The Value of a Negative Pleural Fluid Cytology and Biopsy in Diagnosing Malignant Pulmonary Lesions.

Over 2 million patients developed lung cancer in 2018, and lung malignancy is responsible for an estimated 1.8 million deaths worldwide. Lung cancer diagnosis usually occurs after suspicious symptoms or incidental radiologic findings on chest imaging when the cancer is probably in an advanced stage. Therefore, initial evaluation, diagnosis, staging, and prompt treatment of lung cancer are required to improve pulmonary malignancies' morbidity and mortality rate. Unfortunately, the size of the tumor, the time of imaging, the quality and quantity of pleural fluid, and pleural biopsy all contribute to diagnostic difficulties in evaluating a lung lesion, leaving even the most astute clinician occasionally perplexed. We discuss a case of a female with lung cancer whose diagnosis was challenging because of a negative pleural biopsy, despite initial radiographic imaging suggesting a lung lesion.

The future of medical thoracoscopy in the Kingdom of Saudi Arabia.

Medical thoracoscopy (MT) has changed how we manage exudative pleural effusion. It is a minimally invasive procedure used as a diagnostic and therapeutic tool in pleural disease. Here, we report a case of a lymphocytic exudative pleural effusion that needed a pleural biopsy for diagnosis. Medical thoracoscopy was performed, a biopsy was taken, and adhesiolysis was performed. Medical thoracoscopy has been practiced for a while worldwide, but it has not been utilized in the Kingdom of Saudi Arabia and as we believe that it is useful in diagnosing exudative pleural effusions. It limits patients in hospital-stay and it may be less costly than surgical procedures. It is especially helpful in diagnosing and treating pleural effusions in elderly patients with multiple comorbidities. Such procedures are needed to ease ongoing financial constraints, and with the 2019 coronavirus disease (COVID-19) pandemic, less time in the hospital means better utilization of beds during the pandemic. Spreading the knowledge about this procedure and its availability in the country will improve the health services provided to the patients.

Pleural effusion as an isolated finding in COVID-19 infection.

Common radiological findings of COVID -19 infection include bilateral ground-glass opacities in lower lobes with a peripheral distribution. Pleural effusion is considered a rare manifestation of COVID -19 infection. We present a 52 years old patient with a three-week history of right-sided pleuritic chest pain, fever, and dyspnea. Laboratory investigations revealed high C-reactive protein and ferritin levels and a positive COVID-polymerase chain reaction (PCR) from a nasopharyngeal swab. Chest X-ray and Computed tomography (CT) identified a moderate right-sided pleural effusion, which was exudative with mixed cellularity and high Lactate dehydrogenase (LDH). Histopathology of thoracoscopic pleural biopsy didn't reveal granulomas, malignancy, or any microbiological growth. We postulate that having ruled out any other cause the effusion was likely related to the Covid-19 infection. Our case highlights that COVID-19 can present with isolated pleural effusions, therefore it should be kept as an etiology of effusions especially if other possible causes have been ruled out.