ABSTRACT
A 20-year-old male with hydrocephalus managed with a ventriculoperitoneal shunt (VP) was diagnosed with a cerebrospinal fluid (CSF) pleural effusion. Imaging studies revealed an intrathoracic course of a disconnected VP shunt. Physicians should consider CSF effusion in their differential diagnosis in patients with a VP shunt and an unexplained pleural effusion.
Subject(s)
Equipment Failure , Hydrocephalus/surgery , Hydrothorax/cerebrospinal fluid , Pleural Effusion/cerebrospinal fluid , Ventriculoperitoneal Shunt/adverse effects , Adult , Humans , Hydrocephalus/congenital , Hydrothorax/etiology , Male , Pleural Effusion/etiology , Young AdultSubject(s)
Pleural Effusion/cerebrospinal fluid , Pleural Effusion/surgery , Ventriculoperitoneal Shunt/adverse effects , Ventriculostomy/methods , Device Removal , Equipment Failure , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Pleural Effusion/etiology , Radiography, Thoracic , Third Ventricle/surgeryABSTRACT
Rhino- and/or otoliquorrhea can be diagnosed by detecting beta-trace protein (ß-TP) in nasal or ear secretions, as ß-TP is found in high concentrations in cerebrospinal fluid (CSF) but not in serum. CSF fistulae following trauma or surgery can also occur at other anatomical sites, resulting in CSF leakage into the thoracic and abdominal cavities. By analogy, determination of ß-TP has also been used to diagnose CSF admixture in pleural effusions and ascites. However, no systematic study has yet evaluated the concentrations of ß-TP in such fluids in the absence of CSF. To determine the validity of ß-TP determination as a marker for the presence of CSF, we investigated ß-TP concentrations in pleural effusions and ascites without CSF admixture. Patients from whom samples of ascites or pleural effusion and a paired plasma sample were available were investigated. One hundred sixty-four patients were prospectively recruited. ß-TP concentrations were determined by nephelometry. Mass spectrometric proteome analysis confirmed the presence of ß-TP in the samples. Median ß-TP concentrations detected in ascites and pleural effusions (range, 0.014-26.5 mg/L, median 2.29 mg/L) exceeded the corresponding plasma concentrations 2.6-fold. According to cutoffs published to diagnose rhino- and otoliquorrhea, between 6.1% and 95.7% of the specimens would have been erroneously rated CSF-positive. Protein analysis confirmed the presence of ß-TP in pleural effusion and ascites. Ascites and pleural effusion contain high concentrations of ß-TP that exceed the levels in corresponding plasma. Therefore, ß-TP is not a specific marker for the presence of CSF in these fluids.
Subject(s)
Ascites/metabolism , Intramolecular Oxidoreductases/cerebrospinal fluid , Lipocalins/cerebrospinal fluid , Pleural Effusion/cerebrospinal fluid , Adult , Aged , Aged, 80 and over , Brain Injuries/cerebrospinal fluid , Brain Injuries/diagnosis , Cerebrospinal Fluid Otorrhea/cerebrospinal fluid , Cerebrospinal Fluid Rhinorrhea/cerebrospinal fluid , DNA Fingerprinting , Electrophoresis, Polyacrylamide Gel , False Positive Reactions , Female , Humans , Intramolecular Oxidoreductases/metabolism , Lipocalins/metabolism , Male , Mass Spectrometry , Middle Aged , Pleural Effusion/metabolism , Proteome , Young AdultABSTRACT
We report a 62-year-old male patient with asbestos-related malignant pleural mesothelioma who developed recurrent pleural effusions after surgical resection of paravertebral tumour masses. Pleural effusions were drained on several occasions with the patient suffering severe headaches and vascular dysregulation. Cytological studies of the pleural fluid showed no evidence of inflammatory or malignant cells. The fluid was interpreted as seroma despite its unusual transparency until magnetic resonance imaging was suggestive of a subarachnoid-pleural fistula; its presence was confirmed when beta-trace protein--a specific marker for cerebrospinal fluid--was added to the standard laboratory testing of the pleural effusion. A subarachnoid-pleural fistula has to be included in the differential diagnosis of patients with recurrent pleural effusions after surgical debulkment of malignant pleural mesothelioma. The beta-trace protein may help to establish this diagnosis especially in cases where important therapeutic consequences may need to be drawn.
Subject(s)
Fistula/complications , Mesothelioma/pathology , Pleural Cavity/diagnostic imaging , Pleural Neoplasms/pathology , Subarachnoid Space , Biomarkers/cerebrospinal fluid , Fatal Outcome , Fistula/diagnosis , Fistula/diagnostic imaging , Humans , Intramolecular Oxidoreductases/cerebrospinal fluid , Lipocalins , Magnetic Resonance Imaging , Male , Mesothelioma/diagnostic imaging , Middle Aged , Pleural Cavity/pathology , Pleural Effusion/cerebrospinal fluid , Pleural Effusion/cytology , Pleural Neoplasms/diagnostic imaging , Seroma/complications , Seroma/diagnosis , Tomography, X-Ray ComputedSubject(s)
Cerebrospinal Fluid/diagnostic imaging , Multiple Trauma/diagnostic imaging , Myelography/methods , Pentetic Acid , Pleural Effusion/diagnostic imaging , Spinal Cord Injuries/diagnostic imaging , Wounds, Nonpenetrating/diagnostic imaging , Accidents, Traffic , Adult , Humans , Pleural Effusion/cerebrospinal fluid , Pleural Effusion/etiology , Radionuclide Imaging , Radiopharmaceuticals , Spinal Cord Injuries/complications , Thoracic Injuries/diagnostic imaging , Thoracic Vertebrae/diagnostic imaging , Wounds, Nonpenetrating/complicationsSubject(s)
Diskectomy/adverse effects , Dura Mater/pathology , Fistula/complications , Fistula/pathology , Intracranial Hypotension/etiology , Pleural Diseases/pathology , Adult , Female , Fistula/cerebrospinal fluid , Headache/etiology , Humans , Intracranial Hypotension/cerebrospinal fluid , Intracranial Hypotension/pathology , Magnetic Resonance Imaging , Paraparesis/etiology , Pleural Effusion/cerebrospinal fluid , Pleural Effusion/etiology , Pleural Effusion/pathologyABSTRACT
We used solid phase indirect hemadsorption assay (SPIHA) to detect specific IgM antibodies in specimens from cerebrospinal fluid, pleural fluid and ascitic fluid in patients with tuberculosis and compared with the enzyme linked immunosorbent assay (ELISA) and indirect hemagglutination assay (IHA). The result showed that detection of tuberculous specific IgM antibodies in cerebrospinal fluid by SPIHA is important for diagnosing the tuberculous meningitis.
Subject(s)
Antibodies, Bacterial/analysis , Immunoglobulin M/analysis , Mycobacterium tuberculosis/immunology , Tuberculosis/immunology , Ascites/cerebrospinal fluid , Ascites/immunology , Hemadsorption Inhibition Tests/methods , Humans , Pleural Effusion/cerebrospinal fluid , Pleural Effusion/immunology , Tuberculosis/cerebrospinal fluidABSTRACT
A persistent left pleural effusion caused diagnostic difficulty in a young girl, 2 years after a road accident had rendered her paraplegic. Eventually, after instillation of a contrast medium into the pleural fluid, computed tomography showed a fistulous communication between the subarachnoid and pleural spaces at the level in the dorsal spine where trauma had occurred.