• biology
• cytology
• pleura
• pleural fluid
• tuberculosis

• Humans
• Male
• Female
• Pleural Effusion/pathology
• Pleural Effusion/microbiology
• Adult
• Middle Aged
• Tuberculosis, Pleural/pathology
• Tuberculosis, Pleural/diagnosis
• Aged
• Young Adult

• biopsy
• chest computed tomography
• chest ultrasonography
• diagnostic accuracy
• malignant pleural effusion

• NU/RG/MRC/12/1 Deanship of Scientific Research, Najran University, Kingdom of Saudi Arabia

• chest expansion
• chest physiotherapy
• intercostal drainage
• pleural effusion
• pulmonary function

• acute respiratory failure
• lung aeration
• lung ultrasound
• pleural effusion
• pneumonia
• pneumothorax
• point-of-care ultrasound

• CEA + CA-15-3 + CA-125 + CA-19-9 + CYFRA 21-1 panel
• Cancer biomarker
• carcinoembryonic antigen
• diagnostic algorithm
• exudative pleural effusion
• tumor marker

• physiology
• diseases
• signs and symptoms

• Aged
• Cough/etiology
• Humans
• Paracentesis
• Pleura
• Pleural Effusion/etiology
• Thoracentesis

• Narodowym Centrum Nauki

In this study, we aimed to evaluate the diagnostic value of neutrophil and immature granulocyte levels in peripheral blood in cases with pleural effusion.

Between May 2019 and May 2020, a total of 117 patients (43 males, 74 females; mean age: 63.1±18.1 years; range, 18 to 93 years) who had pleural effusion and analysis of pleural fluid were retrospectively analyzed. All patients were evaluated in terms of age, sex, presence of comorbid diseases, approach to the pleural fluid, biochemical values of peripheral blood and pleural fluid, hemogram series of peripheral blood, diagnosis of pleural fluid, and mortality.

Of the patients, 66 (54.5%) were diagnosed with benign pleural effusion and 51 (43.5%) were diagnosed with malignant pleural effusion. Number of cases with known primary malignancy was 54 (46.1%). Immature granulocyte count number and percentage of venous blood in the malignant pleural effusion group was significantly higher than the group with benign pleural effusion (p<0.05).

As a hemogram parameter, immature granulocyte level is an easily applicable, cheap, and a non-invasive method in the outpatient settings.

Takayasu arteritis (TA) is a chronic, nonspecific inflammatory disease of large and medium-sized vessels that primarily involves the aorta and its branches. TA involving the pulmonary arteries has a prevalence ranging from 14% to 86%, which can lead to pulmonary hypertension, a progressive increase in pulmonary artery pressure, and eventually death from right heart failure. The presentation of pulmonary arteritis (PA) is very nonspecific, with a reported misdiagnosis rate of up to 60% and a diagnosis time ranging from 1 month to more than 10 years. The clinical manifestation of pleural effusion is very rare in both TA and PA cases. Based on our literature review, this is the 6^th reported case of TA with pleural effusion, and the specific mechanism of TA with pleural effusion is still unclear. The characteristics of this case and the previously reported cases are summarized in this article to improve the understanding of TA and PA and reduce the misdiagnosis rate.

(1) Background: Malignant (MPE), parapneumonic (PPE) and tuberculous (TPE) pleural effusions constitute common causes of pleurisy. Discriminating among them is usually challenging. C-reactive protein (CRP) and adenosine deaminase (ADA) pleural levels (p-CRP, p-ADA) have been used as differentiators in many studies showing promising results. This study aims to evaluate the diagnostic value of p-CRP, p-ADA levels and their combination among the three categories. (2) Methods: A prospective study of 100 patients with MPE (n = 59), PPE (n = 34) and TPE (n = 7) from a single centre was performed. p-CRP levels were evaluated between PPE and non-PPE and between complicated (CPPE) and non-complicated PPE. ADA levels were also measured to classify patients among MPE and non- MPE. Eventually, the combination of p-CRP and p-ADA values was used as a discrimination factor among PPE, MPE and TPE. (3) Results: ROC analysis revealed that p-CRP with a cut-off value: 4.4 mg/dL can successfully differentiate PPE (AUC = 0.998). The cut-off level of 10 mg/dL can predict CPPE with sensitivity: 63%, specificity: 71.4%, positive predictive value (PPV): 89%, and negative predictive value (NPV): 33%. Furthermore, patients with ADA levels ≤ 32 U/L were more likely to belong to the malignant group sensitivity: 93%, specificity: 78%, PPV: 85.9%, and NPV: 88.9%. Discriminant analysis showed that the combination of p-CRP and p-ADA levels can discriminate PPE, MPE and TPE in 93% of cases. (4) Conclusion: This study provides evidence that p-CRP and p-ADA levels could be possibly used in clinal practice in order to establish a diagnosis among MPE, PPE and TPE.

• lung ultrasound
• malignant pleural effusions
• parapneumonic pleural effusions
• pleural ADA
• pleural CRP
• pleural biomarker
• pleural effusions
• tuberculous pleural effusions

• Cerebrospinal fluid
• Cerebrospinal fluid diversion
• Hydrocephalus
• Ventriculoperitoneal shunt
• Ventriculopleural shunt

• Cerebrospinal Fluid Shunts/adverse effects
• Humans
• Hydrocephalus/surgery
• Pleural Effusion
• Prostheses and Implants
• Ventriculoperitoneal Shunt

Cutaneous myiasis is frequently observed; however, eosinophilic pleural effusion induced by this condition is rare.

We report the case of a 65-year-old female Tibetan patient from Qinghai Province, who presented to West China Hospital of Sichuan University around mid-November 2011 with a chief complaint of recurrent cough, occasional hemoptysis, and right chest pain. There was no past medical and surgical history of note, except for occasional dietary habit of eating raw meat. Clinical examination revealed a left lung collapse and diminished breathing sounds in her left lung, with moist rales heard in both lungs. Chest X-rays demonstrated a left hydropneumothorax and a right lung infection. Chest computed tomography revealed a left hydropneumothorax with partial compressive atelectasis and patchy consolidation on the right lung. Laboratory data revealed peripheral blood eosinophilia of 37.2%, with a white blood cell count of 10.4 × 10⁹/L. Serum immunoglobulin E levels were elevated (1650 unit/mL). Serum parasite antibodies were negative except for cysticercosis immunoglobulin G. Bone marrow aspirates were hypercellular, with a marked increase in the number of mature eosinophils and eosinophilic myelocytes. An ultrasound-guided left-sided thoracentesis produced a yellow-cloudy exudative fluid. Failure to respond to antibiotic treatment during hospitalization for her symptoms and persistent blood eosinophilia led the team to start oral albendazole (400 mg/d) for presumed parasitic infestation for three consecutive days after the ninth day of hospitalization. Intermittent migratory stabbing pain and swelling sensation on both her upper arms and shoulders were reported; tender nodules and worm-like live organisms were observed in the responding sites 1 wk later. After the removal of the live organisms, they were subsequently identified as first stage hypodermal larvae by the Sichuan Institute of Parasites. The patient’s symptoms were relieved soon afterwards. Telephonic follow-up 1 mo later indicated that the blood eosinophilia and pleural effusion were resolved.

Eosinophilic pleural fluid can be present in a wide array of disorders. Myiasis should be an important consideration for the differential diagnosis when eosinophilic pleural effusion with blood eosinophilia is observed.

• Cutaneous myiasis
• Eosinophilic pleural effusion
• Hypoderma larvae
• Albendazole
• Case report

• Exudate
• Histiocytes
• Malignancy
• Pleural effusion
• Thoracentesis

The predominance of neutrophils in pleural effusions of patients with different serious impairments of the pleural cavity organs is often found. The aim of this study was to identify the type of injury using the cytological-energy analysis of pleural effusions.

We analysed 635 samples of pleural effusions with predominance of neutrophils. We compared the values of the coefficient of energy balance (KEB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) catalytic activities in the following subgroups of patients: with transudative effusions, purulent pneumonia, chest empyema and after chest surgery with and without purulent complications. Statistical analysis was performed using the ANOVA Kruskal–Wallis test (p < 0.05 was considered as significant).

We found the lowest KEB values in pleural effusions of patients with chest empyema and their gradual increases in patients with purulent pneumonia and with transudative effusions. We observed the highest LDH and AST enzymes activity in patients with chest empyema and their gradual decrease in patients with purulent pneumonia and with transudative effusions. LDH and AST enzymes activity was significantly higher in pleural effusions of patients after chest surgery with purulent complications compared with non-purulent cases.

The most intensive inflammation and the most extensive tissue destruction in the pleural cavity were found in patients with chest empyema. Significantly better parameters were observed in patients with purulent pneumonia. The absence of serious inflammation and the absence of tissue destruction were typical for patients with transudative effusions. Finally, our results confirmed an anticipated higher tissue destruction in patients after chest surgery. Significantly worse injury was found in surgical patients with purulent complications compared with non-purulent ones.

The reviews of this paper are available via the supplemental material section.

• coefficient of energy balance
• complicated exudate
• cytology of pleural effusions
• empyema
• exudate
• inflammation
• neutrophils
• pleural effusions
• pneumonia
• transudate

Tuberculous pleural effusions (TBPEs) and malignant pleural effusions (MPEs) are two of the most common and severe forms of exudative effusions. Clinical differentiation is challenging; however, metabolomics is a collection of powerful tools currently being used to screen for disease‐specific biomarkers.

17 TBPE and 17 MPE patients were enrolled according to the inclusion criteria. The normalization gas chromatography‐mass spectrometry (GC‐MS) data were imported into the SIMCA‐P + 14.1 software for multivariate analysis. The principal component analysis (PCA) and orthogonal partial least‐squares discriminant analysis (OPLS‐DA) were used to analyze the data, and the top 50 metabolites of variable importance projection (VIP) were obtained. Metabolites were qualitatively analyzed using the National Institute of Standards and Technology (NIST) databases. Pathway analysis was performed by MetaboAnalyst 4.0. The detection of biochemical indexes such as urea and free fatty acids in these pleural effusions was also verified, and significant differences were found between these two groups.

1319 metabolites were screened by non‐targeted metabonomics of GC‐MS. 9 small molecules (urea, L‐5‐oxoproline, L‐valine, DL‐ornithine, glycine, L‐cystine, citric acid, stearic acid, and oleamide) were found to be significantly different (p < 0.05 for all). In OPLS‐DA, 9 variables were considered significant for biological interpretation (VIP≥1). However, after the ROC curve was performed, it was found that the metabolites with better diagnostic value were stearic acid, L‐cystine, citric acid, free fatty acid, and creatinine (AUC > 0.8), with good sensitivity and specificity.

Stearic acid, L‐cystine, and citric acid may be potential biomarkers, which can be used to distinguish between the TBPE and the MPE.

• GC-MS
• biomarker
• malignant pleural effusion
• metabolomics
• tuberculous pleural effusion

Patients with complicated parapneumonic effusion (CPPE)/empyema have high morbidity and mortality, particularly when adequate management is delayed. We aimed to investigate novel dysregulated cytokines that can be used as biomarkers for infectious pleural effusions, especially for CPPE/empyema. Expression of 40 cytokines in parapneumonic effusions (PPE) was screened in the discovery phase, involving 63 patients, using a multiplex immunobead-based assay. Six cytokines were subsequently validated by enzyme-linked immunosorbent assays (ELISAs). We then used ELISA to further evaluate the diagnostic values and cutoff values of these cytokines as potential biomarkers in an expanded group that included 200 patients with uncomplicated parapneumonic effusion (UPPE), CPPE, empyema, transudates, other exudates, and malignant pleural effusion (MPE). The pleural levels of four cytokines (MIF, MIP-3α, IL-1β, ENA-78) were highest and significantly increased in CPPE/empyema compared with those in other etiologies. According to receiver operating characteristic curve analysis, the four cytokines (MIF, MIP-3α, IL-1β, and ENA-78) had areas under the curve (AUCs) greater than 0.710 for discriminating parapneumonic pleural effusion from noninfectious pleural effusions. In a comparison of nonpurulent CPPE with UPPE, logistic regression analysis revealed that pleural fluid MIF ≥ 12 ng/ml and MIP-3α ≥ 4.3 ng/ml had the best diagnostic value; MIF also displayed the highest odds ratio of 663 for nonpurulent CPPE, with 97.5% specificity, 94.44% sensitivity, and an AUC of 0.950. In conclusion, our results show that elevated MIF and MIP-3α may be used as novel biomarkers for PPE diagnosis, particularly in patients with CPPE/empyema; the findings indicate that dysregulated cytokine expression may provide clues about the pathogenesis of pleural infection.

• Clinical ultrasonography
• Ecografía clínica
• Enfermedades infecciosas
• Enfermedades tropicales
• Fluid responsiveness in shock
• IVT
• Infectious diseases
• Intravenous therapy
• POCUS
• Respuesta a fluidos en el shock
• Sarcopenia
• Sarcopenia.
• Shock
• Tropical diseases

• Clinical ultrasonography
• Ecografía clínica
• Enfermedades infecciosas
• Enfermedades tropicales
• Fluid responsiveness in shock
• IVT
• Infectious diseases
• Intravenous therapy
• POCUS
• Respuesta a fluidos en el shock
• Sarcopenia
• Shock
• Tropical diseases

Empyema thoracis, defined as the accumulation of pus in the pleural space, is a rare entity in the neonatal period. There are very few cases described in the medical literature and there are still no treatment protocols in the management of empyema in neonates. In older infants and children, intrapleural fibrinolytics and surgery are often utilized since treatment of complicated parapneumonic effusions with chest tube and antibiotics alone often fail due to the viscous fluid and presence of loculations. Presented here is a case of a term neonate who exhibited symptoms of respiratory distress on the sixth day of life. Imaging modalities revealed massive left sided pleural effusion with loculations and mass effects. Pleural fluid was grossly pus and exudative in nature. Gram stain revealed gram-positive cocci but culture was negative. Empiric broad-spectrum antibiotics and chest tube drainage were utilized and patient was discharged after forty-seven days of hospital admission. In spite of prolonged hospital stay, patient survived with no complications. Therefore, nonoperative therapy could still be an option for neonates with loculated empyema. The key to success in treatment is immediate identification of effusion, prompt initiation of antibiotics, and early effective chest tube drainage.

• Case report
• Empyema
• Newborn
• Parapneumonic effusion
• Pleural effusion

• Pleural effusion
• sensitivity and specificity
• thoracoscopy

• Chest drain
• Clinical trial
• Physical therapy
• Pleural effusion
• Respiratory care

• Minimally invasive thoracic surgery
• Nonintubated thoracic surgery
• Pleural effusion
• VATS

• cytology
• effusion
• immunohistochemistry
• pleural effusions

We previously demonstrated that the pleural levels of proteins (neutrophil gelatinase-associated lipocalin/NGAL, calprotectin, bactericidal permeability-increasing/BPI, azurocidin 1/AZU-1) were valuable markers for identifying complicated PPE (CPPE). Herein, this study was performed to evaluate whether these proteins are useful as serological markers for identifying CPPE and empyema.

A total of 137 participates were enrolled in this study. The levels of NGAL, calprotectin, BPI and AZU-1 were measured in serum and pleural fluid by enzyme-linked immunosorbent assay. We also characterized the diagnostic values of these markers between different groups.

The serum levels of NGAL, calprotectin, and BPI in PPE patients were significantly higher than those in transudates, noninfectious exudates, and healthy controls. The area under the curve (AUC) values of NGAL, calprotectin, and BPI for distinguishing PPE from transudates or noninfectious exudates were around 0.861 to 0.953. In PPE group, serum NGAL and calprotectin levels were significantly elevated in patients with CPPE and empyema than in those with UPPE, whereas the serum BPI levels were similar between these two groups. In CPPE and empyema patients, the serum NGAL showed a positive correlation with the pleural fluid NGAL (r = 0.417, p <  0.01). When combined with serum CRP, the sensitivity and specificity of serum calprotectin for identifying CPPE and empyema were the highest at 73.52% and 80.55%, respectively.

We concluded that serum calprotectin and NGAL were adjuvant serological markers for CPPE and empyema diagnosis. Patients present with pneumonia and pleural effusion signs in the chest x-ray and the combination of serum calprotectin and CRP constitutes a more highly sensitive and specific assay for identifying CPPE and empyema.

The online version of this article (10.1186/s12890-019-0877-8) contains supplementary material, which is available to authorized users.

• AZU1
• BPI
• Calprotectin
• NGAL
• PPE
• Serum biomarker

• Pulmonary disease
• coefficient of energy balance
• immunocompetent cells
• local inflammatory response
• pleural cavity
• pleural effusion

• Metastatic melanoma
• Pleural effusion
• Pulmonary aspergillosis

• Immigrant population
• Pleural tuberculosis
• Tuberculosis diagnostic tools

Confocal laser endomicroscopy (CLE) enables “in vivo” microscopic tissue diagnosis based on tissue reflectance or tissue fluorescence upon application of fluorescence agents. The aim of the present study was to evaluate CLE as a new diagnostic approach for differentiation between malignant versus non-malignant pleural effusions.

In 100 patients with pleural effusions, thoracentesis was performed. Cresyl violet and acriflavine were used as contrast agents for probe-based CLE of effusions. CLE video sequences were assessed by 4 independent investigators (2 experienced in this technique, 2 with only basic knowledge). In addition, all CLE samples were evaluated by an expert pathologist (p). Results were compared with conventional cytology of effusions and histology of cell blocks.

CLE reliably permitted identification of malignant cells in pleural effusions. Sensitivity for detection of malignant effusions was 87% (p: 87%) and 81% (p: 72%) for acriflavine and cresyl violet, respectively. With regard to specificity, acriflavine and cresyl violet yielded a mean value of 99% (p: 100%) and 92% (p: 100%).

In this pilot study, CLE permitted simple and rapid detection of malignant pleural effusions. Larger prospective studies are warranted to corroborate our findings.

• Quantification
• Thoracentesis
• Ultrasonography
• Volume estimation
• Volumetry
• Pleural effusion

• Preventing adhesion
• VATS
• insoluble hyaluronic acid membrane
• thoracic surgery

• Dyspnea
• Indwelling pleural catheter
• Malignant pleural effusion
• Malignant pleural effusion management
• Pleural fluid cytology

• deep sequencing
• exosome
• mirna
• pleural effusions

• Adenocarcinoma/diagnosis
• Adenocarcinoma/etiology
• Adenocarcinoma/metabolism
• Adenocarcinoma of Lung
• Adult
• Biomarkers/metabolism
• Exosomes/genetics
• Female
• High-Throughput Nucleotide Sequencing
• Humans
• Lung Neoplasms/diagnosis
• Lung Neoplasms/etiology
• Lung Neoplasms/metabolism
• Male
• MicroRNAs/metabolism
• Middle Aged
• Pleural Effusion/genetics
• Tuberculosis, Pulmonary/diagnosis
• Tuberculosis, Pulmonary/etiology
• Tuberculosis, Pulmonary/metabolism

• biliary
• emergency department
• extrabiliary
• right upper quadrant
• ultrasound

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Emergency Service, Hospital
• Female
• Gallbladder Diseases/diagnostic imaging
• Gallbladder Diseases/epidemiology
• Humans
• Male
• Middle Aged
• Point-of-Care Systems
• Prevalence
• Retrospective Studies
• Ultrasonography
• United States/epidemiology
• Young Adult

• PET/CT
• Stage IV ovarian cancer
• Surgical management
• Video-assisted thoracic surgery

• Bedside
• Infections
• Infectious diseases
• Point of care
• Ultrasound