Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 17.994
Filtrar
2.
Ultrasound Med Biol ; 49(1): 72-89, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36216657

RESUMO

Early detection of pulmonary complications can improve outcomes for patients with hematological malignancy (HM). For detecting lung injuries, lung ultrasound (LUS) images have been found to be of greater sensitivity than radiographic images. Our group performed a pilot study of LUS imaging to enhance early detection of pulmonary complications in HM patients. This prospective single-center feasibility study evaluated LUS for detecting pulmonary complications in 18 HM patients enrolled while hospitalized for a hematopoietic cell transplant (HCT) (concurrent-HCT group) or re-hospitalized for complications (post-HCT group). Serial LUS exams were performed and assigned a score from 0 to 5 based on pleural line, B-line, consolidation and pleural effusion features. Correlations between patients' clinical characteristics and LUS features were analyzed. Comparisons between the LUS and radiographic images were evaluated. In the concurrent-HCT patients (79 LUS exams), non-significant fluctuating findings were commonly identified, but one-third of the patients presented pathologic findings (LUS scores ≥ 3). In the post-HCT patients (29 LUS exams), LUS images revealed severe pathologic findings (LUS score = 5) in every patient and, compared with radiographic images, were more sensitive for detecting pleural effusions (p < 0.05). LUS can be routinely performed on hospitalized HM patients, allowing point-of-care early detection of pulmonary complications.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Derrame Pleural , Humanos , Estudos Prospectivos , Projetos Piloto , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Ultrassonografia/métodos , Pulmão/diagnóstico por imagem , Pulmão/patologia
3.
Medicine (Baltimore) ; 101(47): e31377, 2022 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-36451398

RESUMO

RATIONALE: Pulmonary blastoma is an extremely rare and highly aggressive tumor. Only a few hundred cases of pulmonary blastoma have been reported. In other cases, a definitive diagnosis is often made through surgical resection. The use of preoperative histopathological sampling in diagnosing was of limited value because of the variety of pulmonary blastoma histology. And there was no literature that the first biopsy was attempted with medical thoracoscopy for diagnosis. PATIENT CONCERNS: A 65-year-old man presented to our hospital with pleural effusion and lung mass. DIAGNOSES: The patient was initially diagnosed with dedifferentiated chondrosarcoma by medical thoracoscopic biopsy but the final diagnosis was pulmonary blastoma through bilobectomy. INTERVENTIONS: Medical thoracoscopy, and video-assisted thoracoscopic surgery (bilobectomy) followed by adjuvant chemotherapy. OUTCOMES: After surgical resection of the tumor, adjuvant chemotherapy has been performed 5 cycles at 3 weeks intervals, and there was no evidence of recurrence on follow-up computed tomography performed 4 months after surgery. LESSONS: Medical thoracoscopy is useful for the diagnosis of indeterminate pleural effusion; however, caution is needed when confirming rare malignancies, such as pulmonary blastoma. Although surgical resection is the treatment of choice, appropriate adjuvant chemotherapy to improve the prognosis may be necessary if there is pleural metastasis.


Assuntos
Condrossarcoma , Neoplasias Pulmonares , Derrame Pleural , Blastoma Pulmonar , Masculino , Humanos , Idoso , Blastoma Pulmonar/diagnóstico , Blastoma Pulmonar/cirurgia , Cirurgia Torácica Vídeoassistida , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Condrossarcoma/diagnóstico , Condrossarcoma/cirurgia
4.
BMJ Case Rep ; 15(11)2022 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-36446471

RESUMO

Segmental involvement of medium-sized vessels are lesser-known manifestations of systemic lupus erythematosus (SLE) vasculopathy. Medium vessel vasculopathy and peripheral vascular disease (PVD) mimicking manifestations of SLE, although rare, have been reported, particularly in Asian women mostly under the age of 30 years. This is due to metabolic disadvantages in their ethnicity, with high incidence of insulin resistance and resulting metabolic syndrome, leading to lower high-density lipoprotein cholesterol levels, higher triglyceride levels and small dense low-density lipoprotein, increased proinflammatory cytokines, endothelial dysfunction and procoagulant tendency. Owing to the longer duration of the disease with the simultaneous use of steroids, vessels are often affected. SLE may also present with thyroid manifestations against a background of a proinflammatory immune state, where autoimmune thyroid diseases, such as Hashimoto's thyroiditis, may coexist. Here, we describe the case of a young woman who presented with progressive shortness of breath, right leg pain and cough with amenorrhoea and was diagnosed with SLE.


Assuntos
Hipotireoidismo , Lúpus Eritematoso Sistêmico , Derrame Pleural , Doenças Vasculares , Feminino , Humanos , Adulto , Exsudatos e Transudatos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico
5.
Eur Respir Rev ; 31(166)2022 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-36450370

RESUMO

Parasitic lung diseases are caused by a number of parasites as a result of transient passage in the lung or as a result of an immunologic reaction. The clinical presentation may be in the form of focal or cystic lesions, pleural effusion or diffuse pulmonary infiltrates. With increasing globalisation, it is important to consider parasitic infections in the differential diagnosis of lung diseases. This is particularly important since early identification and prompt therapy result in full cure of these conditions. In this review, we summarise the most common parasitic lung diseases.


Assuntos
Pneumopatias Parasitárias , Derrame Pleural , Humanos , Pneumopatias Parasitárias/diagnóstico , Pneumopatias Parasitárias/tratamento farmacológico , Diagnóstico Diferencial , Tórax
6.
Int Heart J ; 63(6): 1150-1157, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36450555

RESUMO

In this study, we aim to investigate the clinical features and outcomes of multichanneled aortic dissection (MCAD) and double-channeled aortic dissection (DCAD) in acute type B aortic dissection (TBAD) patients who underwent thoracic endovascular aortic repair (TEVAR).In total, 479 consecutive acute TBAD patients treated with TEVAR from April 2002 to May 2020 were retrospectively enrolled in this study. The MCAD group was defined as those of multichanneled morphology by initial computed tomography angiography (CTA) (n = 61), whereas the DCAD group was defined as those with double-channeled morphology by initial CTA (n = 418). The clinical and morphological characteristics and short-term and long-term adverse events (30-day and > 30 days) were recorded and evaluated.No significant differences were noted between the 2 groups as regards demographics, comorbidity profiles, or initial feature of CTA. The incidence of true lumen compression was found to be significantly lower in the MCAD group compared with the DCAD group (8.2% versus 20.8%, P < 0.05). During the 65.37 ± 40.06 months of follow-up, there were no statistically significant differences in terms of 30-day mortality or the incidence of early adverse events between the 2 groups. The incidence rates of 5-year cumulative freedom from all-cause mortality and 5-year cumulative freedom from AD-related mortality were not significantly different between the MCAD and DCAD groups, whereas the 5-year cumulative freedom from adverse events were lower in the MCAD group compared to DCAD group (51.1% versus 72.5%, P < 0.05). In multivariate Cox regression models, only age > 60 years, pleural effusion, branch involvement, and length of the stent were independent predictors of mortality, whereas age > 60 years, pulse, pleural effusion, true lumen compression, widest diameter of the descending aorta, branch involvement, and length of stent were independent predictors of adverse aortic events.No significant difference was noted between the MCAD and DCAD groups in the 5-year mortality following, whereas patients with MCAD were found to have significantly lower AD-related events than patients with DCAD in long-term follow-up.


Assuntos
Aneurisma Dissecante , Procedimentos Endovasculares , Derrame Pleural , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Aneurisma Dissecante/cirurgia , Angiografia por Tomografia Computadorizada
7.
BMC Pulm Med ; 22(1): 439, 2022 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-36419155

RESUMO

BACKGROUND: Intrapleural fibrinolytic therapy (IPFT) is one of the treatment options for complex pleural effusion. In this study, the IPFT agent used was alteplase, a tissue plasminogen activator (t-PA). This study aims to determine the difference in the outcome of patients with complex pleural effusion between IPFT and surgery in terms of radiological improvement, inflammatory parameters, length of stay, and post-intervention complications. METHODS: A retrospective review of patients with complex pleural effusion treated at Universiti Kebangsaan Malaysia Medical Center from January 2012 to August 2020 was performed. Patient demographics, chest imaging, drainage chart, inflammatory parameters, length of hospital stay, and post-intervention and outcome were analyzed. RESULTS: Fifty-eight patients were identified (surgical intervention, n = 18; 31% and IPFT, n = 40, 69%). The mean age was 51.7 ± 18.2 years. Indication for surgical intervention was pleural infection (n = 18; 100%), and MPE (n = 0). Indications for IPFT was pleural infection (n = 30; 75%) and MPE (n = 10; 25%). The dosages of t-PA were one to five doses of 2-50 mg. The baseline chest radiograph in the IPFT group was worse than in the surgical intervention group. (119.96 ± 56.05 vs. 78.19 ± 55.6; p = 0.029) At week 1, the radiological success rate for IPFT and surgical intervention were 27% and 20%, respectively, and at weeks 4-8, the success rate was 56% and 80% respectively. IPFT was associated with lesser complications; fever (17.5%), chest pain (10%), and non-life-threatening bleeding (5%). CONCLUSION: IPFT was comparable to surgery in radiological outcome, inflammatory parameters, and length of stay with lesser reported complications.


Assuntos
Doenças Pleurais , Derrame Pleural , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Fibrinolíticos/uso terapêutico , Derrame Pleural/tratamento farmacológico , Estudos Retrospectivos , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico
8.
Gulf J Oncolog ; 1(40): 74-77, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36448074

RESUMO

Dasatinib is a potent second-generation tyrosine kinase inhibitor (TKI) used in the first- and second-line treatment of chronic myeloid leukemia (CML). Chylothorax is a rare presentation that results in chyle leakage from the lymphatic system into the pleural space as a consequence of thoracic duct damage. Pleural effusion has been reported frequently in patients treated with Dasatinib however chylothorax has been rarely reported. Here we report an 18year old female presenting with chylothorax after 63 months of Dasatinib intake along with a review of the relevant literature. Currently there are no standard guidelines regarding the approach to chylothorax management after the initial discontinuation of Dasatinib. Since the TKI options after stopping Dasatinib are limited, and most patients would have already failed the trial of first generation TKI, we suggest implementing a complete treatment strategy for this patient population. Key words: chronic myeloid leukemia, Dasatinib, Pleural effusion, Chylothorax.


Assuntos
Quilotórax , Leucemia Mielogênica Crônica BCR-ABL Positiva , Derrame Pleural , Humanos , Feminino , Dasatinibe/efeitos adversos , Quilotórax/induzido quimicamente , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Derrame Pleural/induzido quimicamente
10.
Biosensors (Basel) ; 12(11)2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36354448

RESUMO

More than half of all pleural effusions are due to malignancy of which lung cancer is the main cause. Pleural effusions can complicate the course of pneumonia, pulmonary tuberculosis, or underlying systemic disease. We explore the application of label-free surface-enhanced Raman spectroscopy (SERS) as a point of care (POC) diagnostic tool to identify if pleural effusions are due to lung cancer or to other causes (controls). Lung cancer samples showed specific SERS spectral signatures such as the position and intensity of the Raman band in different wave number region using a novel silver coated silicon nanopillar (SCSNP) as a SERS substrate. We report a classification accuracy of 85% along with a sensitivity and specificity of 87% and 83%, respectively, for the detection of lung cancer over control pleural fluid samples with a receiver operating characteristics (ROC) area under curve value of 0.93 using a PLS-DA binary classifier to distinguish between lung cancer over control subjects. We have also evaluated discriminative wavenumber bands responsible for the distinction between the two classes with the help of a variable importance in projection (VIP) score. We found that our label-free SERS platform was able to distinguish lung cancer from pleural effusions due to other causes (controls) with higher diagnostic accuracy.


Assuntos
Neoplasias Pulmonares , Derrame Pleural Maligno , Derrame Pleural , Humanos , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/patologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Derrame Pleural/complicações , Derrame Pleural/diagnóstico , Curva ROC , Aprendizado de Máquina
11.
Clinics (Sao Paulo) ; 77: 100133, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36375297

RESUMO

OBJECTIVE: The aim is to evaluate the diagnostic value of Activin A levels in serum and pleural fluid on Parapneumonic Pleural Effusion (PPE). METHODS: The authors collected serum and pleural fluid from 86 PPE and 37 Non-PPE (NPPE) patients. Including Activin A, levels of biomarkers such as Lactate Dehydrogenase (LDH), Procalcitonin (PCT), and C-Reactive Protein (CRP) were measured. All factors were calculated for association with days after admission. The diagnostic potential of biomarkers on PPE was considered by Receiver Operating Characteristic (ROC) curve analysis. RESULTS: Levels of Activin A in serum and pleural fluid of PPE patients were significantly higher than those of the NPPE patients. Moreover, concentrations of Activin A in pleural fluid showed a more obvious relevant days after admission. ROC curve analysis found that Activin A in pleural fluid had AUCs of 0.899 with 93% sensitivity and 84% specificity for PPE diagnosis. CONCLUSION: Activin A in pleural fluid correlated with disease severity could act to diagnose PPE.


Assuntos
Derrame Pleural , Humanos , Derrame Pleural/diagnóstico , Exsudatos e Transudatos/metabolismo , Pleura , Curva ROC , Biomarcadores/metabolismo , Diagnóstico Diferencial
12.
Intern Med ; 61(22): 3415-3419, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36385047

RESUMO

Chest symptoms and pleural effusion due to serositis in familial Mediterranean fever (FMF) are occasionally misdiagnosed as acute pneumonia. However, the actual pulmonary involvement of FMF is extremely rare. A 67-year-old man was referred to our hospital due to repeated and transient anterior chest pain. Chest images revealed a moderate amount of pericardial fluid, slight bilateral pleural effusion, and infiltrations in both lower lung lobes. Colchicine treatment without antibiotics rapidly improved these symptoms and findings. Pericarditis, pleurisy and the response to colchicine indicated FMF. FMF should be considered as a causative disease of pulmonary infiltrations, especially if it occurs repeatedly.


Assuntos
Febre Familiar do Mediterrâneo , Pericardite , Derrame Pleural , Pleurisia , Masculino , Humanos , Idoso , Febre Familiar do Mediterrâneo/complicações , Febre Familiar do Mediterrâneo/diagnóstico , Febre Familiar do Mediterrâneo/tratamento farmacológico , Colchicina/uso terapêutico , Pericardite/complicações , Pleurisia/etiologia , Derrame Pleural/complicações
13.
Ann Med ; 54(1): 3052-3059, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36331267

RESUMO

BACKGROUND AND OBJECTIVE: Community-acquired pneumonia (CAP) is a frequent cause of hospitalisation. Several factors, such as pandemics, vaccines and globalisation may lead to changes in epidemiology, clinical presentation, and outcomes of CAP, which oblige to a constant actualisation. We performed this study to analyse how these factors have evolved over a 10-year period. MATERIALS AND METHODS: Patients diagnosed with CAP for two 1-year periods that were 10 years apart (2007-2008 and 2017-2018) were included. We compared microbiological information, clinical data and evolutive outcomes in the two periods. A mortality analysis was performed. RESULTS: 1043 patients were included: 452 during the first period (2007- 2008), and 591 during the second period (2017-2018). Bacterial aetiology did not change during the 10-year period, besides a slight increase in Staphylococcus aureus (0.9% vs 2.9%, p = 0.026). There was a decline in the proportion of bacteraemia in the second period (14.8% vs 9.6%, p = 0.012). The incidence of complicated pleural effusion and septic shock declined too (6.4% vs 3.6%, p = 0.04 and 15.5% vs 6.3%, p < 0.001). Respiratory failure and Intensive care unit (ICU) admission were similar in both periods. Variables independently associated with mortality were age and septic shock. Influenza vaccine was a protective factor against mortality in the second period. CONCLUSIONS: We have not found relevant differences in the bacterial aetiology of CAP over this 10-year period. There has been a decline in septic complications of CAP such as septic shock, bacteraemia, and complicated pleural effusion. Influenza vaccination is an important tool to reduce mortality.KEY MESSAGESThere were no differences in the bacterial pathogens causing CAP among the 10-year study period. There has been a decline in septic complications of CAP such as septic shock, bacteraemia, and complicated pleural effusion.


Assuntos
Bacteriemia , Infecções Comunitárias Adquiridas , Derrame Pleural , Pneumonia , Choque Séptico , Humanos , Choque Séptico/complicações , Infecções Comunitárias Adquiridas/epidemiologia , Pneumonia/etiologia , Pneumonia/complicações , Derrame Pleural/complicações
14.
Ann Med ; 54(1): 3129-3135, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36345981

RESUMO

BACKGROUND: Paediatric pleural tuberculosis (TB) is a paucibacillary disease, which increases the difficulty of examination. We aimed to assess the performance of pleural fluid adenosine deaminase (ADA) in the detection of paediatric pleural TB. METHODS: PubMed, Web of Science Core Collection, Embase and Cochrane Library databases were searched up to 20 December 2021. We used the bivariate and hierarchical summary receiver operating characteristic models to compute pooled estimates for the overall diagnostic accuracy parameters of ADA for diagnosing paediatric pleural TB. RESULTS: Eight studies, including 290 pleural fluid samples, met the inclusion criteria. The pooled sensitivity of ADA was 0.85 (95% CI: 0.78-0.90, I2: 55.63% < 75%) for detecting patients with paediatric pleural TB. A total of 262 pleural fluid samples from four studies were included to differentiate patients with paediatric pleural TB from controls. At a unified cut-off value of 40 U/L, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the summary receiver operating characteristic curve of ADA were 0.89, 0.58, 2.09, 0.20, 10.48 and 0.89, respectively. CONCLUSIONS: At a cut-off value of 40 U/L, the overall performance of ADA was good for detecting paediatric pleural TB, with relatively high sensitivity and low specificity. Key messageAccurate identification of paediatric pleural TB will help eliminate TB in children. At a cut-off value of 40 U/L, the overall performance of ADA was good for detecting paediatric pleural TB, with relatively high sensitivity and low specificity.


Assuntos
Derrame Pleural , Tuberculose Pleural , Humanos , Criança , Tuberculose Pleural/diagnóstico , Adenosina Desaminase , Derrame Pleural/diagnóstico , Sensibilidade e Especificidade , Curva ROC
15.
Front Immunol ; 13: 1031122, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36389754

RESUMO

Nodal Marginal Zone Lymphoma(NMZL) is an indolent lymphoma with a very low clinical incidence and is sometimes difficult to differentiate diagnostically from Lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia (LPL/WM). NMZL with elevated monoclonal immunoglobulin M (IgM) is even rarer. Nontraumatic chylothorax can be seen in aggressive lymphoma, which often happens with chest tightness and dyspnea as the primary clinical manifestation. We reported the first case of monoclonal IgM elevated NMZL complicated by atypical nontraumatic chylothorax. A 64-year-old male patient was first admitted to the Department of Respiratory Medicine with symptoms of chest tightness and shortness of breath. He was given several times thoracentesis to drain pleural effusion to improve pulmonary compression symptoms. The patient had a combination of elevated monoclonal IgM and atypical lymph node biopsy pathology. After two times lymph node biopsies and genetic testing, the patient was finally diagnosed with NMZL. Within a short time, he was admitted to the Department of Hematology due to the reappearance of massive pleural effusion, which indicated chylothorax. The patient repeatedly presented with left-sided pleural effusion, and the color went from red to yellow, and finally white. Only about half of the chylothorax cases present with typical clinical manifestations. We report this case intending to draw the attention of clinicians to hematologic malignancies with atypical nontraumatic chylothorax.


Assuntos
Quilotórax , Linfoma de Zona Marginal Tipo Células B , Derrame Pleural , Masculino , Humanos , Pessoa de Meia-Idade , Quilotórax/diagnóstico , Quilotórax/etiologia , Linfoma de Zona Marginal Tipo Células B/complicações , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Paraproteínas , Imunoglobulina M , Anticorpos Monoclonais
16.
BMJ Case Rep ; 15(11)2022 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-36414336

RESUMO

Gorham-Stout disease (GSD) is thought to be due to uncontrolled proliferation of vascular and lymphatic structures within bone tissue causing destruction and osteolysis of bone. We present a patient in her mid-40s who reported chronic shoulder pain, a pleural effusion and irregular periods. Investigations showed osteolysis of her ribs, pleural effusions, an ovarian mass and a raised carbohydrate antigen 125 (Ca-125). She was subsequently diagnosed with GSD, and referred to gynaecology-oncology in consideration of potential ovarian malignancy. GSD is a diagnosis of exclusion that requires a high degree of clinical suspicion, as well as multiple investigations to achieve diagnosis. Clinicians rely on a small number of case reports to provide guidance for this. Therefore, this report provides an overview of a rare pathology, considers the differentials of a raised Ca-125 and describes how a pleural effusion, which links them both, alarmed us regarding an incidental finding of an ovarian cyst.


Assuntos
Osteólise Essencial , Osteólise , Neoplasias Ovarianas , Derrame Pleural , Feminino , Humanos , Osteólise Essencial/diagnóstico , Osteólise Essencial/patologia , Diagnóstico Diferencial , Osteólise/diagnóstico , Costelas/patologia , Derrame Pleural/etiologia , Derrame Pleural/diagnóstico , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/diagnóstico
17.
BMJ Case Rep ; 15(11)2022 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-36343981

RESUMO

High amylase pleural effusion remains an entity which includes a wide variety of differentials, with pancreatitis, oesophageal rupture or malignant pleural effusion being most commonly encountered in clinical practice. Keeping the clinical picture (suggestive of pain in abdomen preceding any respiratory complaints) and differentials at hand, the case was evaluated with contrast-enhanced CT of the thorax and abdomen which revealed normal pancreatic architecture and no abnormal communication was noted between the pancreas and pleural space. A contrast oesophagogram, done when pancreatitis was ruled out, showed no evidence of any leak. The patient underwent upper gastrointestinal endoscopy which was suggestive of an ulcer with fistulous communication with the pleural space. Following nasojejunal feeding and clipping of the fistulous tract the patient's symptoms improved.


Assuntos
Gastroenteropatias , Neoplasias , Pancreatite , Derrame Pleural , Humanos , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Pancreatite/complicações , Pancreatite/diagnóstico , Exsudatos e Transudatos , Amilases
18.
Am J Case Rep ; 23: e938319, 2022 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-36444127

RESUMO

BACKGROUND Chronic myeloid leukemia (CML) is a myeloproliferative malignancy generally treated with Dasatinib, a tyrosin-kinase inhibitor. Pleural effusions are a known adverse effect, but only 0.8% of patients develop pleural effusions after 6 years of use. Recent case reports have implicated Dasatinib as a rare cause of chylothorax. CASE REPORT We describe a woman in her 30's with a history of chronic myeloid leukemia, who had been taking Dasatinib for 10 years and presented to the Emergency Department after a chest X-ray revealed bilateral pleural effusions in the setting of worsening dyspnea on exertion for 6 months. She had previously received radiotherapy at age 11 prior to an allogenic bone marrow transplant nearly 30 years prior. Thoracentesis removed 900 cc of chylous fluid, and flow cytometry and cultures found no evidence of infection or malignancy. Dasatinib was discontinued, and she was treated with diuretics, steroids, and a low-fat diet. The effusions reaccumulated twice in the following month and required 2 additional thoracenteses and courses of steroids. Months later, the bilateral chylous effusions recurred, and MR lymphangiogram demonstrated 2 thoracic duct tears. CONCLUSIONS While previous reports have indicated that Dasatinib can rarely cause chylous pleural effusions, it is unlikely after 5 years of use, and other etiologies must be considered by clinicians. Initial misattribution to Dasatinib alone can delay further necessary investigations, including lymphangiography. In our patient, it is more likely that other factors contributed to her chylothorax, including her previous radiotherapy 30 years prior, given her recurrence of chylous effusions following cessation of the medication.


Assuntos
Quilotórax , Leucemia Mielogênica Crônica BCR-ABL Positiva , Derrame Pleural , Feminino , Humanos , Criança , Dasatinibe/efeitos adversos , Quilotórax/induzido quimicamente , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Ducto Torácico , Derrame Pleural/induzido quimicamente
19.
BMC Pulm Med ; 22(1): 428, 2022 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-36402998

RESUMO

BACKGROUND: This study aimed to evaluate the diagnostic accuracy of pleural fluid (PF) lactate dehydrogenase (LDH) to adenosine deaminase (ADA) (LDH/ADA) ratio for tuberculous pleural effusion (TPE). Especially to explore whether the LDH/ADA ratio provides added diagnostic value to ADA. METHODS: The diagnostic accuracy of PF LDH/ADA ratio and ADA for TPE was evaluated in two cohorts, named the BUFF (Biomarkers for patients with Undiagnosed pleural eFFusion) cohort (62 with TPE and 194 with non-TPE) and the SIMPLE (a Study Investigating Markers in PLeural Effusion) cohort (33 with TPE and 177 with non-TPE). Receiver operating characteristic (ROC) curve and decision curve were used to measure the diagnostic accuracy of the PF LDH/ADA ratio. The added diagnostic value of the LDH/ADA ratio to ADA was evaluated with net reclassification improvement (NRI) and integrated discrimination improvement (IDI). RESULTS: The area under the ROC curves (AUCs) of PF ADA and LDH/ADA ratio in the BUFF cohort were 0.76 and 0.74, respectively. In the SIMPLE cohort, the AUCs of PF ADA and LDH/ADA ratio were 0.80 and 0.85, respectively. The decision curves of PF LDH/ADA and ADA were close in both the BUFF and SIMPLE cohorts. The NRI and IDI analyses did not reveal any added diagnostic value of LDH/ADA to ADA. CONCLUSIONS: PF LDH/ADA ratio has moderate diagnostic accuracy for TPE. It does not provide added diagnostic value beyond ADA. The current evidence does not support LDH/ADA ratio for diagnosing TPE.


Assuntos
Derrame Pleural , Tuberculose Pleural , Humanos , Adenosina Desaminase , Tuberculose Pleural/diagnóstico , L-Lactato Desidrogenase , Derrame Pleural/diagnóstico , Exsudatos e Transudatos , Biomarcadores
20.
Zhonghua Jie He He Hu Xi Za Zhi ; 45(11): 1071-1072, 2022 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-36344223

RESUMO

The consensus published in this issue was developed over a period of 1.5 years, and it was discussed and revised by the expertpanel from pleural and mediastinal diseases working group (preparatory) of Chinese Thoracic Society and external experts in several meetings. This article introduced the purpose, process and thinking in the writing of the consensus, hoping to provide a reference for readers to understand the content of this consensus and to make reasonable application in clinical practice.


Assuntos
Medicina Tradicional Chinesa , Derrame Pleural , Humanos , Consenso , Derrame Pleural/diagnóstico , Pleura , China
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...