Correlación fisiopatológica, diagnóstica y terapéutica en el derrame pleural paraneumónico / Pathophysiological, diagnostic and therapeutic correlation in parapneumonic pleural effusion

Introducción: La inflamación de la pleura desencadenada por bacterias y mediada por citocinas, aumenta la permeabilidad vascular y produce vasodilatación, lo cual genera desequilibrio entre la producción de líquido pleural y su capacidad de reabsorción por eficientes mecanismos fisiológicos. La condición anterior conduce al desarrollo de derrame pleural paraneumónico. Objetivo: Exponer la importancia de la correlación fisiopatológica y diagnóstica con los pilares fundamentales de actuación terapéutica en el derrame pleural paraneumónico. Métodos: Revisión en PubMed y Google Scholar de artículos publicados hasta abril de 2021 que abordaran el derrame pleural paraneumónico, su fisiopatología, elementos diagnósticos, tanto clínicos como resultados del estudio del líquido pleural, pruebas de imágenes, y estrategias terapéuticas. Análisis y síntesis de la información: El progreso de una infección pulmonar y la producción de una invasión de gérmenes al espacio pleural favorece la activación de mecanismos que conllevan al acúmulo de fluido, depósito de fibrina y formación de septos. Este proceso patológico se traduce en manifestaciones clínicas, cambios en los valores citoquímicos y resultados microbiológicos en el líquido pleural, que acompañados de signos radiológicos y ecográficos en el tórax, guían la aplicación oportuna de los pilares de tratamiento del derrame pleural paraneumónico. Conclusiones: Ante un derrame pleural paraneumónico, con tabiques o partículas en suspensión en la ecografía de tórax, hallazgo de fibrina, líquido turbio o pus en el proceder de colocación del drenaje de tórax, resulta necesario iniciar fibrinólisis intrapleural. Cuando el tratamiento con fibrinolíticos intrapleurales falla, la cirugía video-toracoscópica es el procedimiento quirúrgico de elección(AU)

Introduction: The inflammation of the pleura triggered by bacteria and mediated by cytokines, increases vascular permeability and produces vasodilation, which generates imbalance between the production of pleural fluid and its resorption capacity by efficient physiological mechanisms. The above condition leads to the development of parapneumonic pleural effusion. Objective: To expose the importance of the pathophysiological and diagnostic correlation with the fundamental pillars of therapeutic action in parapneumonic pleural effusion. Methods: Review in PubMed and Google Scholar of articles published until April 2021 that addressed parapneumonic pleural effusion, its pathophysiology, diagnostic elements, both clinical and results of the pleural fluid study, imaging tests, and therapeutic strategies. Analysis and synthesis of information: The progress of a lung infection and the production of an invasion of germs into the pleural space favors the activation of mechanisms that lead to the accumulation of fluid, fibrin deposition and formation of septa. This pathological process results in clinical manifestations, changes in cytochemical values and microbiological results in the pleural fluid, which accompanied by radiological and ultrasound signs in the chest, guide the timely application of the pillars of treatment of parapneumonic pleural effusion. Conclusions: In the event of a parapneumonic pleural effusion, with septums or particles in suspension on chest ultrasound, finding fibrin, turbid fluid or pus in the procedure of placement of the chest drain, it is necessary to initiate intrapleural fibrinolytic. When treatment with intrapleural fibrinolytics fails, video-thoracoscopic surgery is the surgical procedure of choice(AU)

Ascitis quilosa en el posoperatorio de hepatectomía derecha / Chylous ascites after right liver resection

La ascitis quilosa posoperatoria (AQP) se debe a acumulación de líquido rico en triglicéridos en la cavidad peritoneal tras una lesión en la cisterna del quilo o en sus afluentes. Es infrecuente verla después de una hepatectomía. Se presenta el caso de un varón de 44 años con adenocarcinoma a 16 cm del margen anal T3N1, con metástasis que ocupaba casi la totalidad del lóbulo hepático derecho. Luego de quimioterapia se realizó hepatectomía derecha, observándose al cuarto día postoperatorio líquido del drenaje endotorácico de aspecto lechoso, con triglicéridos 223 mg/dL y 77 mg/dL de triglicéridos séricos. Se inició dieta sin grasas, hiperproteica, con ácidos grasos de cadena media y octreótide (100 microgramos subcutáneos cada 8 horas), con resolución del cuadro. En conclusión, la complicación quilosa puede tratarse exitosamente con un abordaje menos agresivo, sin suprimir la ingesta oral, utilizando octreótide subcutáneo, dieta exenta de grasas, suplementada con proteínas y ácidos grasos de cadena media.

Postoperative chylous ascites is an intraperitoneal collection of lymphatic fluid enriched with long-chain triglycerides that results from injury of the cisterna chyli or its main tributaries. This complication is rare after liver resections. Here, we report on the case of a 44 year-old man with a T3N1 rectal adenocarcinoma 16 cm above the anal margin, with metastatic compromise of almost the entire right liver lobe. Following chemotherapy, he underwent right liver resection. On postoperative day four, the thoracic drain evidenced milky fluid containing triglyceride 223 mg/dL with serum triglycerides 77 mg/dL. A fat-free diet was indicated with fat-free protein supplements, medium chain triglycerides and octreotide (100 μg subcutaneously every 8 hours), with complete resolution. In conclusion, postoperative chylous complications may be treated successfully by a less aggressive approach, with oral diet, subcutaneous octreotide, fat-free diet supplemented with proteins and medium chain fatty acids.

COVID-19 findings identified in chest computed tomography: a pictorial essay / Achados da COVID-19 identificados na tomografia computadorizada de tórax: ensaio pictórico

ABSTRACT The disease caused by the new coronavirus, or COVID-19, has been recently described and became a health issue worldwide. Its diagnosis of certainty is given by polymerase chain reaction. High-resolution computed tomography, however, is useful in the current context of pandemic, especially for the most severe cases, in assessing disease extent, possible differential diagnoses and searching complications. In patients with suspected clinical symptoms and typical imaging findings, in which there is still no laboratory test result, or polymerase chain reaction is not available, the role of this test is still discussed. In addition, it is important to note that part of the patients present false-negative laboratory tests, especially in initial cases, which can delay isolation, favoring the spread of the disease. Thus, knowledge about the COVID-19 and its imaging manifestations is extremely relevant for all physicians involved in the patient care, clinicians or radiologists.

RESUMO A doença causada pelo novo coronavírus, ou COVID-19, foi descrita recentemente e tornou-se uma questão de saúde mundial. Seu diagnóstico de certeza é dado pela reação em cadeia da polimerase. A tomografia computadorizada de alta resolução, entretanto, mostra-se útil no contexto atual de pandemia, especialmente nos casos mais graves, na avaliação da extensão da doença, em possíveis diagnósticos diferenciais e na pesquisa de complicações. Em pacientes com quadro clínico suspeito e achados de imagem típicos, nos quais ainda não há resultado laboratorial ou a reação em cadeia da polimerase não se encontra disponível, ainda se discute o papel desse exame. Importante ressaltar que parte dos pacientes apresenta exames laboratoriais falsos-negativos, notadamente em casos iniciais, o que pode retardar medidas de isolamento, favorecendo a propagação da doença. Dessa forma, o conhecimento da COVID-19 e de suas manifestações nos exames de imagem é de extrema importância para os médicos envolvidos no atendimento, sejam clínicos ou radiologistas.

Acometimento pulmonar e articular secundário à síndrome de Lemierre: relato de caso e revisão de literatura / Pulmonary and joint involvement secondary to Lemierre syndrome: case report and literature review

A síndrome de Lemierre caracteriza-se por uma rara entidade que gera tromboflebite da veia jugular interna e embolismo séptico em história da infecção recente da orofaringe, além de sinais radiológicos e isolamento de patógenos anaeróbicos, principalmente Fusobacterium necrophorum. Relatamos o caso de uma paciente do sexo feminino, 13 anos de idade, com histórico de carcinoma de nasofaringe associado ao vírus Epstein-Barr (estadiamento T4N2M0), submetida a procedimentos cirúrgicos e quimiorradioterapia. Iniciou com queixa de mialgia intensa, diplopia, lesões infectadas em membros e choque séptico. Por meio de exames de ultrassonografia cervical com Doppler colorido e tomografia computadorizada de pescoço com contraste endovenoso, foram identificados trombos intraluminais na veia jugular interna, além de trombos sépticos pulmonares, por meio da tomografia computadorizada de tórax. Posteriormente, ainda evoluiu com artrite piogênica coxofemoral esquerda. Foi isolada, por hemocultura, a bactéria Klebsiella pneumoniae Carpemenase, e o tratamento se deu pela associação entre vancomicina, amicacina, meropenem, metronidazol e anfotericina B. Conclui-se que, após o diagnóstico de SL e, embora com múltiplas complicações e diagnóstico tardio, a paciente encontra-se bem e assintomática, além do relato comprovar a dificuldade diagnóstica e de seu tratamento

Lemierre's syndrome is a rare condition that leads to thrombophlebitis of the internal jugular vein and septic embolism following recent oropharyngeal infection, being characterized by radiological signs and isolation of anaerobic pathogens, especially Fusobacterium necrophorum. We report the case of a 13-year-old female patient with history of nasopharyngeal carcinoma associated with Epstein-Barr virus (T4N2M0 staging), who underwent surgical procedures and chemoradiotherapy. Her initial complaint was severe myalgia, diplopia, infected limb injuries, and septic shock. Cervical color Doppler ultrasound and computed tomography scan of the neck with intravenous contrast showed intraluminal thrombi in the internal jugular vein, and chest computed tomography showed pulmonary septic thrombi. Subsequently, she progressed with left coxofemoral pyogenic arthritis. The bacterium Klebsiella pneumoniae Carpemenase was isolated in blood culture, and the patient was treated with the association of vancomycin, amikacin, meropenem, metronidazole, and amphotericin B. It is concluded that, despite the multiple complications and late diagnosis, the patient is well and asymptomatic after the diagnosis of Lemierre's syndrome; in addition, the report proves the difficulty of diagnosis and treatme

Hemangioma esplênico no adulto associado à síndrome de Kasabach-Merritt / Kasabach-Merritt Syndrome-associated adult splenic hemangioma

O hemangioma esplênico, tumor benigno mais frequente do baço, porém, por vezes de difícil diagnóstico, pode integrar a síndrome de Kasabach-Merritt, afecção rara e potencialmente fatal, descrita como associação entre hemangioma, trombocitopenia e coagulopatia de consumo. Apresentamos um caso de paciente de 73 anos em acompanhamento com a hematologia por trombocitopenia crônica a princípio idiopática, que evoluiu com dor abdominal, anemia e derrame pleural. Foi realizada tomografia computadorizada de abdome, que evidenciou massa esplênica sólida heterogênea. A paciente foi submetida a esplenectomia total videolaparoscópica e evoluiu com melhora da dor abdominal e normalização da série plaquetária, sem recorrência do derrame pleural após o procedimento. A raridade e a complexidade do caso, somadas à dificuldade diagnóstica e à abordagem terapêutica, foram fatores que corroboraram para a apresentação desse caso. (AU)

Splenic hemangioma, the most common, but sometimes hard to diagnose, benign tumor of the spleen may integrate Kasabach- Merritt syndrome, a rare and potentially fatal condition described as an association ofhemangioma, thrombocytopenia and consumption coagulopathy. We present a case of a 73-year-old female patient being monitoring, with Hematology due to chronic idiopathic thrombocytopenia who progressed with abdominal pain, anemia and pleural effusion; a computed tomography scan of the abdomen was performed, showing a heterogeneous solid splenic mass. The patient underwent total videolaparoscopic splenectomy and progressed with improvement of abdominal pain and normalization of the platelet series, with no recurrence of pleural effusion after the procedure. The rarity and complexity of the case added to the diagnostic difficulty and therapeutic approach were factors that corroborated for the presentation of this case. (AU)

Hemopneumotórax recorrente: descrição da síndrome da endometriose torácica / Recurrent hemopneumothorax: thoracic endometriosis syndrome description

A endometriose torácica é uma forma de endometriose extrapélvica encontrada em tecidos pulmonares ou na pleura. Caracteriza- se clinicamente pela presença de pneumotórax catamenial, hemotórax catamenial, hemoptise e nódulos pulmonares. O pneumotórax catamenial é a manifestação mais frequente, sendo caracterizado pelo acúmulo recorrente de ar na cavidade torácica durante o período menstrual. Ocorre, geralmente, no hemitórax direito e possui maior incidência na faixa etária dos 30 aos 40 anos de idade. Nosso objetivo é descrever um caso de derrame pleural hemorrágico recorrente e pneumotórax espontâneo correlacionados ao período menstrual em paciente de 34 anos. (AU)

Thoracic endometriosis is a form of extrapelvic endometriosis found in pulmonary tissue or the pleura. Clinically, it is characterized by the presence of catamenial pneumothorax, catamenial hemothorax, hemoptysis, and pulmonary nodules. The most frequent clinical presentation is catamenial pneumothorax, which is typified by a recurrent collection of air in the thoracic cavity occurring in conjunction with menstrual periods. It occurs more commonly on the right side and its highest incidence is between 30 and 40 years of age. Our objective is to describe a case of recurrent hemorrhagic pleural effusion and spontaneous pneumothorax correlated to the menstrual period in a 34-year-old patient. (AU)

Report of a rare case of histiocytic necrotizing lymphadenitis with bilateral pleural effusion diagnosed via cervical lymph node biopsy

ABSTRACT CONTEXT: Histiocytic necrotizing lymphadenitis (HNL) is a rare disorder that is often benign and self-limiting. There have been reports of co-occurrence of HNL with other diseases, including systemic lupus erythematosus, hemophagocytic syndrome and antiphospholipid syndrome. CASE REPORT: Here, we report a case in which a patient experienced unexplained fever, swelling of the cervical lymph node and bilateral pleural effusion and was ultimately diagnosed with HNL based on results from a lymph node biopsy. After treatment with glucocorticoid, the patient regained normal body temperature, the swelling of the lymph nodes disappeared and the pleural effusion was reabsorbed. CONCLUSIONS: The pathogenesis of HNL remains unclear, and pleural effusion is rarely reported in HNL patients. We presented this case to improve diagnostic awareness of this condition among clinicians and help reduce the likelihood of misdiagnosis.

Derrame pleural por micosis endémica en un paciente de 8 años: reporte de un caso / Pleural effusion due to endemic mycosis in an 8-year-old patient: a case report

Coccidioides is a fungus that is frequently found in dry places of sparse storms, with warm temperatures during most of the year. Two species are known to infect the human being: C. immitis and C. posadasii.It is endemic in northern Mexico, southern United States, as well as in some regions of Central America and South America. It is a highly contagious organism, but mostly it generates self-limited and asymptomatic diseases. Only 10 percent of cases with pulmonary symptoms are severe and may manifest as lobar pneumonia. Some cases of multiple foci and pleural effusion are diagnosed through biopsy with molecular methods. The treatment in many cases includes the use of azole antifungals for 3-6 months and follow-up with antibody titres

El Coccidioides es un hongo que se encuentra de manera frecuente en lugares secos, con temperaturas cálidas durante la mayoría del año. Son dos especies las que se conoce que infectan al ser humano la C. Immitis y C. Posadasii. Es endémico del norte de México, sur de Estados Unidos, así como algunas pequeñas regiones de centro y Sudamérica. Es un organismo altamente contagioso, pero en su mayoría genera enfermedades autolimitadas y de tipo asintomático, los pacientes con manifestaciones pulmonares solamenteen 10 por ciento son de presentación grave. Esta puede ser como una neumonía lobar, pero en algunos casos de focos múltiples y con derrame pleural, el diagnóstico es mediante biopsia en a fechas recientes con métodos moleculares. Los tratamientos en muchos casos requieren únicamente vigilancia. De requerir tratamiento se usa antimicótico 3-6 meses con azoles y seguimientos con títulos de anticuerpos

Parapneumonic pleural effusion: early versus late thoracoscopy / Derrame pleural parapneumônico: comparação entre toracoscopia precoce e tardia

ABSTRACT Objective: To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications. Methods: This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or loculations on chest ultrasound who underwent thoracoscopy between January of 2000 and January of 2013. The patients were divided into two groups: early thoracoscopy (ET), performed by day 5 of hospitalization; and late thoracoscopy (LT), performed after day 5 of hospitalization. Results: We included 60 patients, 30 in each group. The mean age was 3.4 years; 28 patients (46.7%) were male; and 47 (78.3%) underwent primary thoracoscopy (no previous simple drainage). The two groups were similar regarding gender, age, weight, and type of thoracoscopy (p > 0.05 for all). There was a significant difference between the ET and the LT groups regarding the length of the hospital stay (14.5 days vs. 21.7 days; p < 0.001). There were also significant differences between the groups regarding the duration of fever in days; the total number of days from admission to the initiation of drainage; and the total number of days with the drain in place. Eight patients (13.6%) had at least one post-thoracoscopy complication, there being no difference between the groups. There were no deaths. Conclusions: Performing ET by day 5 of hospitalization was associated with shorter hospital stays, shorter duration of drainage, and shorter duration of fever, although not with a higher frequency of complications, requiring ICU admission, or requiring blood transfusion.

RESUMO Objetivo: Avaliar o melhor momento para a realização de toracoscopia no tratamento de derrame pleural parapneumônico complicado na fase fibrinopurulenta em pacientes ≤ 14 anos de idade quanto a evolução e ocorrência de complicações pós-operatórias. Métodos: Estudo retrospectivo e comparativo com pacientes com derrame pleural parapneumônico que apresentavam septações ou loculações à ultrassonografia de tórax e que foram submetidos a toracoscopia no período entre janeiro de 2000 e janeiro de 2013. Os pacientes foram divididos em dois grupos: toracoscopia precoce (TP), realizada até o 5º dia da hospitalização; e toracoscopia tardia (TT), realizada após o 5º dia de internação. Resultados: Foram incluídas 60 pacientes, 30 em cada grupo. A média de idade foi de 3,4 anos, 28 pacientes (46,7%) eram do sexo masculino, e 47 (78,3%) foram submetidos à toracoscopia primária, sem realização de drenagem simples prévia. Os grupos TP e TT foram semelhantes quanto ao sexo, idade, peso e tipo de toracoscopia (p > 0,05 para todos). Observou-se uma diferença significativa quanto à média de duração da internação nos grupos TP e TT (14,5 dias vs. 21,7 dias; p < 0,001). Houve também diferenças significativas entre os grupos quanto ao total de dias com febre, total de dias entre internação e início da drenagem e total de dias com dreno. Oito pacientes (13,6%) apresentaram alguma complicação após a toracoscopia, sem diferença entre os grupos. Não houve óbitos. Conclusões: A TP, realizada até o 5º dia da admissão hospitalar, associou-se a menor duração da internação, menor tempo de drenagem e menor duração da febre, sem estar associada a maior frequência de complicações, necessidade de CTI ou hemotransfusão.

The efficacy of thoracic ultrasonography in postoperative newborn patients after cardiac surgery

Abstract Objective: In this study, the efficacy of thoracic ultrasonography during echocardiography was evaluated in newborns. Methods: Sixty newborns who had undergone pediatric cardiac surgery were successively evaluated between March 1, 2015, and September 1, 2015. Patients were evaluated for effusion, pulmonary atelectasis, and pneumothorax by ultrasonography, and results were compared with X-ray findings. Results: Sixty percent (n=42) of the cases were male, the median age was 14 days (2-30 days), and the median body weight was 3.3 kg (2.8-4.5 kg). The median RACHS-1 score was 4 (2-6). Atelectasis was demonstrated in 66% (n=40) of the cases. Five of them were determined solely by X-ray, 10 of them only by ultrasonography, and 25 of them by both ultrasonography and X-ray. Pneumothorax was determined in 20% (n=12) of the cases. Excluding one case determined by both methods, all of the 11 cases were diagnosed by X-ray. Pleural effusion was diagnosed in 26% (n=16) of the cases. Four of the cases were demonstrated solely by ultrasonography, three of them solely by X-ray, and nine of the cases by both methods. Pericardial effusion was demonstrated in 10% (n=6) of the cases. Except for one of the cases determined by both methods, five of the cases were diagnosed by ultrasonography. There was a moderate correlation when all pathologies evaluated together (k=0.51). Conclusion: Thoracic ultrasonography might be a beneficial non-invasive method to evaluate postoperative respiratory problems in newborns who had congenital cardiac surgery.

Diagnóstico y tratamiento del derrame pleural paraneumónico / Diagnosis and treatment of parapneumonic pleural effusion

El derrame paraneumónico ocurre como complicación de una neumonía y en nuestro medio corresponde al 2% de las hospitalizaciones de causa respiratoria. Se debe sospechar en pacientes con neumonía presentan evolución desfavorable y debe confirmarse por exámenes de imágenes. El estudio y drenaje del líquido pleural es fundamental para un manejo adecuado y evolución satisfactoria, por lo que la toracocentesis y la instalación de drenaje pleural no deben retrasarse. El tratamiento debe ser hospitalizado, con antibióticos endovenosos y en la mayoría de los casos la evolución es satisfactoria y sin secuelas para el paciente.

Paraneumonic effusion occurs as a complication of pneumonia and in our case corresponds to 2% of respiratory hospitalizations. It should be suspected in patients with pneumonia presenting unfavorable evolution and must be confirmed by imaging tests. The study and drainage of pleural fluid is essential for adequate management and satisfactory evolution, so that thoracentesis and pleural drainage installation should not be delayed. The treatment should be hospitalized with intravenous antibiotics and in most cases the evolution is satisfactory and without sequelae for the patient.

Aplicaciones torácicas del ultrasonido / A review on thoracic ultrasound

The use of thoracic ultrasound as a diagnostic tool in the emergency department, intensive care unit or in patients with pulmonary diseases is increasing steadily. It is used to guide percutaneous tracheostomies, to assess pleural effusions, to rule out pneumothorax, and to guide the placement of endovascular and pleural catheters. It is also useful in the assessment of patients with dyspnea. The aim of this review is to provide the practical and technical basics for the use of this diagnostic tool among internists and specialists in pulmonary diseases.

Características clínicas y epidemiológicas de los pacientes hospitalizados con derrame pleural / Clinical and epidemiological characteristics of patients hospitalized with pleural effusion

El derrame pleural tiene una prevalencia mundial de aproximadamente 400 de cada 100.000 habitantes y Venezuela tiene cifras similares. Se relaciona con múltiples patologías, por lo que determinar sus características podría ayudar a obtener un mejor diagnóstico y tratamiento. Métodos: Se realizó un estudio de casos, retrospectivo y descriptivo, obteniendo información de las historias de pacientes hospitalizados con derrame pleural en el servicio de Medicina Interna del Hospital Dr. Domingo Luciani en el período Enero 2010- Abril 2015. Resultados: La edad promedio fue de 49±19 años, género masculino (53%). Motivo de consulta: disnea (81%), dolor torácico (44%) y tos (37%). Los síntomas: disnea (92%), dolor pleurítico (58%) y fiebre (54%). Antecedentes personales: HTA (32%), DM (22%) e IC (20%). Radiografía de tórax: (60%) derrame pleural derecho y (26%) izquierdo. Tomografía de tórax realizada en (77%). Citoquímicos: (85%) exudado (53% mononuclear y 32% polimorfonucleares). La prueba de ADA positiva en 25%, cultivo para bacterias realizado en 89 casos, positivos 18%. Bloque celular con resultado inflamatorio (80%). Biopsia pleural realizada (22%): inflamatorio (36,4%), seguido por ADC metástasico (31,8%). Estancia hospitalaria > 15 días (76%) y el diagnóstico final fue infeccioso (51%). Conclusión: Contando con estos datos clínicos- epidemiológicos se puede caracterizar el comportamiento del derrame pleural en nuestro centro para el rápido y acertado diagnóstico, igualmente proponer una investigación prospectiva donde se analice el comportamiento de dicha enfermedad, y crear protocolos de actuación(AU)

Pleural effusion has a worldwide prevalence of approximately 400 per 100,000 inhabitants and Venezuela has similar statistics. It is related to multiple pathologies, which determine their characteristics which could help for better diagnosis and treatment. Methods: A retrospective descriptive case study was conducted, obtaining information from the charts of hospitalized patients with pleural effusion in Internal Medicine Dr. Domingo Luciani Hospital Venezuela in the period January 2010-April 2015. Results: Mean age 49 ± 19 years, male genre (53%). Complaints: dyspnea (81%), chest pain (44%) and cough (37%). Symptoms: dyspnea (92%), pleuritic pain (58%) and fever (54%). Personal history: hypertension (32%), DM (22%) and HF (20%). Chest x-ray: right pleural effusion (60%), left (26%). Chest tomography performed on (77%). Cytochemical: exudate: 85% (53% mononuclear and polymorphonuclear 32%). ADA testing positive in 25%. For bacteria culture: performed in 89 cases, 18% positive. Cell block inflammatory (80%). Pleural followed by metastatic ADC (31.8%). Hospital stay> 15 days (76%) and final diagnosis was infection (51%). Cause of discharge from hospital: improvement (80%). Conclusion: Having these clinical and epidemiological data can characterize the behavior of pleural effusion for quick and accurate diagnosis(AU)

Hallazgos imagenológicos en la enfermedad pleuropulmonar asociada al asbesto / Imaging findings in pleuropulmonary disease associated with asbestos

Abestos-related pleuropulmonary disease involves a number of pathologic conditions that share inhalation exposure to asbestos fibers as a common factor. Dose and time of exposure have a role in the clinical manifestations of it, the main ones being benign pleural disease, asbestosis, malignant mesothelioma and bronchogenic carcinoma. Despite the ban on asbestos material usage in Chile, there is a long latency between exposure and clinical manifestations, which lead to it being still a relevant public health issue to this day. We present a series of representative images of abestos-related pleuropulmonary disease diagnosed at our centre. The pathogeny and radiologic manifestations are discussed, with an emphasis on the latter.

Papel da ultrassonografia na avaliação das doenças pleurais / The role of ultrasound in the assessment of pleural diseases

A Ultrassonografia tem grande valor na avaliação das doenças da pleura. Trata-se de um método não invasivo e isento de riscos que permite a realização de exame em tempo real e à beira do leito. Ela é útil na análise dos derrames pleurais, inclusive podendo ser utilizada como guia para procedimentos invasivos. Na suspeita de pneumotórax a US também tem grande utilidade assim como na análise das alterações sólidas das superfícies pleurais e das estruturas adjacentes. AU

The ultrasound has great value in the evaluation of diseases of the pleura. This is a non-invasive and risk--free method that allows the realization of examination in real time and at the bedside. It is useful in the analysis of pleural effusions, even can be used as a guide to invasive procedures. In suspected cases of pneumothorax US also has great utility as well as the analysis of the solid changes in pleural surfaces and adjacent structures AU

Enfoque diagnóstico en el paciente con derrame pleural / Diagnostic approach in pleural effusion

En el estudio diagnóstico del paciente con derrame pleural se deben considerar la historia clínica y el análisis de las imágenes para acotar el diagnóstico diferencial. El uso adecuado de las técnicas de imágenes contribuye a realizar procedimientos en forma segura. Se debe realizar una toracocentesis diagnóstica y/o evacuadora y se debe analizar completamente el líquido pleural. A veces es necesario realizar biopsia pleural para lo cual existen diversas técnicas disponibles. En los pacientes con pleuritis crónica inespecífica se debe hacer seguimiento por dos años para evaluar el desarrollo de malignidad.

The diagnostic approach in patients with pleural effusion must begin considering clinical aspects and image interpretation. Different imaging techniques can safely guide invasive procedures. Diagnostic or therapeutic thoracentesis must be performed and pleural fluid must be completely analyzed. Some patient will require pleural biopsy, and different techniques are available. Patients with chronic unspecific pleuritis histological diagnosis after pleural biopsy, must be followed for two years long to be sure no malignancy is developed.

Clinical and Prognostic Features of Erionite-Induced Malignant Mesothelioma

This review analytically examines the published data for erionite-related malignant pleural mesothelioma (E-MPM) and any data to support a genetically predisposed mechanism to erionite fiber carcinogenesis. Adult patients of age > or =18 years with erionite-related pleural diseases and genetically predisposed mechanisms to erionite carcinogenesis were included, while exclusion criteria included asbestos- or tremolite-related pleural diseases. The search was limited to human studies though not limited to a specific timeframe. A total of 33 studies (31042 patients) including 22 retrospective studies, 6 prospective studies, and 5 case reports were reviewed. E-MPM developed in some subjects with high exposures to erionite, though not all. Chest CT was more reliable in detecting various pleural changes in E-MPM than chest X-ray, and pleural effusion was the most common finding in E-MPM cases, by both tests. Bronchoalveolar lavage remains a reliable and relatively less invasive technique. Chemotherapy with cisplatin and mitomycin can be administered either alone or following surgery. Erionite has been the culprit of numerous malignant mesothelioma cases in Europe and even in North America. Erionite has a higher degree of carcinogenicity with possible genetic transmission of erionite susceptibility in an autosomal dominant fashion. Therapeutic management for E-MPM remains very limited, and cure of the disease is extremely rare.

Fluid Collection in the Right Lateral Portion of the Superior Aortic Recess Mimicking a Right Mediastinal Mass: Assessment with Chest Posterior Anterior and MDCT

OBJECTIVE: We observed patients in whom the fluid collection in the right lateral portion of the superior aortic recess on computed tomography (CT) scans mimicked a right anterior mediastinal mass on chest PA radiographs. The purpose of this study was to assess chest PA and CT features of these patients. MATERIALS AND METHODS: All chest PA radiographs and CT scans in 9 patients were reviewed by two radiologists on a consensus basis; for the presence of pleural effusion, pulmonary edema and heart size on chest PA radiographs. For the portion of the fluid collection in the superior aortic recess (SAR), a connection between the right lateral portion of the SAR (rSAR) and posterior portion of the SAR (pSAR) on CT scans, and the distance between the right lateral margin of the rSAR and the right lateral margin of the superior vena cava. RESULTS: Fluid collection in the rSAR on CT scans caused a right anterior mediastinal mass or a bulging contour on chest PA radiographs in all women patients. All patients showed cardiomegaly, five patients had pleural effusion, and two patients had mild pulmonary edema. Further, eight patients showed a connection between the rSAR and the pSAR. CONCLUSION: The characteristic features of these patients are the right anterior mediastinal mass-like opacity due to fluid collection in the rSAR, are bulging contour with a smooth margin and cardiomegaly regardless of pulmonary edema on the chest PA radiographs, and fluid connection between the rSAR and the pSAR on CT scans.

Factors affecting the occurrence of hydrothorax in Egyptian patients with decompensated liver disease

It is well known that in cirrhotic patients, a large volume of ascetic fluid is generally well tolerated due to the capacitance of the peritoneal cavity. On the other hand, even modest volumes of pleural fluid can cause significant respiratory symptoms, including dyspnea and chest pain. Therefore, although infrequent, hepatic hydrothorax may represent a major clinical problem in the management of patients with portal hypertension. This work search for factors affecting the occurrence of hepatic hydrothorax in Egyptian patients with decompensated liver disease A total of 40 patients selected from Al Azhar University Hospitals with decompensated liver disease and ascites were included in this study divided into two groups 20 patients have ascites without pleural effusion were selected to be included in the study as a group [I], another a 20 patients have ascites with pleural effusion were selected also, to be included in the study as a group [II].All patients were subjected to the following:-Careful history taking, Careful clinical examination, laboratory investigations, including, complete urine and stool analysis, complete blood picture and, Liver function tests, Renal function tests, ascitic fluid and pleural fluid analysis for, physical, chemical, Cytological examinations. Abdominal Ultrasonography, Chest X ray, Results showed that the mean of BMI and ascitic fluid LDH are higher in patients with pleural effusion than in patients without pleural effusion. In contrast, the mean of alkaline phosphatase, ascitic fluid glucose and ascitic fluid RBCs are lower in patients with pleural effusion than in patients without pleural effusion but these findings are not enough to explain the occurrence of hepatic hydrothorax in those patients and these factors still obscure so more studies are needed to detect these factors