Clinical relevance of bilateral pleural effusion in patients with acute pulmonary embolism.

BACKGROUND: The clinical relevance of bilateral pleural effusion (BPE) in patients with acute pulmonary embolism (PE) is unclear. AIMS: To describe characteristics of patients with acute PE that present with BPE. METHODS: Patients with acute PE were retrospectively analysed and divided into three groups: without pleural effusion, unilateral pleural effusion and bilateral effusion. Clinical, laboratory and radiological characteristics were compared between the three groups. RESULTS: The study population (n = 343) consisted of unilateral effusion group (n = 83), BPE group (n = 94) and without effusion group (n = 166). Several variables were noted in higher proportion (%), in the BPE group in comparison to both the unilateral effusion and without effusion groups: heart failure (17.0 vs 7.2 vs 6.7, P = 0.017), hypoalbuminaemia (59.3 vs 39.5 vs 25.6, P ˂ 0.001), PE occurrence in-hospital setting (51 vs 25.6 vs 15.1, P ˂ 0.001), major operation (31 vs 19.2 vs 15.2, P = 0.01) and mechanical ventilation (13.0 vs 4.9 vs 4.2, P = 0.019). Norton scale scores were found to be lower among patients with BPE in comparison to both patients with unilateral and without pleural effusion (15.55 vs 16.92 vs 17.36, P = 0.006). After adjusting confounding variables, patients with BPE have lower probability for in-hospital survival in comparison to both patients with unilateral pleural effusion (odds ratio = 0.30, 95% confidence interval 0.12-0.79), and patients without pleural effusion (odds ratio = 0.26, 95% confidence interval 0.11-0.61). CONCLUSIONS: BPE in patients with acute PE may have significant clinical implications. It may signify serious underlying comorbidities which contribute to higher in-hospital mortality in comparison to both patients with unilateral pleural effusion and patients without pleural effusion.

Diagnostic tool for initial evaluation of the intracranial pressure on computed tomography in pediatric patients with headache.

BACKGROUND: Headache is one of the most common complaints among pediatric patients and can be due to many causes, some benign but others potentially seriously. Increased intracranial pressure, which is known to cause papilledema, is a serious cause of headache, and immediate diagnosis is critical, although difficult. The current study evaluates the diagnostic value of optic nerve sheath diameter (ONSD) and eyeball transverse diameter (ETD) ratio in pediatric patients presenting with headache and papilledema. METHODS: A retrospective analysis of all pediatric patients undergoing head computed tomography scans between January 2013 and December 2015. Patients with normal brain scans were included in the study. Patients presenting with headache underwent funduscopic evaluation and grouped as either headache with papilledema or headache without papilledema. A control group of patients without headache was also included. Studies were reviewed blindly by a neuroradiologist and ONSD and ETD for both eyes were measured. RESULTS: ONSD/ETD index was found to have significantly higher values (p<0.001) in patients with papilledema (median 0.24, interquartile range (IQR) = 0.22-0.25) compared to patients without papilledema (median 0.18, IQR = 0.16-0.19) and the control group (median 0.17, IQR = 0.15-0.18). The ONSD/ETD index showed excellent discrimination ability for patients with headache and papilledema (AUC = 0.96, 95% CI, 0.94-0.99). The ONSD/ETD index of 0.21 was found to have a sensitivity and specificity of 82% and 93%, respectively, for identifying pediatric patients with headache and papilledema. CONCLUSION: Our study shows that ONSD/ETD index of 0.21 can be used as an easy-to-use reference tool for diagnosing papilledema and elevated intracranial pressure in pediatric patients.