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Aims The aim of the study was to determine the performance of Xpert MTB/RIF assay in diagnosing tuberculosis on thoracoscopic pleural biopsies in exudative pleural effusion. Methods Patients who underwent thoracoscopic pleural biopsy in the defined period were included in the study. Histopathology was done for all and Xpert MTB RIF assay and AFB culture of pleural biopsy specimen and pleural fluid were done as per the clinician's discretion. Results Total of 110 patients underwent pleural biopsy and tissue Xpert MTB/RIF and MTB culture were done in 29 patients. XpertMTB/RIF assay and MTB culture had a sensitivity of 59% and 35% respectively and specificity of specificity of 100. Conclusion The study described the ability of XPERT MTB/RIF in getting additional diagnostic information from thoracoscopic Pleural biopsy. Pleural biopsy Xpert MTB/RIF had sensitivity of 59% and specificity of 100% in diagnosing TPE. In addition to the diagnosis, Xpert MTB/RIF can also give valuable information about rifampicin resistance too. XPERT MTB/RIF assay also helped in getting diagnosis when histopathology alone was not able to confirm or rule out the diagnosis of TPE. Pleural fluid ADA of 38 IU/L had a sensitivity of 71% and a specificity of 86% for diagnosis of TPE in present study.

BACKGROUND: Differential diagnosis between malignant pleural effusion (MPE) and benign pleural effusion (BPE) remains a clinical challenge. OBJECTIVE: The aim of the study is to assess the efficacy of the serum and pleural fluid (PF) miRNA panels in distinguishing MPE from BPE. METHODS: Fourteen candidate miRNAs which were shown aberrant expression in lung cancer based on previous studies were tested by quantitative real-time PCR (qRT-PCR) in 20 MPE patients and 20 BPE patients. Significantly aberrantly expressed miRNAs were further assessed by qRT-PCR in all patients enrolled in this study. A receiver operating characteristic (ROC) curve was constructed, and the area under the ROC curve (AUC) was calculated to evaluated the diagnostic performance of the miRNAs. RESULTS: miR-21, miR-29c and miR-182 were found to be significantly aberrantly expressed in the serum and PF of MPE patients. The AUCs for the combination of miR-21, miR-29c and miR-182 in serum and PF were 0.832 and 0.89 respectively in distinguishing MPE from infection-associated PE including tuberculous pleurisy and parapneumonia PE, and 0.866 and 0.919 respectively for differentiating MPE from heart failure-associated PE, which were superior to AUC of each individual miRNAs. CONCLUSIONS: miR-21, miR-29c and miR-182 in serum and PF could be useful biomarkers for diagnosis of MPE.

Classically, both chylothorax and pseudochylothorax present as a pleural effusion with a characteristic milky white appearance to the pleural fluid. Although both are rare causes of pleural effusion, they have distinct etiologies and clinical implications, and as a result require different management strategies. Pleural fluid analysis of cholesterol and triglyceride levels is key to differentiating the 2 entities from one another and then guide the clinician to determine the best next steps in evaluation and management.

Purpose of the article: The indication of pleural drainage in parapneumonic pleural effusion (PPE) is still controversial. Pleural fluid's (PF) pH is widely used as an indicator of the need for pleural drainage. We hypothesized that PF's lactate will have a high concordance with pH, and thus, may be a valuable tool to determine the need for pleural drainage in pediatric PPE.We performed a descriptive, prospective study sequentially enrolling those pediatric patients admitted to a tertiary University Hospital with a PPE between 2008 and 2018. Patients were classified in two groups: drainable PPE (pH 7) and non-drainable PPE (pH 7). Correlation with the pH, the area under the curve (AUC), and the sensitivity and specificity values for lactate and other parameters (glucose, and LDH) were analysed too.72 patients with a median age of 4 years (interquartile range 2.25-6) were included. Both groups were homogeneous. Lactate levels were higher in the drainable PPE group (p 0.001), and a strong inverse correlation between pH and lactate was found (r: -0.7; p 0.001). A lactate cut-off value of 60.5 mmol/L, exhibit an AUC of 0.86 with a sensitivity of 70% and a high specificity (97.9%) to predict a pH 7.Our data indicates that lactate in PF presents a strong correlation with pH and could potentially serve as a highly specific biomarker of the need for pleural drainage.

Primary pleural angiosarcoma (PPA) is an extremely rare and clinically aggressive tumor. We report the case of a 66-year-old man having PPA with chest computed tomography (CT) scan showing a large oval-shaped, nonenhancing high attenuation cystic mass in the left hemithorax. Morphological and immunohistochemical findings supported the diagnosis of epithelioid angiosarcoma. Pleural angiosarcoma should be considered in the differential diagnosis of spontaneous hemothorax manifesting as high attenuation loculated pleural fluid on CT.

Background A pleural fluid adenosine deaminase (ADA) has been used globally to assist in the diagnosis of a tuberculous pleural effusion (TPE) with a notable negative predictive value. Case presentation We report a case of a patient with a negative pleural fluid ADA who was found to have culture-positive and biopsy-proven Mycobacterium tuberculosis. Conclusions This case shows the importance of pursuing gold standard diagnostic studies when clinical suspicion remains high despite negative preliminary testing. We further describe gaps in research to improve pleural fluid biomarkers for TPE.

Background: Accurate diagnosis of exudate pleural effusion is definitely important. Few studies have been published on this topic. The current work present evidence for the importance of the pleural fluid markers like high sensitivity-C reactive protein [hsCRP]; tumor necrosis factor alpha [TNFα]; and cholesterol levels measurement in differentiating types of exudative from transudative pleural effusion. Aim: The current study was to determine and evaluate the diagnostic importance of measured levels of pleural fluid cholesterol, high sensitivity-CRP and tumor necrosis factorα in diagnosing and differentiating transudate from exudate pleural effusion. Methods: This study was carried out on 100 patients suffering from pleural effusion who subjected to diagnostic evaluation at Al Sahel Teaching Hospital. The full biochemical analysis of the pleural fluid, pleural fluid culture, and cytology examination were also performed. TNFα, hs CRP, and cholesterol level were assessed in the samples of pleural fluid. Results: One hundred patients were initially evaluated, in accordance to Light's criteria, of 100 patients suffering from pleural effusion, 67 had exudative effusions while 33 patients had transudative pleural effusion. The concentrations of pleural fluid hs CRP and TNFα, found to be significantly elevated in the exudative nature group of pleural fluid than the transudative pleural effusion group (p < 0.05). Also, pleural fluid cholesterol level was elevated in the exudative pleural effusion than transudative pleural effusion (P< 0.001). Conclusion: Patients presented with pleural effusion, simple markers of elevated pleural fluid hsCRP, TNFα, and cholesterol levels may be helpful in discrimination between exudates and transudates effusion.

Introduction: The cytological examination of serous effusions helps in diagnosis, staging, management and prognostication of patients with various malignancies. But cytological method has disadvantage of lower sensitivity in differentiating reactive atypical mesothelial cells from malignant cells. Aim: The aim of this study is to compare the cytomorphology of pleural exudative uids by conventional smear (CS) method and cell block (CB) method and also to assess the utility of their combined approach. Furthermore, immunohistochemistry is used in differentiating the benign from malignant tumour cells in exudative pleural effusions. Materials and Methods: It is a cross sectional study. 38 pleural exudative uid samples were subjected to evaluation by both CS and CB methods over a period of 1 year. Cellularity, architecture patterns, morphological features and yield for malignancy were compared. Chi-square and P-value were calculated, p value

The evolution of pleural disease imaging modalities through the years has helped the scientific community understand and treat various disease states. Ultrasound (US) has been an image modality that has reigned superior to those used in the past such as chest X-ray and computed tomographic scan in terms of cost effectiveness, portability, and reduction in unwarranted radiation exposure to patients. Here we provide a succinct review of US use in pleural disease including imaging techniques, identifying safe pleural space for access, and predicting pleural fluid volume and etiology along with specificities regarding trapped lung identification and pleural mass biopsy. We believe bedside chest US is an adjunct to the physical exam adding superior diagnostic abilities. Further research is warranted in more specific aspects of sonographic use such as in fibrinolytic therapy management, evaluation for trapped lung, and the utility of specific modes like the color flow Doppler.

Pleural fluid is a liquid located in the pleural cavity, between the pleural visceral and pleural parietal. Analysis of pleural fluid is mandatory in all cases of diseases that give rise to pleural effusion. Cytopathological test gives the first indication of malignancy in malignant effusion, one of which is by making cell block. The stages of making cell block begin with fixation to maintain the cell component and its state is close to the original. The purpose of this study was to determine the comparison of the quality of the cytopathological examination results from the manufacture of cell block using a fixative solution of Nathan Alcohol Formalin Substitute (NAFS) and alcohol 96% -NBF 10% in pleural fluid samples. Experimental research with cross-sectional research design. The results showed that 13 samples of pleural fluid preparations in cell block preparations with NAFS fixative solution and cell block preparations with 96%-NBF 10% alcohol fixative solution there was no significant difference in the morphological figure of the cells, the number of cells produced, the number of malignant cells analyzed, the absorption of staining and cytodiagnosis sensitivity. Based on the results of this study, it can be concluded that alcohol 96% -NBF 10% can be used as an alternative solution to fixative for pleural fluid samples.

Background Tuberculous pleural effusion (TPE) is usually characterized by lymphocytic predominance and high pleural fluid adenosine deaminase (pfADA), while parapneumonic pleural effusion (PPE) is usually characterized by neutrophilic predominance. However, in some cases, neutrophils can be predominant in TPE. In such cases, the differential diagnosis between TPE and PPE is challenging and has been rarely investigated. The aim of this study was to evaluate the accuracy of pfADA, pleural fluid lactate dehydrogenase (pfLDH) and other parameters, such as age/pfADA in the differential diagnosis of neutrophil-predominant TPE (NP-TPE) and PPE. Methods Between January 2003 and August 2018, 19 patients with NP-TPE and 54 patients with PPE at Shanghai Jiao Tong University Affiliated Sixth People's Hospital were retrospectively reviewed. Age, blood and pleural fluid findings, and eight ratios that consisted of routine biomarkers were compared between the two groups in ≤50 and >50 years old groups. ROC curve analysis was used to evaluate diagnostic performance. Results The three parameters with the largest AUC were age/pfADA, pfADA and pfLDH in ≤ 50 years old group, and pfADA, age/pfADA and the percentage of neutrophils in pleural fluid (pfN%) in >50 years old group. For patients ≤ 50 years old, pfADA combined with pfLDH or age/pfADA combined with pfLDH could increase the specificity to 100%, while the sensitivity of the former was high (84.6% vs 76.9%). For patients >50 years old, both pfADA combined with pfN% and age/pfADA combined with pfN% could increase the specificity to 90.3% with the same sensitivity. Conclusions Although pfADA played an important role in the discrimination of NP-TPE from PPE, combining pfADA with pfLDH for patients ≤50 years old or combining pfADA with pfN% for patients >50 years old might improve diagnostic performance.

Background: Pleural effusion may be a result of a primary pulmonary illness. It also can be the pleural manifestation of numerous of diseases that primarily affect other organs. Quantification of pleural effusion is of great value in clinical practice, as it usually guides the plan of management. Chest ultrasound (U/S) is one of the helpful non-invasive means in estimating pleural fluid volume. Objective: To correlate the U/S estimated volumes of pleural fluid calculated by studied formulae, with the actual effusion volume, and to identify the most accurate formula in quantifying the pleural fluid volume. Patients and Methods: This prospective cross-sectional study was carried out in the department of Chest, Bab Al-sha'reia University Hospital, during the period from October 2019 to September 2020, and included forty patients with clinical and radiological diagnosis of pleural effusion. Ultrasound estimation of the amount of pleural effusion was done using 4 different formulae, followed by full pleural drainage through either simple aspiration or tube thoracostomy. Lastly, the ultrasonographically estimated fluid volumes were then compared to the actually drained fluid volume. Results: The supine formulae showed excellent correlation with the drained pleural fluid volume, with Pearson correlation coefficient(r) = 0.9607 and 0.9602 for Eibenberger and Balik formulae respectively (p-value

Pleural effusion is one of the common condition encountered in day to day practise. A correct diagnosis of the underlying disease is essential to rational management. Today there are a number of laboratory tests available to differentiate exudates and transudates which are considered cost effective to the patients, so this study was designed for the measurement of pleural fluid cholesterol to differentiate transudative and exudative pleural effusions (sensitivity-97.8%, specificity-100%) with the advantage that a contemporary blood sample is not required, thereby lowering cost of diagnostic procedure. Objectives: To study the diagnostic value of Pleural fluid Cholesterol in differentiating transudative and exudative pleural effusions. Materials and Methods: This cross sectional descriptive study was conducted on patients of pleural effusion (n=60) age >18 years patients with definitive clinical diagnosis and evidenced by radiological diagnosis of pleural effusion were taken as inclusion criteria. Results: The results showed majority of the patients were males (63.3%) and females (36.7%). According to lights criteria 46 patients were exudates and 14 patients were transudates and according to Pleural fluid Cholesterol criteria 45 patients were exudates and 15 patients were transudates with sensitivity of 97.8% and specificity of 100% and accuracy of 98.3%. Conclusion: The pleural fluid cholesterol criteria were found to be the most efficient criteria. Since this parameter involves the measurement of only pleural fluid values of cholesterol, it has following advantages- Economically it reduces number of biochemical tests and Simpler as there is no need to take simultaneous blood sample at the time of thoracocentesis. Keywords: Pleural Effusion, Transudates, Exudates. Cholesterol.

Resumen Objetivos This work aims to investigate the diagnostic accuracy of a nucleic acid amplification test (FluoroType MTB®) in pleural fluid (PF) and sputum to diagnose tuberculous pleural effusion (TPE). We also analyzed the increase in diagnostic accuracy of a second FluoroType MTB® test on a second thoracentesis sample when the first was negative. Metodos We conducted a prospective single-center study that included 207 patients with pleural effusion (31 tuberculous and 176 due to other causes). Of the 31 cases of TPE, 21 (68%) were confirmed histologically or microbiologically; the other cases were considered probable. Resultados The operational characteristics of FluoroType MTB® in PF for identifying tuberculosis were a sensitivity of 13%, a specificity of 99%, a positive likelihood ratio of 11, and a negative likelihood ratio of 0.9. The diagnostic efficacy data for sputum samples were 21%, 91%, 2.4, and 0.9, respectively. PF and sputum cultures in solid and liquid media had greater sensitivity (36% and 31%, respectively). A second FluoroType MTB® test in PF was negative for 24 patients who had TPE and for whom the first FluoroType MTB® test was also negative. Only two (6.5%) patients with TPE had a confirmed diagnosis based exclusively on the positive results of the FluoroType MTB® in PF. Conclusion Due to its low sensitivity, the FluoroType MTB® test in PF has a limited role in diagnosing tuberculous pleurisy.

Extramedullary relapse is becoming a frequent manifestation of myeloma. Here we are reporting a case who developed pleural effusion demonstrated with clonal plasma cell infiltration which responded completely to a combination of Daratumumab and Carfilzomib. To overcome the problem of failure to flowcytometric recognition of clonal plasma cells capped with Daratumumab, a different clone of anti-CD38-FITC monoclonal antibody, a generous gift from Janssen, was utilized. Serial follow-up of the patient’s pleural fluid composition and simultaneous imaging showed disappearance of malignant cells. In view of the literature where no reports on use of this combination is present, although of short duration, the complete remission being reported here is promising. It may be helpful as a bridging approach prior to cellular therapies for such patients who belong to an unmet need category.

OBJECTIVE: The purpose of this study was to determine the prognostic role of C-Reactive Protein (CRP) in acute PE. MATERIAL AND METHODS: Two hundred and twenty patients with acute PE were consecutively enrolled and followed for 30 days after discharge. Serum CRP and NT-proBNP were determined. Right ventricular function was evaluated by transthoracic echocardiography. RESULTS: There was a significant difference in age, S-PESI, and CRP levels between the early mortality group and without early mortality group. There was statistically no significant difference between the groups with and without early mortality in terms of gender distribution and whether or not they received thrombolytic therapy for DVT. Pulmonary infarct, pleural fluid, or both have no effect on early mortality. There was no correlation between CRP and pro-BNP, right/left ventricular ratio. The serum CRP levels at diagnosis were significantly higher in patients with PE and with pleural effusion and pulmonary infarct than those in PE patients without pleural effusion and pulmonary infarct (4.75±4.91 ng/mL, 9.67±8.02 ng/mL; p

Objective The purpose of this study was to determine the diagnostic value of pleural fluid lactate dehydrogenase (LDH)/pleural fluid adenosine deaminase (ADA) ratio in differentiating pleural effusions owing to tuberculous pleurisy (TBP) and parapneumonic effusion (PPE). Patients and methods The data of 272 patients (140 patients with TBP and 132 patients with PPE) between January 2012 and October 2018 were analyzed retrospectively. Demographic data of all patients; concurrent serum glucose, albumin, protein, and LDH values; and pleural fluid pH, glucose, albumin, protein, and ADA results have been reviewed. Results Pleural fluid ADA values were statistically significantly higher in the TBP group than PPE (P

Background: Light's criteria was reported 25% of misclassification transudates as exu­dates. This study aimed to analyse the accuracy of examining uric acid levels and pleural fluid uric acid levels, and pleural fluid cholesterol and cholesterol ratios to distinguish the exudates and transudates in pleural effusions. Subjects and Method: This was a cross-sectional study de­sign conducted at Dr. Moe­wardi Hospital, Surakarta, Central Java, from July to August 2019. The study subjects were 30 pleural effusion patients treated in the pul­monology ward. The dependent variables were pleural fluid exudates and transudates. The indepen­dent variables were (1) Uric acid levels in pleu­ral fluid; (2) The ratio of uric acid levels be­tween pleural fluid and serum; (3) Pleural fluid cholesterol levels; and (4) The ratio of cho­lesterol levels between pleural fluid and serum. The study instruments were Light's cri­teria and laboratory examination. The diag­nosis's accuracy was analysed using sensi­tivi­ty, specificity, and the area under the ROC (AUC) curve. Results: Pleural fluid cholesterol showed sen­­sitivity and specificity of 86% and 83%, with a cut-off of 32.00 for transudate results. AUC value = 0.82 with p = 0.012. Serum cholesterol showed sensitivity and specificity of 71% and 61%, with a cut-off of 175.50 for transudate re­sults. AUC value = 0.67 with p = 0.194. Pleu­ral fluid uric acid levels showed a sensitivity and specificity of 86% and 87%, with a cut-off of 7.25 for transudate results. AUC value = 0.83 with p = 0.009. Examination of serum uric acid levels showed a sensitivity and specificity of 86% and 70%, with a cut-off of 7.10 for trans­udate results. AUC value = 0.65 with p = 0.249. Conclusion: Examination of uric acid and pleural fluid cholesterol levels can be used in routine pleural effusion examinations to distin­guish exudates and transudates. Keyword s : accuracy, uric acid, exudates, cho­les­te­rol, transudates Correspondence: Yusup Subagio Sutanto. Department of Pul­mo­no­logy and Respiratory Medicine, Faculty of Medicine Universitas Sebelas Maret, Dr. Moe­wardi Hospital, Surakarta. Jl. Kolonel Sutarto 132, Jebres, Surakarta 57126, Central Java. Email: dr_yusupsubagio­@yahoo.com. Mobile: +62811284165. Indonesian Journal of Medicine (2021), 06(02): 159-167 https://doi.org/10.26911/theijmed.2021.06.02.05

Background: Pleurodesis fails in 10%-40% of patients with recurrent malignant pleural effusions malignant pleural effusion and dyspnea. This study aimed to assess the values of pleural elastance (PEL) after the aspiration of 500 mL of pleural fluid and their relation to the pleurodesis outcome, and to compare the pleurodesis outcome with the chemical characteristics of pleural fluid. Methods: A prospective study was conducted in Kasr El-Aini Hospital, Cairo University, during the period from March 2019 to January 2020. The study population consisted of 40 patients with malignant pleural effusion. The measurement of PEL after the aspiration of 500 mL of fluid was done with “PEL 0.5” (cm H2O/L), and the characteristics of the pleural fluid were chemically and cytologically analyzed. Pleurodesis was done and the patients were evaluated one month later. The PEL values were compared with pleurodesis outcomes. Results: After 4-week of follow-up, the success rate of pleurodesis was 65%. The PEL 0.5 was significantly higher in failed pleurodesis than it was in successful pleurodesis. A cutoff point of PEL 0.5 >14.5 cm H2O/L was associated with pleurodesis failure with a sensitivity and specificity of 93% and 100%, respectively. The patients with failed pleurodesis had significantly lower pH levels in fluid than those in the successful group (p

In high-burden settings, the diagnosis of pleural tuberculosis (TB) is frequently inferred in patients who present with lymphocyte predominant exudative effusions and high adenosine deaminase (ADA) levels. Two recent small retrospective studies suggested that the lactate dehydrogenase (LDH)/ADA ratio is significantly lower in TB than in non-TB pleural effusions and that the LDH/ADA ratio may be useful in differentiating pleural TB from other pleural exudates. We compared the pleural LDH/ADA ratios, ADA levels, and lymphocyte predominance of a prospectively collected cohort of patients with proven pleural TB (n = 160) to those with a definitive alternative diagnosis (n = 68). The mean pleural fluid LDH/ADA ratio was lower in patients with pleural TB than alternative diagnoses (6.2 vs. 34.3, p < 0.001). The area under the receiver operating characteristic curve was 0.92 (p < 0.001) for LDH/ADA ratio and 0.88 (p < 0.001) for an ADA ≥40 U/L alone. A ratio of ≤12.5 had the best overall diagnostic efficiency, while a ratio of ≤10 had a specificity of 90% and a positive predictive value of 95%, with a sensitivity of 78%, making it a clinically useful “rule in” value for pleural TB in high incidence settings. When comparing the LDH/ADA ratio to an ADA level ≥40 U/L in the presence of a lymphocyte predominant effusion, the latter performed better. When lymphocyte values are unavailable, our data suggest that the LDH/ADA ratio is valuable in distinguishing TB effusions from other pleural exudates.

Introduction: Pleural fluid adenosine deaminase (pfADA) is a simple, rapid and inexpensive surrogate marker for tuberculous pleural effusion (TPE). A nationwide cut-off of 40 U/L is currently used based on overseas data. There is a need to optimise the diagnostic utility of pfADA by establishing a local cut-off value. In this study, we aimed to describe the demographics and clinical characteristics of patients with TPE and non-TPE; determine the sensitivity and specificity of current pfADA of 40 U/L; and establish a new local pfADA cut-off for TPE. Methods: We conducted a single-centre, observational, prospective study of patients with exudative pleural effusion and pfADA measured from 1 October 2019 to 30 April 2020 at Queen Elizabeth Hospital, Malaysia. Results: The diagnosis of analysed patients ( n = 93) included TPE ( n = 41), malignancy ( n = 28), parapneumonic effusion ( n = 12) and other causes ( n = 12). The mean pfADA was 51.15 U/L (standard deviation (SD) = 13.77) among TPE group and 18.86 U/L (SD = 12.33) among non-TPE. When analysis was restricted to TPE patients, the local pfADA cut-off is 29.6 U/L, with a sensitivity of 97.6% and specificity of 90.4%. The current pfADA of 40 U/L has a sensitivity of 87.8% and specificity of 92.3%. Conclusion: We established a local pfADA cut-off of 29.6 U/L for TPE. Optimising the utility of pfADA helps to enhance clinicians’ treatment confidence of TPE when initial work-up is inconclusive.

The objective of the study: to assess the diagnostic informative value of ADA isoenzymes – ADA-1 and ADA-2 – in the pleural fluid in case of tuberculous pleurisy with the relevance to the age of patients. Subjects and methods. In 200 patients with pleural effusion of tuberculous etiology and 152 patients with pleural effusion of non-tuberculous etiology, the activity of ADA (and its isoenzymes of ADA-1 and ADA-2) was tested. Results. In patients with tuberculous pleurisy, the activity of ADA, ADA-1 and ADA-2 was significantly higher than in patients with pleurisy of a different etiology. Tests of ADA activity (above the threshold value of 30 u/L) had sensitivity and specificity of 95 and 94%, respectively. The sensitivity of testing the activity of ADA-1 and ADA-2 (above the threshold value of 20 u/L) was 30 and 93% with the specificity of 96% and 88%, respectively. The frequency of detecting the activity of ADA and ADA-2 above the threshold did not depend on the cellular nature of tuberculous pleurisy. The activity of ADA-2 was associated with the percentage of pleural fluid lymphocytes in the case of tuberculosis. No influence of age on the diagnostic informative value of ADA and ADA-2 was found out. ADA-1 activity was weakly positively correlated with the age of the patients.

Background: Delay in diagnosis and non-compliance to tuberculosis (TB) treatment will increase the risk of MDR TB. WHO recommends GeneXpert as a diagnostic tool, however, the availability is still an obstacle and this tool is not owned by many health facilities. The Neutrophil-Lymphocyte Ratio (NLR) value was thought to be used to estimate the likelihood of TB cases. This study aimed to assess the sensitivity comparison of pleural fluid and serum NLR values in patients with pleural effusion at H. Adam Malik Medan General Hospital. Methods: This was an analytical study with a diagnostic test design, by calculating the sensitivity and specificity of pleural fluid and serum NLR. The sample was calculated by comparing the absolute neutrophil count and the absolute lymphocyte count from both pleural fluid and serum. Results: The sample of this study was 78 patients. In this study, pleural fluid NLR with a cut off value of 2.2 showed a sensitivity of 74% and specificity of 28%, whereas serum NLR with a cut off value of 7.0 produced a sensitivity of 53% and specificity of 68%. Conclusion: The sensitivity of pleural fluid NLR was greater than that of serum, while the specificity of serum NLR was more superior than that of pleural fluid.

Correlation of pleural fluid cholesterol level with light’s criteria to differentiate exudate from transudate pleural effusion. Classification of transudate and exudate clinically was done independently based on the light's criteria. Pleural fluid cholesterol levels of 100 selected patients were obtained. The cholesterol levels were compared with the earlier obtained data to study its specificity and sensitivity in differentiating exudate from transudate effusion. It was found that pleural fluid cholesterol in comparison to protein values in differentiating exudate from transudate showed a sensitivity of 79.55%, specificity of 91.07%, the positive predictive value of 87.50%, the negative predictive value of 85.00%, with a P-value of

Pleural effusion is very common, but an etiologic diagnosis is often difficult. We used three unconventional diagnostic techniques (voltammetric analysis, protein electrophoresis and pH measurement) performed on pleural effusion to do a preliminary distinction between a neoplastic and a non-neoplastic origin. Pleural fluid samples were collected through thoracentesis, thoracoscopy, or post-surgery pleural drainage of 116 patients admitted to acute care wards. Samples were analyzed with the three unconventional techniques: voltammetric analysis using the BIONOTE system, capillary electrophoresis and pH measurement using a potentiometric method. The BIONOTE system is an innovative system that performs a cyclic voltammetric analysis of a biological liquid sample. The final output of the electrochemical analysis is an electrical pattern that represents a fingerprint of the analyzed sample and each sample has a different fingerprint. Data from the three unconventional diagnostic techniques were analyzed using partial least squares discriminant analysis to discriminate neoplastic from non-neoplastic effusions; we also evaluated sensitivity, specificity and percentage of correct classification. The mean age was 68 years (SD: 12); 78 (67.24%) participants were men. Results obtained from all the unconventional techniques employed showed that neoplastic and non-neoplastic pleural effusions were correctly classified in 80.2% of cases, with a sensitivity of 77% and specificity of 83%. The combined use of voltammetric analysis, protein electrophoresis and pH measurement of pleural fluid can easily and quickly distinguish a neoplastic from a non-neoplastic pleural effusion with reliable accuracy and represents an innovative diagnostic approach. In fact, this protocol can be executed in just few minutes directly in the patient's bed and it holds great promise to improve the prognosis and therapeutic chances.

Background Recently, the combination of clinical and pleural fluid data can be used to calculate a score which helps facilitate differential diagnosis between tuberculous pleuritis (TBP) and No-TBP effusions. However, a reliable determination of adenosine deaminase (ADA) remains difficult to obtain in Thailand. Therefore, the aim of our study was set out to develop a scoring which makes use of clinical and pleural fluid data. Methods A retrospective study involved 15 patients with TBP and 41 patients with no-TBP. The clinical and pleural fluid data of all patients from January 1, 2011, 32 to December 31, 2014, were collected. The diagnostic sensitivity, specificity, positive and negative predictive value were calculated. Results The parameters were superior in detecting TBP, including the ADA ≥17.5 U/L, In scoring I [ADA ≥40 U/L, age The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.35 years, temperature ≥37.8 ℃, and RBC The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.5×109 /L] as ≥1.5 points, and scoring II [no previous history of cancer, age The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.35 years, temperature ≥37.8 ℃ RBC The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.5×109 /L, pleural protein ≥50 g/L, and LDH ratio ≥2.2] as ≥4.5 points, since the area under curve (AUC) 74.0%, 74.0%, and 81.0%, sensitivity 73.3%, 73.3%, and 71.4%, and specificity 68.7%, 62.5%, and 71.1%, respectively). Moreover, no previous history of cancer and lower RBC The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.5×109 /L indicated sensitivity (90.6% and 65.5%), and specificity (70.0% and 44.4%), respectively. Summated scores of ≥5 points in model 1 and ≥6 points in model 2 yielded measures of sensitivity (46.7% and 57.1%), and specificity (84.4% and 80.5%), respectively. Conclusions The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.

Developing a feasible and accurate means of evaluating pleural pathology has been an ongoing effort for over 150 years. Pleural fluid cellular and biomarker analyses are simple ways of characterizing and uncovering pathologic entities of pleural disease. However, obtaining samples of pleural tissue has become increasingly important. In cases of suspected malignancy and certain infections histopathology, culture, and molecular testing are necessary to profile diseases more effectively. The pleura is sampled via several techniques including blind transthoracic biopsy, image-guided biopsy, and surgical thoracotomy. Given the heterogeneity of pleural disease, low diagnostic yields, or invasiveness no procedural gold standard has been established in pleural diagnostics.Herein, we provide a review of the literature on medical thoracoscopy (MT), its development, technical approach, indications, risks, current and future role in the evaluation of thoracic disease. Pubmed was searched for articles published on MT, awake thoracoscopy, and pleuroscopy with a focus on reviewing literature published in the past 5 years.As the proficiency and number of interventional pulmonologists continues to grow, MT is ideally positioned to become a front-line diagnostic tool in pleural disease and play an increasingly prominent role in the treatment algorithm of various pleural pathologies.

Background The differentiation between malignant (MPE) and tuberculous (TPE) pleural effusions should be considered in any patient with an exudative lymphocytic pleural effusion. A rapid precise diagnosis is valuable as the treatment and prognosis are totally different. The histopathological proof may shorten the time to differential diagnosis. But it may be invasive and costly. The aim of this study is to validate the clinical reliability of joined detection of cancer ratio (serum LDH to pleural ADA), cancer ratio plus (cancer ratio to percentage of pleural fluid lymphocytic count), pleural interferon gamma (pIFN-ϒ), and pleural carcinoembryonic antigen (pCEA) values to differentiate between lymphocytic pleural effusions. Results Seventy-eight patients were included with mean age ± SD 53.09 ± 9.56 years old, 49 males and 29 females, diagnosed as 47 MPE, 24 TPE, and 7 others. Cancer ratio at cutoff value of ≥ 22 and cancer ration plus at cutoff value of ≥ 41 can discriminate MPE from any other cause with sensitivity (91.5%, 93.6%), specificity (87.5%, 91.7%), and diagnostic accuracy (90.1%, 92.9%) respectively. When the levels of pCEA and pIFN-ϒ were combined with cutoff value of cancer ratio, there were powerful diagnostic differentiating results. Conclusions Cancer ratio and cancer ratio plus offered valid, efficient, non-invasive, and easy measuring diagnostic tools. On diagnostic uncertainty, the add-on of pCEA in cases of suspected MPE, and pIFN-ϒ in cases of suspected TPE has a trustable diagnostic efficacy with no need for further investigations.

İntraplevral streptokinaz etkinliğinin incelenmesi amacıyla, enfekte plevral sıvıda intraplevral streptokinaz tedavi (İPST) takiben cerrahi ihtiyacı, opere olan ve olmayan olgularda plevral sıvı parametrelerinin bu ihtiyacı öngörmedeki etkisinin değerlendirilmesi planlanmıştır. Kliniğimizde beş yıllık periyotta İPST uygulanan olgular retrospektif olarak incelenmiştir. Tüberküloz plörezi olguları çalışma dışı bırakılmıştır. Çalışmaya dahil edilen İPST uygulanmış 72 hastanın 58’i parapnömonik efüzyon (PPE), 10’u komplike parapnömonik efüzyon (KPE) ve 4’ü ampiyem idi. İPST sonrası 72.saat, 24saat öncesi ile karşılaştırıldığında plevral sıvı drenajının anlamlı düzeyde arttığı gözlenmiştir [0 ml (0–1000) karşı 650 ml (0-2935), p, We aimed to asses clinical efficacy of intrapleural streptokinase, as well as to examine the relationship between the need for surgery follow-ing intrapleural streptokinase treatment (IPST) and, ability to predict surgery requirement of the pleural fluid parameters in operated and non-operated groups. We retrospectively analysed data of patients treated with intrapleural streptokinase, within a period of five years, in our clinic. Tuberculosis pleurosiy cases were excluded. Seventy-two patients treated with intrapleural streptokinase were recruited. Of the patients 58 with parapneumonic effusion (PPE), 10 with complicated parapneumonic effusion (CPE) and 4 were diagnosed with empyema. A significant increase was observed when the pleural fluid drainage on the 72nd hour of IPST was compared to that measured 24 hours before treatment [0 ml (0–1000) vs. 650 ml (0-2935), p

Melioidosis is a potentially life-threatening infection caused by the Gram-negative bacterium Burkholderia pseudomallei. Diagnosis of melioidosis is difficult due to its diverse clinical manifestations and ability to mimic many other diseases. We report a case of pulmonary melioidosis in a diabetic patient with the air crescent sign evident on a thoracic computed tomography. B. pseudomallei was cultured from the patient's sputum and pleural fluid samples. The infection fully resolved following antimicrobial treatment for melioidosis. This case report highlights the importance of recognizing the air crescent sign as a radiological manifestation of melioidosis to facilitate the prompt administration of appropriate antibiotic treatment, thus reducing morbidity and mortality.

Tuberculosis-related pleural effusion (TPE) is reported in 12 to 38% of thoracic tuberculosis (TB) cases in the pediatric population. In TPE, the pleural fluid bacilli load is very low, generally resulting in negative acid-fast bacill (AFB) staining and Mycobacterium culture. In the pleural fluid, AFB stain positivity is reported in

Urinothorax (UT) is a rare and often undiagnosed condition, defined as the presence of urine in the pleural cavity due to the retroperitoneal leakage of urine (known as urinoma) into the pleural space. It is a rare cause of pleural effusion and is secondary to traumatic or obstructive reasons. UT is usually a transudate pleural effusion. Its diagnosis requires a high degree of clinical suspicion, because the respiratory symptoms tend to be absent or mild and urological signs tend to dominate. Thoracocentesis followed by measurement of creatinine in the pleural fluid is a procedure to establish the true diagnosis. The average pleural fluid-to-serum creatinine ratio is in the range of 1.09–19.8. Pleural fluid-to-serum creatinine ratio >1 is the diagnostic criterion of UT. We report a case of UT associated with trauma.

Tuberculous pleural effusion is the manifestation of Mycobacterium tuberculosis infection in pleura. With existing means, it is difficult to establish the diagnosis of tuberculosis (TB) and non-TB pleural effusions; thus, establishing the diagnosis of TB pleural effusion and non-TB pleural effusion is still a clinical problem. Tumour necrosis factor alpha (TNFα) is a potent inflammatory cytokine that plays an important role in immunity to Mycobacterium tuberculosis infections, this level of cytokine increases in pleural effusion due to tuberculosis.To compare the TNF-α level of pleural fluid in TB and non-TB pleural effusion.The samples in this study that fulfilled the inclusion criteria were patients with non-TB pleural tuberculosis effusion in the inpatient ward in Pulmonology Unit Dr. Soetomo General Hospital Surabaya, male and female, aged between 15 and 60 years. The data is divided into two: primary data and secondary data of patients who fulfilled inclusion and exclusion criteria. The data with normal distribution was analyzed using independent t2 test and if the data distribution is abnormal, it was analyzed using Fisher's exact test.There were 22 subjects divided into 2 groups that were 11 patients with TB pleural effusion and 11 patients with non-TB pleural effusion. The TNF-α level of pleural fluid in TB pleural effusion was 25.43±13.55pg/mL. The TNF-α level of pleural fluid in non-TB was 5.98±1.89pg/mL. The serum TNF-α level in TB pleural effusion was 83.22±88.15pg/mL. The serum TNF-α level in non-TB was 68.54±57.88pg/mL. There was higher level of TNF-α pleural fluid in TB pleural effusion than in non-TB pleural effusion (25.43±13.55pg/mL vs 5.98±1.89pg/mL, p value0.05). The serum TNF-α level in patients with TB pleural effusion was higher than TNF-α serum level of non-TB pleural effusion. There was no significant difference between TNF-α level of pleural fluid and serum TNF-α levels in the TB pleural effusion group (p value0.05).The TNF-α level of pleural fluid in TB pleural effusion was higher than non-TB pleural effusions and there was no significant difference between serum TNF-α levels in the TB pleural effusion group and in the non-TB pleural effusion group.

Background Adenosine deaminase (ADA) activity is typically elevated in patients with tuberculous pleural effusion (TPE), but low ADA has occasionally been reported in patients with TPE. The characteristics of these patients are not well-known, and erroneous exclusion of the possibility of TPE can result in a delayed diagnosis. This study investigated the characteristics of patients with TPE who had low ADA activity. Methods We retrospectively reviewed patients with microbiologically or pathologically confirmed TPE between 2012 to 2018 in a tertiary hospital in South Korea. Patients were categorised into two groups: high ADA (≥40 IU/L) and low ADA ( Results A total of 192 patients with TPE were included; 36 (18.8%) had ADA p p p p < 0.001). Patients with 2 or ≥ 3 organ dysfunctions constituted 19.4 and 13.9% of the patients in the low ADA group, whereas they constituted 7.1 and 1.3% of the patients in the high ADA group (p < 0.001). Multivariate logistic regression analyses showed that older age (odds ratio = 1.030, 95% confidence interval 1.002–1.060, p = 0.038) and a higher SOFA score (odds ratio = 1.598, 95% confidence interval 1.239–2.060, p Conclusions ADA activity can be low in patients with TPE who are elderly, critically ill, and exhibit multiorgan failure. Low ADA activity cannot completely exclude the diagnosis of TPE, and physicians should exercise caution when interpreting pleural fluid exams.

BackgroundAs median survival time for patients with malignant pleural effusions (MPE) is nine months, rapid and accurate diagnosis is important. Cytological examination of pleural fluid has a good specificity but imperfect sensitivity. Published estimates of sensitivity vary substantially and predictors of false negative cytology are not well established. We aim to establish a local estimate of pleural fluid cytology sensitivity and identify risk factors for false negative cytology.MethodsWe conducted a retrospective cohort study of patients who had cytology testing of pleural fluid at Christchurch Hospital, New Zealand 21 July 2017 to 31 October 2019. Data on patient demographic, clinical and pleural fluid characteristics were collected. MPE was defined by positive pleural fluid cytology, tissue histology, or multi-disciplinary meeting consensus. We estimated sensitivity of the first pleural cytology assessment. We performed multivariate logistic regression to ascertain patient groups at greatest risk of false negative results. ResultsOf 156 patients with confirmed malignant pleural effusion included in our study, the initial pleural fluid cytology was diagnostic in 117, providing a sensitivity (95% confidence interval) of 75.0% (67.4-81.6%). The sensitivity was 79.0% (66.8-88.3%) for lung cancer, 91.3% (72.0-98.9%) for breast cancer and 33.3% (95% CI 11.8-61.6%) for mesothelioma. Cloudy appearance of pleural fluid (OR 0.17, 95% CI 0.04-0.84), but not pH, lactate dehydrogenase or polynuclear cell ratio, reduced the odds of false negative pleural cytology.ConclusionPleural fluid cytology was sensitive in diagnosing MPE due to primary lung and breast cancer, however it had low sensitivity in mesothelioma. Clinicians should be particularly alert to the high likelihood of false negative results when suspecting mesothelioma and consider early use of biopsy.

Thoracoscopy is commonly used minimally invasive procedure in the field of interventional pulmonology. While medical thoracoscopy is the widely preferred modality, modifications to the technique and expansion in the scope of its utility have always challenged the conventional approach. We describe a modified technique of medical thoracoscopy in absence of pleural effusion also known as dry thoracoscopy under sedation and local anaesthesia.

Introduction: Tuberculosis, both pulmonary and extra pulmonary pose great threat to individual health and community economy. The diagnosis of tuberculosis is currently made by a detailed medical history, clinical examination, radiological, microbiological, immunological, biochemical, molecular-biological and histological investigations. The current diagnostic methods either are relatively expensive, feasible, and insufficient or give erroneous results especially while diagnosing extra pulmonary tuberculosis. However recent trials have shown that enzymatic, evaluations in serum and pleural fluid have given excellent diagnostic results in diagnosis of extra pulmonary tuberculosis. Aim: The current study was aimed to evaluate whether analysis of adenosine deaminase enzyme in serum and pleural fluid helps in diagnosis of HIV sero negative tuberculous pleural effusion. Material and Methods: The study encompassed a total of 100 subjects of which 50 patients were known cases of tuberculous pleural effusion and remaining 50 patients served as control subjects Adenosine deaminase was estimated in serum and pleural fluids using kits and auto analyzer. Results: The results were tabled and analyzed using MEDCALC statistical software and are in favor of the study, supporting adenosine deaminase as a reliable marker in diagnosis of sero negative pleural effusions. Conclusion: The current study has indicated that promising positive results can be obtained by estimating levels of Adenosine deaminase enzyme in diagnosis of HIV sero negative pleural effusions. Further the study concludes that testing the adenosine deaminase levels in a cheaper, cost effective diagnostic tool and can be used in large community of individuals with minimal costs. Keywords: Adenosine deaminase, Extrapulmonary tuberculosis, Exudative pleural fluid HIV, seronegative.

Background: Cytological Smear (CS) is extremely useful in patients with pleural effusions especially when malignancy is suspected. Cellblock (CB) technique is another method for examination of pleural fluid. In this study we aimed to compare the diagnostic yields of CS and CB technique and the combi-nation of both, regardless of the etiology of Pleural Effusion (PE), and to compare their results with clinicopathological and radiological results.Aim of Study: This study aims to compare the diagnostic yields of CS and CB techniques and their combination in diagnosis of PF regardless of its etiology.Material and Methods: 140 cases of PE samples were obtained, CS and CB were done, results were compared with each other and correlated with the clinicopathological and radiology results when available.Results: Agreement between results of CS and CB was 87.86% (p=0.0001). There was an agreement between CS at one side and either radiological findings or biopsy at the other side; 88.89% and 88.1% respectively (p=0.0001 for each). There was an agreement also between CB results and either radiological findings or biopsy; 94.87% and 95.24% respec-tively (p=0.0001 for each).Conclusions: Our study showed that the CB method yielded better results in diagnosis of malignancy in PE. Therefore, this technique could be considered as a useful adjuvant in evaluating PE fluid cytology and final cytodiag-nosis, along with the routine CS method.

Background Eosinophilic pleural effusion (EPE) is a distinct entity among pleural effusions, but its diagnostic and prognostic significance is still controversial. This study aimed to evaluate the incidence and aetiological distribution of EPE in our institution and to assess the relationship between EPE and malignancy and other underlying diseases and the relevance of the percentage of eosinophils and other laboratory parameters. Methods A retrospective study was conducted by reviewing the medical records of 252 patients with PE from September 2017 to January 2021. Results EPE was found in 34 (13.49%) out of 252 patients. There were 20 (58.82%) males and 14 (41.18%) females in the EPE group. The mean percentage of eosinophils in EPE (21.7%, range (10.0–67.5%)) was significantly higher than the percentage of eosinophils in peripheral blood (5.65%, range (0–34.60%); p versus nonmalignant EPE showed that patients with malignant EPE were significantly older, and had a lower white blood cell (WBC) count in the pleural fluid (1.8 vs 4.7 cells × 109/L, p p = 0.66). There was no correlation between the percentage of eosinophils in PE and peripheral blood (r = 0.29; p = 0.09). Conclusions Malignant disease ranks as the leading cause of EPE. The presence of EPE should not be considered as a predictive factor of benign conditions. Pleural parasitic infestation (PPI) should be emphasized in areas with a high incidence of parasitic disease.

Objective: To explore the value of dehydrogenase (LDH) and adenosine deaminase (ADA) in serum and pleural fluid in predicting the prognosis of non-small cell lung cancer.Methods: A total of 134 patients with non-small cell lung cancer (NSCLC) with pleural effusion were enrolled. LDH in Serum and LDH and ADA in pleural fluid were detected, and the cancer ratio (serum LDH/pleural fluid ADA ratio) was calculated. Patients were followed until death. To analyze the correlation between the above indicators and the clinical pathological characteristics of the patients, and the predictive value for the prognosis of the patients.Results: Among the included NSCLC patients with pleural effusion, the average age was 61.76 years old, mainly male (66.7%), the right lung was more common (47.2%), adenocarcinoma was the main (82.1%), and smoking patients accounted for 48.0%. In the diagnosis method, there were 94 cases were diagnosed by pleural fluid exfoliated cells or pleural biopsy. In terms of clinical features, serum LDH is only related to adrenal metastasis (p = 0.000), and pleural fluid LDH is related to the patient's pathological type (p = 0.001). There was no correlation between pleural fluid ADA or cancer ratio and patient gender, lesion location, pathological type, diagnosis method, smoking history, and metastatic location. In terms of prognostic value, patients with ADA < 20U/L and cancer ratio >20 have shorter overall survival and worse prognosis (​​p < 0.0001 and p = 0.0178, respectively). The multivariate Cox regression analysis suggested that the cancer ratio (HR = 1.699, 95%CI: 1.097–2.630, p = 0.017) was an independent risk factor for the poor prognosis of patients.Conclusion: The NSCLC patients with pleural fluid ADA < 20U/L and cancer ratio > 20 combined with pleural effusion had a shorter overall survival and worse prognosis.

Background Malignant pleural mesothelioma (MPM) is a rare but aggressive and often fatal malignancy. Most patients present with advanced disease, and the median overall survival is approximately one year. Objective To review the cases of malignant mesothelioma admitted to Imbaba Chest Hospital in the period between 2013 and 2016. Subjects and Methods The current study spotted the light over the malignant mesothelioma from epidemiological view, as a retrospective cohort study, conducted on all cases of malignant mesothelioma that were diagnosed at Embaba Chest Hospital in the period between 2013 until 2016 to explore the incidence of that disease and its characteristic features. The medical records of patients had been revised for the demographic criteria of patients, which included; age, sex, smoking status, residence and occupation, clinical presentation of cases, radiological findings, cytological examination of pleural fluid, pleural biopsy either thoracoscopic or open, and finally, histopathological diagnosis. Results The prevalence of mesothelioma across years of the study was 1.5% (60 out of 4000cases) with increasing annual incidence; 1.7, 2 and 2.3% respectively. The mean age of mesothelioma patients was 57.96 years, most of them above 40 years (91.67%) and more than half of them were males (55%). In spite of decreasing percentage of male with mesothelioma within the study time (2014-2016), which was accompanied with increasing the percentage of female patients, it did not reach statistical significance. Conclusion The overall incidence of malignant mesothelioma was 1.5% with increasing annual incidence from 1.7% up to 2.3%. The male gender was the more presentable one with gradual growing of female percent. The urban area was more affected than the rural one, specially the area near industries. Non-exposed persons (unemployed industrial workers) showed higher frequency of MM. Right-sided MM was more common than Left one, beside that the epithelial form of MM was the dominant histological pattern.

Background: There is still no wide agreement regarding the efficacy of the serum levels of C-reactive protein (CRPs), pleural fluid levels of CRP (CRPpf), and their ratio (CRPr) in the discrimination between transudative (Tr) and exudative (Ex) pleural effusions (PEs). Most of the previous studies were conducted on small cohorts, and the role of CRPs in the CRPpf gradient (CRPg) in this discrimination has not been previously reported. The present study aims to assess the diagnostic efficacy of CRPs, CRPpf, CRPg, and CRPr in the discrimination between TrPE and ExPE in a relatively large cohort of patients with PE. Methods: The study population included 492 patients with PE, 210 of them with TrPE and 282 with ExPE. The levels of CRPs and CRPpf were measured, and the CRPg and CRPr were calculated. The values are presented as mean ± SD. Results: The mean levels of CRPs, CRPpf, CRPg, and CRPr of the TrPEs were 11.3 ± 5.7 mg/L, 4.6 ± 2.8 mg/L, 6.7 ± 3.9 mg/L, and 0.40 ± 0.14, respectively, and for the ExPEs, they were 140.5 ± 112.8 mg/L, 52.8 ± 53.2 mg/L, 87.2 ± 72.4 mg/L, and 0.37 ± 0.15, respectively. The levels of CRPs, CRPpf, and CRPg were significantly higher in the ExPEs than in the TrPEs (p &lt, 0.0001). No significant difference was found between the two groups for the levels of CRPr (p = 0.15). The best cut-off value calculated by the receiver operating characteristic (ROC) analysis for discriminating TrPE from ExPE was for CRPs, 20.5 mg/L with area under the curve (AUC) = 97% and p &lt, 0.0001, for CRPpf, 9.9 mg/L with AUC = 95% and p &lt, and for CRPg, 13.6 mg/L with AUC = 96% and p &lt, 0.0001. Conclusion: CRPs, CRPpf, and CRPg are strong markers for discrimination between TrPE and ExPE, while CRPr has no role in this discrimination.

Intro: The pandemic has put a strain on healthcare services and resources. Overall procedure capacity was reduced and cancer diagnostic pathways were disrupted. The procedural urgency associated with symptomatic patients with often undiagnosed malignant pleural effusion means that nasopharyngeal PCR testing to exclude COVID-19 prior to procedures can often be impractical or logistically challenging Aim: To assess two hypotheses; that SARS-CoV-2 could not be detected in pleural fluid samples from patients with no clinical features of COVID-19 and that pleural procedures can be conducted safely using a pragmatic infection control strategy in the context of a respiratory pandemic Methods: 24 patients completed a screening questionnaire covering symptoms, travel and contacts. If there was no clinical evidence of COVID-19 infection, the day case intervention could proceed as planned, otherwise a negative nasopharyngeal PCR swab within 48 hours was required. Pleural fluid specimens were prospectively collected for the Oxford Radciffe Biobank study and promptly processed and stored using pre-specified protocols. Viral RNA extraction was performed using the QIAamp UltraSens kit (Qiagen, Germany) Result: All patients had no clinical evidence of COVID-19 infection and therefore none required nasopharyngeal PCR swabs. qPCR assays did not detect SARS-CoV-2 virus in pleural fluid of any of the patients. Conclusion: In the absence of clinical evidence of COVID-19, SARS-CoV-2 is unlikely to be detected in pleural fluid. In the face of an ongoing pandemic, urgent outpatient pleural procedures can be safely continued, so as not to negatively impact the care for non-COVID patients

ALK-negative anaplastic large cell lymphoma (ALCL) is an aggressive non-Hodgkin T-cell lymphoma. Compared to ALK-positive ALCL, patients with ALK-negative ALCL typically are older, present with nodal disease, and have lower survival rates. We report a unique presentation of ALK-negative ALCL in a pleural fluid. Cell block preparation enabled both confirmation of the diagnosis via immunohistochemical staining and gene rearrangement testing for prognostic information.

Objective This study aimed to establish a predictive model based on the clinical manifestations and laboratory findings in pleural fluid of patients with pleural effusion for the differential diagnosis of malignant pleural effusion (MPE) and tuberculous pleural effusion (TPE). Methods Clinical data and laboratory indices of pleural fluid were collected from patients with malignant pleural effusion and tuberculous pleural effusion in Zigong First People's Hospital between January 2019 and June 2020，and were compared between the two groups. Independent risk factors or Independent protective factors for malignant pleural effusion were investigated using multivariable logistic regression analysis. Receiver operating characteristic curve (ROC) analysis was performed to assess the diagnostic performance of factors with independent effects, and combined diagnostic models were established based on two or more factors with independence effect. ROC curve was used to evaluate the diagnostic ability of each model, and the fit of the eath model was measured using Hosmer-Lemeshow goodness-of-fit test. Results Patients with MPE were older than those with TPE, the rate of fever of patients with MPE was lower than that of patients with TPE, and these differences were statistically significant (p < 0.05). Carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin-19 fragment antigen (CYFRA21-1), cancer antigen 125 (CA125), and glucose (GLU) levels in the pleural fluid were higher, but total protein (TP), albumin (ALB) and Adenosine deaminase (ADA) levels in the pleural fluid were lower in MPE patients than in TPE patients, and the differences were statistically significant (PConclusion The model established with the combination of CEA and ADA in the pleural fluid has a high differential diagnostic value for malignant pleural effusion and tuberculous pleural effusion, and NSE in the pleural fluid and fever cannot improve the diagnostic efficacy of the diagnostic model.

Introduction: The most appropriate treatment for parapneumonic effusion (PPE), including empyema, is controversial. We analyzed the experience of our center and the hospitals in its reference area after adopting a more conservative approach that reduced the use of chest tube pleural drainage (CTPD).Methods: Review of the clinical documentation of all PPE patients in nine hospitals from 2010 to 2018.Results: A total of 318 episodes of PPE were reviewed; 157 had a thickness of p < 0.001). CTPD was placed in 2.9% of PE+1 patients, 19.3% of PE+2, and 63.9% of PE+3 (p < 0.001). The referral of patients with PE+1 decreased over time (p = 0.033), as did the use of CTPD in the combined PE+1/PE+2 group (p = 0.018), without affecting LHS (p = 0.814). There were no changes in the use of CTPD in the PE+3 group (p = 0.721).Conclusions: The size of the PPE is strongly correlated with its severity and with LHS. Most patients can be treated with antibiotics alone.

Simple Summary Malignant pleural effusion is a common complication arising as the natural progression of many tumors, such as lung cancer. When this occurs, the common protocol consists of analyzing the pleural fluid for the presence of malignant cells. However, on many occasions no malignant cells are found despite a clear suspicion of cancer. Thus, the current diagnostic methodology is imperfect and more precise methods for the identification of malignancy are needed. Nonetheless, these methods are often invasive, which may be counterproductive, especially for patients with poor health condition. These concerns have made clinicians consider alternative non-invasive strategies to diagnose cancer using the generally abundant pleural fluid (e.g., liquid biopsy). Thus, a liquid sample can be analyzed for the presence of cancer footprints, such as circulating malignant cells and tumor nucleic acids. Herein, we review the literature for studies considering pleural fluid as a successful source of liquid biopsy. Abstract Liquid biopsy is emerging as a promising non-invasive diagnostic tool for malignant pleural effusions (MPE) due to the low sensitivity of conventional pleural fluid (PF) cytological examination and the difficulty to obtain tissue biopsies, which are invasive and require procedural skills. Currently, liquid biopsy is increasingly being used for the detection of driver mutations in circulating tumor DNA (ctDNA) from plasma specimens to guide therapeutic interventions. Notably, malignant PF are richer than plasma in tumor-derived products with potential clinical usefulness, such as ctDNA, micro RNAs (miRNAs) and long non-coding RNAs (lncRNAs), and circulating tumor cells (CTC). Tumor-educated cell types, such as platelets and macrophages, have also been added to this diagnostic armamentarium. Herein, we will present an overview of the role of the preceding biomarkers, collectively known as liquid biopsy, in PF samples, as well as the main technical approaches used for their detection and quantitation, including a proper sample processing. Technical limitations of current platforms and future perspectives in the field will also be addressed. Using PF as liquid biopsy shows promise for use in current practice to facilitate the diagnosis and management of metastatic MPE.