly develops in male.However,more case studies are needed to confirm the above conclusions.

Characteristics of myocardial injury in patients with acute myocardial infarction complicated with pleural effusion and its influence on long-term prognosis / 天津医药

Objective To explore the characteristics of myocardial injury in patients with acute myocardial infarction(AMI)complicated by pleural effusion and its effect on long-term prognosis.Methods It was a prospective single-center study.Patients with AMI who were admitted to hospital within 15 days from symptom onset and performed echocardiography and cardiac magnetic resonance imaging(CMR)during hospitalization were consecutively enrolled and assigned to the with-pleural effusion group and the without-pleural effusion group according to the echocardiography result.Baseline data,cardiac magnetic resonance myocardial injury index and echocardiography characteristics were compared between the two groups.The occurrence of major adverse cardiovascular and cerebrovascular events(MACCE)was recorded through outpatient follow-up and telephone follow-up,including all-cause death,re-infarction,revascularization,rehospitalization for congestive heart failure and stroke.Cox regression analysis was performed to analyze influencing factors of all-cause death.Results Among 211 patients,31(14.7%)patients had pleural effusion and 180(85.3%)had no pleural effusion.Compared with the group without pleural effusion,the left ventricular end-diastolic diameter was larger,and left ventricular ejection fraction assessed by echocardiography was lower in the group with pleural effusion(P＜0.05).There were no significant differences in infarct size,left ventricular end-diastolic volume,left ventricular end-systolic volume,left ventricular ejection fraction and the presence of microvascular obstruction and intramyocardial hemorrhage between the two groups in CMR(all P＞0.05).At a median follow-up of 31 months,MACCE occurred in 43(20.4%)patients,and there was no significant difference between the two groups(χ2=3.160,P=0.075).Six cases(2.8%)had all-cause death.The incidence of all-cause death was higher in the group with pleural effusion than that in the group without pleural effusion(9.7%vs.1.7%,P<0.05).There was no significant difference in the incidence of other adverse events between the two groups(P＞0.05).Multivariate Cox regression analysis showed that advanced age and presence of pleural effusion were independent risk factors of all-cause death during follow-up.Conclusion Patients with AMI combined with pleural effusion have more severe myocardial injury and higher all-cause mortality.

Study on the value of screening cytokines in pleural effusion by liquid array technology in the diagnosis of tuberculous pleurisy / 天津医药

Objective To screen the specific cytokines of tuberculous pleural effusion(plTB)by using liquid array technique to establish a diagnostic model and discuss its application value.Methods A total of 86 patients with plTB(plTB group)were included,including 41 patients in the confirmed plTB group and 45 patients in the clinically diagnosed plTB group.There were 42 other patients with pleural effusion in the control group.Seventeen cytokines in pleural effusion were analyzed by liquid array technology.Interleukin(IL)-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-9,IL-10,gamma-interferon-induced protein 10(IP-10),IL-15,IL-17F,IL-27,tumor necrosis factor(TNF)-α,monocyte chemotactic protein-1(MCP-1),the expression levels of macrophage inflammatory protein-3a(MIP-3α),macrophage colony-stimulating factor(M-CSF)and β-interferon(IFN-β)were detected.Difference factors between the confirmed plTB group and the control group were screened,and the receiver operating characteristic(ROC)curve was drawn in the confirmed plTB patients.IP-10,IL-27 and MCP-1 with AUC>0.850 and specificity>80%were combined to diagnose plTB,and were compared with adenylate deaminase(ADA)and T-SPOT.TB in pleural effusion to evaluate the diagnostic efficacy.Results The levels of IL-2,IP-10,IL-27,TNF-α and MCP-1 were higher in the confirmed plTB group than those in the control group(P＜0.05).The sensitivity and specificity of IP-10,IL-27 and MCP-1 in the diagnosis of plTB were 87.8%and 81.0%.The sensitivity of three-factor combined diagnosis in 45 patients with plTB was still as high as 86.7%,and there was no significant difference in sensitivity compared with that in the diagnosed plTB group(P＞0.05).In the plTB group,the sensitivity of IP-10,IL-27 and MCP-1 combined detection was 87.2%,which was higher than that of T-SPOT.TB(81.4%)and ADA(54.7%).Conclusion The application of liquid array technology to the joint detection of pleural effusion IP-10,IL-27 and MCP-1 can provide help for the diagnosis of plTB.

Application of DNA image cytometry ploidy analysis in pathological diagnosis of malignant pleural effusion / 肿瘤研究与临床

Objective:To explore the clinical application value of DNA image cytometry ploidy analysis (DNA-ICM) in the pathological diagnosis of malignant pleural effusion.Methods:A retrospective case series study was conducted. The clinical data of 101 patients with pleural effusion from October to December 2021 in Shanxi Bethune Hospital were retrospectively analyzed. Liquid-based cytology (LBC) and DNA-ICM were performed on pleural effusion specimens. The sensitivity and specificity of the two methods were compared with the clinical diagnosis, imaging, biopsy, and follow-up results of the patients.Results:Among the pleural effusions of 101 patients, 39 were malignant pleural effusions and 62 were benign pleural effusions. The sensitivity of LBC and DNA-ICM in diagnosing malignant tumor cells in pleural effusions was 74.7% and 94.9%, respectively, and the specificity was 98.4% and 83.9%, respectively; the combination of the two had an increased diagnostic positivity rate compared with that of LBC alone [36.6% (37/101) vs. 28.7% (29/101)]. Seven cases with positive DNA-ICM but negative LBC result were followed up, and 1 case was diagnosed as small cell lung cancer. Conclusions:DNA-ICM can effectively improve the positive cytology detection rate of pleural effusion, and the combined detection of DNA-ICM and LBC can reduce the underdiagnosis rate of cytology, which is of great clinical value in the pathological diagnosis of malignant pleural effusion.

Giant extralobar pulmonary sequestration with severe pleural effusion in neonatal period: A case report / 中国胸心血管外科临床杂志

@#Giant extralobar pulmonary sequestration in newborns is still relatively rare in pulmonary diseases, and there are few relevant studies published. A neonate with the giant extralobar pulmonary sequestration accompanied by severe pleural effusion was reported here. After 12 days of birth, the diseased lung tissue was surgically extracted. The patient had an uneventful postoperative recovery and was discharged from the hospital. The case shows the advantage of early surgical treatment to extralobar pulmonary sequestration with severe pleural effusion in neonatal period.

Investigation and Ethical Consideration of Perioperative Complications in Patients with Liver Transplantation / 中国医学伦理学

To explore the prevention and treatment of perioperative complications of adult liver transplantation patients from the perspective of ethics, and carry out ethical thinking in order to provide theoretical support. Through a cross-sectional study, 189 patients selected by strict admission criteria who received liver transplantation in the department of hepatobiliary surgery of the First Affiliated Hospital of Xi’an Jiaotong University from January 2018 to May 2019, to explore the incidence and ethical problems of perioperative complications in adult liver transplantation. The results showed that 87 patients had complications among 189 patients, the incidence was 46.03%. Among them, 28 patients with pleural effusion, the incidence was 14.81%; 15 patients with biliary complications, the incidence was 7.94%; 14 patients with diabetes mellitus, the incidence was 7.41%. The incidence of complications after liver transplantation is high, mainly including pleural effusion, biliary complications and diabetes mellitus. Thus, the prevention and intervention from the perspective of nursing ethics is worth exploring.

Comparison between use of a pleural drainage system with flutter valve and a conventional water-seal drainage system after lung resection: a randomized prospective study

ABSTRACT BACKGROUND: There is still a debate regarding the most appropriate pleural collector model to ensure a short hospital stay and minimum complications. OBJECTIVES: To study aimed to compare the time of air leak, time to drain removal, and length of hospital stay between a standard water-seal drainage system and a pleural collector system with a unidirectional flutter valve and rigid chamber. DESIGN AND SETTING: A randomized prospective clinical trial was conducted at a high-complexity hospital in São Paulo, Brazil. METHODS: Sixty-three patients who underwent open or video-assisted thoracoscopic lung wedge resection or lobectomy were randomized into two groups, according to the drainage system used: the control group (WS), which used a conventional water-seal pleural collector, and the study group (V), which used a flutter valve device (Sinapi® Model XL1000®). Variables related to the drainage system, time of air leak, time to drain removal, and time spent in hospital were compared between the groups. RESULTS: Most patients (63%) had lung cancer. No differences were observed between the groups in the time of air leak or time spent hospitalized. The time to drain removal was slightly shorter in the V group; however, the difference was not statistically significant. Seven patients presented with surgery-related complications: five and two in the WS and V groups, respectively. CONCLUSIONS: Air leak, time to drain removal, and time spent in the hospital were similar between the groups. The system used in the V group resulted in no adverse events and was safe. REGISTRATION: RBR-85qq6jc (https://ensaiosclinicos.gov.br/rg/RBR-85qq6jc).

Computed tomography attenuation in differential diagnosis of transudative and exudative pleural effusions

Abstract Objective: Pleural effusion is a common medical problem. It is important to decide whether the pleural fluid is a transudate or an exudate. This study aims to measure the attenuation values of pleural effusions on thorax computed tomography and to investigate the efficacy of this measurement in the diagnostic separation of transudates and exudates. Materials and methods: 380 cases who underwent thoracentesis and thorax computed tomography with pleural effusion were classified as exudates or transudates based on Light's criteria. Attenuation measurements in Houns-field units were performed through the examination of thorax computed tomography images. Results: 380 patients were enrolled (39 % women), the mean age was 69.9 ± 15.2 years. 125 (33 %) were transudates whereas 255 (67 %) were exudates. The attenuation values of exudates were significantly higher than transudates (15.1 ± 5.1 and 5.0 ± 3.4) (p< 0.001). When the attenuation cut-off was set at ≥ 10 HU, exudates were differentiated from transudates at high efficiency (sensitivity is 89.7 %, specificity is 94.4 %, PPV is 97 %, NPV is 81.9 %). When the cut-off value was accepted as < 6 HU, transudates were differentiated from exudates with 97.2 % specificity. Conclusion: The attenuation measurements of pleural fluids can be considered as an efficacious way of differentiating exudative and transudative pleural effusions.

Talc slurry versus thoracoscopic talc insufflation for malignant pleural effusion: a systematic review and meta-analysis

ABSTRACT Objective: Talc pleurodesis is a widely used treatment option for malignant pleural effusion (MPE). However, the optimal form of administration remains controversial. Thus, we performed a systematic review and meta-analysis to assess the effectiveness of talc slurry (TS) in comparison with thoracoscopic talc insufflation/poudrage (TTI) for MPE treatment. Methods: We searched PubMed, EMBASE, and Cochrane Library databases for studies that compared TS with TTI in patients with MPE. We used a random-effects model with a 95% CI to pool the data. Heterogeneity was assessed with I2 statistics. Results: We included eight studies involving 1,163 patients, 584 of whom (50.21%) underwent TS. Pleurodesis failure rates were similar between the procedures (OR = 1.07; 95% CI: 0.56-2.06; p = 0.83; I2 = 62%); and 68% of patients (95% CI: 0.31-1.47; p = 0.33; I2 = 58%) had postoperative complications, which were lower in patients in the TS group than in the TTI group. In a subgroup analysis considering only randomized clinical trials, the failure rate was significantly lower in the TS treatment group (OR = 0.62; 95% CI: 0.42-0.90; p = 0.01; I2 = 0%). Similarly, dyspnea was less common in the TS group (OR = 0.74; 95% CI: 0.41-1.34; p = 0.32; I2 = 55%). Adverse effects were reported in 86 patients, and no significant difference was seen between the TS and TTI groups: empyema (OR = 1.43; 95% CI: 0.36-5.64; p = 0.86; I2 = 0%), pain (OR = 1.22 (95% CI: 0.67-2.21; p = 0.51; I2 = 38%), and pneumonia (OR = 1.15; 95% CI: 0.30-4.46; p = 0.86; I2 = 27%). Conclusions: Our findings suggest that TS is an effective treatment for MPE, with no significant increase in adverse events. Results suggest equivalent efficacy and safety for both procedures.

A complex case of eosinophilic pleural effusion: an unconventional response to anti-tubercular therapy

Eosinophilic tuberculosis (TB) is a rare form of TB characterized by the presence of eosinophils in pleural fluid. It remains an uncommon presentation and often poses a diagnostic challenge due to its resemblance to other conditions with eosinophilic pleural effusions. Here, we present a detailed case report of a 26-year-old female who presented with a two-week history of on-and-off fever, non-productive cough, and exertional dyspnea. Physical examination revealed absent air entry in the left infra-scapular and intra-axillary areas. Routine investigations and chest X-ray indicated a moderate left-sided pleural effusion with peripheral eosinophilia. Liver and kidney function tests were within the normal range. A left pleural tap was performed, and the pleural fluid analysis demonstrated an exudative effusion with predominantly eosinophils. Additional investigations, including ADA levels, Genexpert for TB, TB PCR, C-ANCA, P-ANCA, and total IgE levels, were performed to rule out other possible causes of eosinophilia, but the results were all negative or normal. No growth was observed on culture. Based on clinical history, examination findings, and investigation results, a diagnosis of eosinophilic TB was considered. The patient was started on empirical anti-tubercular drugs, which led to a favorable response and near-complete resolution of pleural effusion after 6 weeks of treatment. Regular follow-up and monitoring were conducted, and the patient completed a 6-month course of anti-tubercular treatment. This case report highlights the importance of considering eosinophilic TB in the differential diagnosis of pleural effusions, especially in young patients with no history of allergies or other underlying conditions.

Usefulness of pleural fluid cholesterol in the diagnosis of tuberculous pleural effusion

Background: Tuberculous pleural effusion (TPE) is the most common etiology of exudative pleural effusion in high tuberculosis burden countries like Bangladesh. The usefulness of pleural fluid cholesterol for the diagnosis of TPE is not evaluated yet. This study aimed to assess the usefulness of pleural fluid cholesterol for the diagnosis of TPE. Methods: This cross-sectional study was conducted at the department of respiratory medicine at Bangabandhu Sheikh Mujib medical university. A total of thirty-five TPE was included in this study. Pleural fluid aspiration followed by cytological (total count, differential count), and biochemical (protein, glucose, lactate dehydrogenase, adenosine deaminase, and cholesterol) investigations were done. At the same time, blood was sent for biochemical (protein, glucose, and lactate dehydrogenase) investigation. Pleural biopsy followed by a histopathological examination was done to confirm TPE. Ethical clearance was obtained from the institutional review board (IRB) prior to starting this study. Results: In our study, the mean age of the participants was 35.54±14.13 years, and male predominant (74.3%). The mean pleural fluid cholesterol was 99.87±23.82 mg/dl. With a cut of value 69.85, the sensitivity, specificity, and accuracy were 97.14%, 57.14%, and 77.14% respectively. Conclusions: Pleural fluid cholesterol has significant diagnostic usefulness for the diagnosis of tuberculous pleural effusion.

Características clínicas, diagnóstico e tratamento de mulher com síndrome de Meigs: relato de caso e revisão narrativa / Clinical characteristics, diagnosis and treatment of a woman with Meigs syndrome: case report and narrative review

O objetivo deste estudo é descrever o caso de mulher com síndrome de Meigs e apresentar a revisão narrativa sobre o tema. Paciente do sexo feminino, 30 anos, nulípara, encaminhada ao hospital por massa anexial e história prévia de drenagem de derrame pleural. Evoluiu com instabilidade hemodinâmica por derrame pleural hipertensivo à direita, sendo submetida a drenagem torácica, com citologia do líquido negativa. Após, foi submetida a laparotomia: realizada salpingo-ooforectomia esquerda. A congelação e a análise histopatológica diagnosticaram fibroma ovariano. A citologia ascítica foi negativa. CA-125 elevado, presença de derrames cavitários e exame de imagem suspeito podem mimetizar um cenário de neoplasia maligna de ovário em estágio avançado. Entretanto, na síndrome de Meigs clássica, o tratamento é cirúrgico, sendo o diagnóstico obtido por meio da análise histopatológica do tumor ovariano. O manejo da síndrome de Meigs clássica é cirúrgico e, após a remoção do tumor, o derrame pleural e a ascite desaparecem.

To describe a case of Meigs syndrome and present a narrative review of the condition. Female patient, 30 years old, nulliparous, referred to the hospital due to an adnexal mass and a previous drainage of pleural effusion. She developed hemodynamic instability due to a hypertensive right pleural effusion being submitted to chest drainage, with negative cytology of the fluid. She underwent laparotomy: Left salpingo-oophorectomy was performed and frozen section and histopathological analysis diagnosed an ovarian fibroma. Ascites cytology was negative. Elevated CA-125, presence of cavitary effusions, suspicious imaging exam can mimic a scenario of ovarian cancer at an advanced stage. However, in classical Meigs syndrome, treatment is surgical, and the diagnosis is obtained through histopathological analysis of the ovarian tumor. Classical Meigs syndrome' management is surgical. After tumor removal, pleural effusion and ascites resolve.

Quilotórax en pacientes con linfoma: a propósito de 2 casos clínicos. Revisión bibliográfica / Chylothorax in patients with lymphoma: about 2 clinical cases. Bibliographic review

Resumen El quilotórax es una condición médica caracterizada por la acumulación de quilo dentro de la cavidad pleural. El quilo es un líquido lechoso compuesto de linfa y grasas emulsionadas que normalmente se transporta a través del sistema linfático. El quilotórax ocurre cuando hay una interrupción o daño en el conducto torácico u otros vasos linfáticos, lo que provoca una fuga de quilo al espacio pleural. Las causas más comunes del quilotórax incluyen los linfomas, seguido del carcinoma broncogénico y los traumatismos. El diagnóstico se obtiene mediante toracocentesis y la determinación de las concentraciones de triglicéridos y colesterol en el líquido pleural. Se presenta el reporte de 2 casos clínicos de pacientes diagnosticados con linfoma B difuso de células grandes fenotipo post centro germinal y con linfoma de células del manto, quienes recibieron tratamiento con quimioterapia protocolo R-CHOP (rituximab, ciclofosfamida, clorhidrato de doxorrubicina (hidroxidaunorrubicina), sulfato de vincristina (Oncovin) y prednisona). Durante el seguimiento oncológico presentaron como complicación derrame pleural. En ambos casos el derrame pleural fue drenado y las pruebas bioquímicas del líquido pleural confirmaron el diagnóstico de quilotórax. En ambos casos los pacientes mejoraron con nutrición parenteral y quimioterapia, sin llegar a requerir procedimientos quirúrgicos o intervenciones por radiología intervencionista.

Abstract Chylothorax is a medical condition characterized by the accumulation of chyle within the pleural cavity. Chyle is a milky fluid composed of lymph and emulsified fats that is normally transported through the lymphatic system. Chylothorax occurs when there is disruption or damage to the thoracic duct or other lymphatic vessels, causing chyle to leak into the pleural space. The most common causes of chylothorax include lymphomas, followed by bronchogenic carcinoma and trauma. Diagnosis is obtained by thoracentesis and determination of triglyceride and cholesterol concentrations in pleural fluid. We report 2 clinical cases of patients diagnosed with diffuse large B-cell lymphoma post-germinal center phenotype and mantle cell lymphoma, who received treatment with chemotherapy protocol R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride (hydroxydaunorubicin), vincristine sulfate (Oncovin), and prednisone). During oncological follow-up they presented pleural effusion as a complication. In both cases the pleural effusion was drained and biochemical tests of the pleural fluid confirmed the diagnosis of chylothorax. In both cases the patients improved with parenteral nutrition and chemotherapy, without requiring surgical procedures or interventions by interventional radiology

Protracted tuberculous empyema necessitans following intercostal drainage tube insertion

Empyema necessitans (EN) is a rare long-term sequela of poorly or untreated empyema thoracis, characterized by the dissection of pus through the soft tissues and skin of the chest wall, ultimately forming a fistula between skin and pleural cavity. We herein present a male patient in his late 30s, a known case of tuberculosis (TB) on anti-tubercular therapy (ATT) under directly observed treatment short-course (DOTS), who recently came with complaints of backache for 3 days. Chest X-ray showed a massive pleural effusion, in view of which an intercostal drainage tube (ICD) was inserted and 1.5 L of pleural fluid was drained. An ultrasound (USG) back done revealed subcutaneous collection with communication to pleural space, which resolved after pleural fluid drainage. As there was a persistent communication between pleural space and right-sided subcutaneous plane with a massive effusion i.e., EN, he was advised to undergo thoracotomy with decortication and resection of communication which he underwent successfully. This case is presented for its rarity with atypical presentation.

A comparative study of conventional cytology and cell block in the diagnosis of pleural effusion with special reference to immunohistochemistry

Background: Body cavity fluids are evaluated by cell block (CB) technique. In conventional cytological smears (CS), appropriate identification of the cells as either reactive mesothelial cells or malignant cells is a diagnostic problem. In CB method, there is increase in cellularity, so it gives more morphological details of cells and improving the sensitivity of diagnosis. Sections obtained by CB method are also can be stored for future study like immunohistochemistry (IHC). Aims and Objectives: The aim of the study was to determine the diagnostic efficacy of CB technique over conventional CS and to study of IHC in CB of malignant pleural effusion. Materials and Methods: This will be institution-based, cross-sectional, and observational study. The pleural fluid (except blood and pus) obtained by thoracocentesis from both male and female patient (>18 years of age) 100 cases was included in the study. Pleural fluid mixed with blood/pus, fluid from cystic lesion, and inadequate sample (<15 ml vol.) were excluded in the study. Results: Association between architectural pattern in CB versus architectural pattern in cytology smear showed statistically significant value Chi-square: 201.7417, P < 0.0001. Conclusion: We may conclude that CB technique is better than conventional cytology smear technique especially in case of malignant pleural effusion. It increases true positive cases and decreases false negative cases. It also increases cellularity, maintain architectural pattern, and cellular morphology.

Congenital chylothorax managed with octreotide and skimmed milk: a case report

Pleural effusion occurs when a large amount of free fluid accumulates in the pleural space. A chylothorax is caused by chyle-containing lymphatic fluid draining into the pleural cavity. This is the most common type of pleural effusion observed during the neonatal period. It causes a number of respiratory and nutritional issues and has a significant mortality rate. It is usually treated by intercostal chest tube drainage and total parenteral nutrition. Octreotide is a relatively newer strategy in the management. Here we describe the case of a 16 days old male neonate who presented to us with sudden onset severe respiratory distress requiring invasive ventilation. Radiology suggested pleural effusion and so intercostal chest tube was inserted, which revealed Chylous effusion. The patient was successfully managed with dietary therapy including skimmed milk and octreotide infusion.