Assuntos
Meningites Bacterianas/diagnóstico , Doença Aguda , Idoso , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/etiologia , Erros de Diagnóstico , Suscetibilidade a Doenças , Encefalocele/complicações , Endoscopia , Feminino , Sinusite Frontal/etiologia , Humanos , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/diagnóstico por imagem , Meningites Bacterianas/etiologia , Meningocele/complicações , Recidiva , Rinite Alérgica Perene/diagnóstico , Punção Espinal , Tomografia Computadorizada por Raios XRESUMO
This study describes a 64-yr-old male with a chronic left pleural effusion following a coronary artery bypass 3 yrs earlier. On thoracocentesis, turbid fluid was obtained with crystals of cholesterol on microscopic examination, establishing the diagnosis of pseudochylothorax. The pleural fluid cholesterol level was 207 mg x dL(-1) (5.36 mmol x L(-1)). This is the first report of pseudochylothorax in a chronic pleural effusion due to coronary artery bypass surgery.
Assuntos
Quilotórax/etiologia , Ponte de Artéria Coronária/efeitos adversos , Derrame Pleural/etiologia , Colesterol/análise , Doença Crônica , Humanos , Masculino , Pessoa de Meia-Idade , Pleura/patologia , Derrame Pleural/química , Derrame Pleural/patologiaRESUMO
BACKGROUND AND OBJECTIVES: In a previous study we concluded that the pleural fluid/serum (PF/S) ratio of cholinesterase was the most useful parameter to discriminate between exudates and transudates. The objective of the present study was to confirm these findings in a prospective series of patients with pleural effusion. MATERIAL AND METHODS: A total of 177 patients, consecutively studied at two institutions, with the diagnosis of pleural effusion were included in this study. Thirty-six (20.3%) effusion were transudates and 141 (79.7%) exudates; of these, 73 and 68 were of malignant and benign origin, respectively. Both PF/S cholinesterase and Light's criteria were compared. RESULTS: The PF/S cholinesterase ratio incorrectly classified 12 pleural effusions (6.8%). These included 7 out the 36 transudates (19.4%) and 5 out of the 141 exudates (3.5%), the latter of malignant etiology. Following Light's criteria, four (2.2%) exudates were misclassified, all of them transudates. The higher accuracy of Light's criteria was statistically significant (p = 0.04). CONCLUSIONS: In this series of patients, Light's criteria were more accurate than PF/S cholinesterase ratio to discriminate between transudates and exudates. From these results, the use of the PE/S cholinesterase ratio parameters is no longer recommended.
