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Fulltext Pulmonary atelectasis from compression of the left main bronchus by an aortic aneurysm

Yap KH, Sulaiman S

Singapore Med J, 2009 Jul;50(7):e247-9.
PMID: 19644610

Pulmonary atelectasis may be caused by endobronchial lesions or by extrinsic compression of the bronchus. However, lung collapse due to compression from a thoracic aneurysm is uncommon. We report a 76-year-old hypertensive female patient who has pulmonary atelectasis due to an extrinsic compression from a descending thoracic aortic aneurysm, and discuss possible treatment options.

Matched MeSH terms: Pleural Effusion/diagnosis; Pleural Effusion/radiography
Ultrasound findings of plasma leakage as imaging adjunct in clinical management of dengue fever without warning signs

Xin Tian C, Baharuddin KA, Shaik Farid AW, Andey R, Ridzuan MI, Siti-Azrin AH

Med J Malaysia, 2020 11;75(6):635-641.
PMID: 33219170

INTRODUCTION: Plasma leakage is a major cause of morbidity and mortality in dengue fever. Few studies have shown the sensitivity of thoracoabdominal ultrasound in detecting plasma leakage in severe dengue, however its sensitivity in the early presentation of dengue fever without warning signs remains unknown. This study is aimed to determine the role of serial ultrasound in order to detect plasma leakage in dengue fever without warning signs.
METHODS: This prospective cohort study was conducted at Hospital Universiti Sains Malaysia (USM) from 1st October 2016 to 30th November 2017. Serial bedside ultrasound procedures were performed for 83 patients who were diagnosed as having dengue fever without warning signs and were initially treated as outpatients. Ultrasonography evidence of plasma leakage either pleural effusion, thickened gallbladder wall, ascites or pericardial effusion were compared with clinical findings and laboratory parameters for plasma leakage.
RESULTS: Of the 83 dengue patients, eventually 72.3% had dengue fever with warning signs and 6.0% had severe dengue fever. There were 38 patients who had subclinical plasma leakage at initial presentation, 84.2% and 7.9% of them then progressed to dengue fever with warning signs and severe dengue respectively. There was a minimal agreement between serial bedside ultrasound and haematocrit level in the detection of plasma leakage (observed kappa 0.135).
CONCLUSIONS: Serial bedside ultrasound is an adjunct procedure to physical examination and may detect plasma leakage earlier compared to haemoconcentration. The early usage of serial ultrasound is of paramount importance in detecting dengue patients who are at risk of progressing to severe dengue.

Matched MeSH terms: Pleural Effusion
Massive pleural effusions in cryptococcal meningitis

Wong CM, Lim KH, Liam CK

Postgrad Med J, 1999 May;75(883):297-8.
PMID: 10533638

Cryptococcal infection uncommonly presents with pulmonary manifestations and even more rarely so as massive bilateral effusions. Pleural involvement is usually associated with underlying pulmonary parenchymal lesions and is unusual while on antifungal therapy. We report a patient with cryptococcal meningitis who, while on intravenous 5-flucytosine and amphotericin B, developed life-threatening bilateral massive pleural effusions with evidence of spontaneous resolution, consistent with prior hypothesis of antigenic stimulation as the cause of pleural involvement.

Matched MeSH terms: Pleural Effusion/etiology*
Fulltext Strongyloides stercoralis induced bilateral blood stained pleural effusion in patient with recurrent Non-Hodgkin lymphoma

Win TT, Sitiasma H, Zeehaida M

Trop Biomed, 2011 Apr;28(1):64-7.
PMID: 21602770

Infections and mTalignancies are common causes of pleural effusion. Among infectious causes, hyperinfection syndrome of Strongyloides stercoralis may occur in immunosuppressive patient. A 62-year-old man, known case of Non-Hodgkin lymphoma (NHL) was presented with recurrent NHL stage IV and had undergone salvage chemotherapy. Patient subsequently developed pneumonia with bilateral pleural effusion and ascites. We reported rhabditiform larvae of S. stercoralis in pleural fluid of both lungs without infiltration by lymphoma cells. Stool for microscopic examination also revealed rhabditiform larvae of S. stercoralis. This patient was a known case of NHL receiving chemotherapy resulting in immunosuppression state. Although S. stercoralis infection is not very common compared to other parasitic infections, it is common in immunosuppressive patients and may present with hyperinfection. Therefore, awareness of this parasite should be kept in mind in immunosuppressive patients.

Matched MeSH terms: Pleural Effusion/diagnosis*; Pleural Effusion/parasitology*; Pleural Effusion/pathology
Chest wall stretching exercise as an adjunct modality in post operative pulmonary management

Vikram, M., Joseph, Leonard H., Kamaria, K.

Journal of Surgical Academia, 2012;2(1):39-41.
MyJurnal

Emphysematous pyelonephritis is a form of infection of the kidney. Chest physiotherapy was executed on a 15-year-old girl who had complications such as secretion retention and pleural effusion following percutaneous pigtail nephrostomy in addition to oxygen therapy and medical management to promote respiratory functions. The processes to increase chest wall mobility includes particular passive stretching and mobilization. Chest mobility exercises composed of an intercostal stretch on a determined intercostal space using index fingers, thoracic rotation and anterior compression with stretching in sitting position to improve respiratory functions. These exercises were suggested to the patient as a regular daily treatment along with low-level incentive spirometry breathing exercises. Following 9th sessions of treatment patient demonstrated satisfactory improvement by means of increasing in chest expansion and reduction in dyspnea level without using supplemental oxygen. The results expressed a substantial clinical improvement in reduction of dyspnea level and improvement in chest expansion

Matched MeSH terms: Pleural Effusion
Fulltext Invasive Pneumococcal Pneumonia with Massive Empyema: a case report

Tin Nwe Latt

Journal of Clinical and Health Sciences, 2016;1:41-47.

Although the use of appropriate antibiotics has significantly improved the outcome of pneumonia, severe complications are still encountered. We report here of a case with invasive pneumococcal pneumonia with massive empyema. A 2-year-4-month old girl presented with fever for 8 days and intermittent cough for 2 weeks. On examination, reduced air entry with dullness on percussion was noted on the left lung. Chest ultrasound revealed moderate to gross pleural effusion with septations, for which left thoraco-centesis with insertion of pigtail tube was performed. Streptococcus pneumoniae was detected via polymerase chain reaction (PCR) test in the pleural fluid. Intravenous (IV) benzylpenicillin and ceftriaxone were given together with one course (5 days) of intrapleural urokinase to breakdown the septations. Timely and appropriate management of pneumonia including the use of thrombolytic agent is vital to ensure optimal outcome and reduce the need of invasive procedures in cases with massive empyema. Public awareness of pneumococcal vaccination is also essential as a part of preventive measures.

Matched MeSH terms: Pleural Effusion
Fulltext Invasive Pneumococcal Pneumonia with Massive Empyema: a case report

Tin Nwe Latt

Journal of Clinical and Health Sciences, 2016;1(2):41-47.
MyJurnal

Although the use of appropriate antibiotics has significantly improved the outcome of pneumonia, severe complications are still encountered. We report here of a case with invasive pneumococcal pneumonia with massive empyema. A 2-year-4-month old girl presented with fever for 8 days and intermittent cough for 2 weeks. On examination, reduced air entry with dullness on percussion was noted on the left lung. Chest ultrasound revealed moderate to gross pleural effusion with septations, for which left thoraco-centesis with insertion of pigtail tube was performed. Streptococcus pneumoniae was detected via polymerase chain reaction (PCR) test in the pleural fluid. Intravenous (IV) benzylpenicillin and ceftriaxone were given together with one course (5 days) of intrapleural urokinase to breakdown the septations. Timely and appropriate management of pneumonia including the use of thrombolytic agent is vital to ensure optimal outcome and reduce the need of invasive procedures in cases with massive empyema. Public awareness of pneumococcal vaccination is also essential as a part of preventive measures.

Matched MeSH terms: Pleural Effusion
Fulltext First Two Cases of Fungal Infections Associated with Multi-drug Resistant Yeast, Fereydounia khargensis

Tap RM, Ramli NY, Sabaratnam P, Hashim R, Bakri AR, Bee LB, et al.

Mycopathologia, 2016 Aug;181(7-8):531-7.
PMID: 27010640 DOI: 10.1007/s11046-016-0002-y

The number of new fungal pathogens is increasing due to growing population of immunocompromised patients and advanced identification techniques. Fereydounia khargensis is a yeast and was first described in 2014 from environmental samples. As far as we know, this is the first report of human infections associated with F. khargensis. The yeasts were isolated from blood of a HIV-positive patient and pleural fluid of chronic renal failure patient. Amplification and sequencing of the internal transcribed spacer and the large subunit regions confirmed the identity of the isolates. Both isolates showed multi-drug resistance to antifungal agents tested.

Matched MeSH terms: Pleural Effusion/microbiology
Rapid detection of Mycobacterium tuberculosis in clinical samples by multiplex polymerase chain reaction (mPCR)

Tang TH, Ahmed SA, Musa M, Zainuddin ZF

World J Microbiol Biotechnol, 2013 Dec;29(12):2389-95.
PMID: 23807412 DOI: 10.1007/s11274-013-1407-0

Although the multi-copy and specific element IS6110 provides a good target for the detection of Mycobacterium tuberculosis complex by PCR techniques, the emergence of IS6110-negative strains suggested that false negative may occur if IS6110 alone is used as the target for detection. In this report, a multiplex polymerase chain reaction (mPCR) system was developed using primers derived from the insertion sequence IS6110 and an IS-like elements designated as B9 (GenBank accession no. U78639.1) to overcome the problem of detecting negative or low copy IS6110 containing strains of M. tuberculosis. The mPCR was evaluated using 346 clinical samples which included 283 sputum, 19 bronchial wash, 18 pleural fluid, 9 urine, 7 CSF, 6 pus, and 4 gastric lavage samples. Our results showed that the sensitivity (93.1 %) and specificity (89.6 %) of the mPCR system exceeds that of the conventional method of microscopy and culture. The mPCR assay provides an efficient strategy to detect and identify M. tuberculosis from clinical samples and enables prompt diagnosis when rapid identification of infecting mycobacteria is necessary.

Matched MeSH terms: Pleural Effusion/microbiology
Fulltext Disseminated AIDS-related Kaposi's sarcoma

Tang ASO, Teh YC, Chea CY, Yeo ST, Chua HH

Oxf Med Case Reports, 2018 Dec;2018(12):omy107.
PMID: 30487992 DOI: 10.1093/omcr/omy107

We present a case of disseminated Kaposi's sarcoma with both cutaneous and extracutaneous involvement in an HIV-infected patient with a relatively high CD4 count of 369 cell/mm3. He developed chronic diarrhea, constitutional symptoms, worsening bilateral pleural effusion with respiratory distress, and progression of skin lesions distributed over his chest and extremities. The temporal relationship between rapid clinical progression and initiation of HAART suggested the possibility of Kaposi's sarcoma-associated immune reconstitution inflammatory syndrome, which eventually resulted in the death of this patient.

Matched MeSH terms: Pleural Effusion
Fulltext Idiopathic hypereosinophilic syndrome with unusual presentation: two case reports and review of literature

Suria, A.A., Hafizah, H., Nurasyikin, Y., Azlin, I., Yousuf, R., Azma, R Z., et al.

Medicine & Health, 2018;13(2):208-216.
MyJurnal

Idiopathic hypereosinophilic syndrome (HES) is an uncommon disorder which usually presents with prolonged and significant primary eosinophilia with end-organ dysfunction. Damaging proteins released by the eosinophilic granules are responsible for the tissues and organ system damage. Here we report two cases of idiopathic HES. Both the patients were young lady presented with high grade fever and concomitant symptoms. Laboratory findings showed leucocytosis with predominant neutrophilia and marked eosinophilia. A diagnosis of idiopathic HES was made after excluding secondary causes of eosinophilia. However, the first patient was complicated with multiple venous thrombosis and intravenous heparin was started which was later changed to subcutaneous low molecular weight heparin (LMWH). The patient developed pleural effusion and consolidation. Intravenous Tazoscin, tablet Prednisolone and tablet Hydroxyurea was started and the patient responded well. Despite treatment, two weeks later, suddenly the patient collapsed and unfortunately succumbed. On the other hand, the second patient was complicated with fever, thrombocytopenia, haemolytic anaemia, acute renal failure and neurological deficit which were part and parcel of thrombotic thrombocytopenic purpura (TTP). Plasma exchange was commenced and patient’s condition had slowly improved. Nevertheless, the hypoxia which she sustained during the multiple episodes of fits had resulted in permanent brain injury and thus requiring a tracheostomy for prolonged ventilatory support. Currently, there is no cure for HES. The main aim of treatment is to minimise the tissue damage caused by the hypereosinophilia. Early diagnosis and intervention are therefore crucial in preventing the spread of the disease and the end-organ damage.

Matched MeSH terms: Pleural Effusion
The diagnostic usefulness of tumour markers CEA and CA-125 in pleural effusion

Sthaneshwar P, Yap SF, Jayaram G

Malays J Pathol, 2002 Jun;24(1):53-8.
PMID: 16329556

Pleural effusion is a common diagnostic problem. The analysis of serum and pleural fluid for tumour markers is widely used as a diagnostic aid in clinical practice. The aim of the present study was to determine the usefulness of simultaneous quantification of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA-125) in distinction of malignant from benign effusion. Data from a total of 78 patients including 53 patients with benign and 25 patients with malignant effusion was evaluated. The cut-off values for differentiating benign from malignant effusions were determined using results obtained from patients with known benign effusions (mean + 2 SD, 95% confidence interval). The cut-off for CEA and CA-125 were 5.1 ng/ml and 1707 IU/ml respectively. CEA assay in pleural fluid had an acceptable sensitivity and good specificity of 64% and 98% respectively. CA-125 had a sensitivity of 36% and specificity of 94%. The combination of the two tumour markers gave a sensitivity of 72% and specificity of 92.4%. We suggest a good clinical strategy may be to begin with CEA measurement (assay specificity 98%); if CEA is below the cut-off value (negative), CA-125 could then be measured to improve the sensitivity of detection of malignant effusions. However, measurement of these tumour markers is not cost effective from the point of view that it does not give information on the type of malignancy present. The latter has to be determined either by histological or cytological study.

Matched MeSH terms: Pleural Effusion, Malignant/classification; Pleural Effusion, Malignant/diagnosis*; Pleural Effusion, Malignant/chemistry
Fulltext Pulmonary melioidosis presenting with pleural effusion: A case report and review of literature

Soo CI, Abdul Wahab S, Abdul Hamid F

Respir Med Case Rep, 2015;16:54-6.
PMID: 26744655 DOI: 10.1016/j.rmcr.2015.07.005

Melioidosis is a serious infection, which can involve multiple systems. We report a case of pulmonary melioidosis with the initial presentation mimicking a partially treated pneumonia complicated by right-sided pleural effusion. The patient is a 49-year old man who did not respond to parenteral ceftriaxone and tazobactam/piperacillin therapy. However, upon culture and sensitivity results from blood and pleural samples isolated Burkholderia pseudomallei; antimicrobial therapy was de-escalated to parenteral ceftazidime. Within 72 h duration, his fever subsided and other respiratory symptoms improved tremendously. This case highlights the importance of early recognition of B. pseudomallei in pulmonary infection in order for prompt institution of appropriate antibiotics treatment; thus reducing morbidity and mortality.

Matched MeSH terms: Pleural Effusion
Fulltext Efficacy of anti-tuberculosis treatment alone on resolution of tuberculosis pleural effusions

Selvarajah, V.S., Samudram, S., Chua, L.T., Yuhana, D. Siti, Lim, B.K., S. Wan Yusuf, et al.

International e-Journal of Science, Medicine & Education, 2007;1(2):83-86.
MyJurnal

To determine the degree of resolution in pleural effusions treated with anti-tuberculosis treatment alone without thoracentesis, 62 eligible adult cases [mean age (SD), 46 (17) yrs; 77% male] of tuberculosis pleural effusions treated in two urban-based university teaching hospitals were retrospectively reviewed for changes in effusion size at 2, 6 and 12 months after initiation of treatment. The proportions of patients in whom resolution were complete, partial and unchanged were 64.5%, 27.4% and 8.1%. Effusions with size smaller than three tenth of hemithorax were at three-fold increased likelihood of complete resolution, compared with those with larger effusions [Odds ratio (95% CI): 3.295 (1.033 to 10.514); p=0.04]. Consideration for thoracentesis is therefore still important in certain patients.

Matched MeSH terms: Pleural Effusion
Fulltext Pulmonary Tuberculosis in HIV Infection : The Relationship of the Radiographic Appearance to CD4 T-Lymphocytes Count

San KE, Muhamad M

Malays J Med Sci, 2001 Jan;8(1):34-40.
PMID: 22973154

Pulmonary tuberculosis (TB) in the AIDS population has a variable chest radiographic presentation. The association between the chest radiographic presentation of pulmonary TB and CD4 T-lymphocyte count in the HIV-infected patient was investigated in order to provide an empirical approach for early diagnosis, treatment, and isolation of these patients. A retrospective analysis of chest radiographs, CD4 T-lymphocyte counts, and clinical history of 80 patients from Hospital Kota Bharu, was performed. All patients were HIV-seropositive and had culture and /or cytology-proven pulmonary tuberculosis. Radiographs were evaluated for the presence of atypical or typical patterns of pulmonary TB. Thirteen (16.2%) patients had typical postprimary pattern, where opacities were distributed at the upper zones, with or without cavitation. Sixty-seven (83.8%) patients had atypical patterns, consisting of normal chest radiograph, middle and/or lower zones parenchymal opacities, mediastinal lymphadenopathy, pleural effusion and miliary TB. Of these, 18 (22.5%) patients demonstrated normal chest radiographs, 36 (45%) patients showed parenchymal opacities at the middle and/or lower zones of the lungs, 30 (37.5%) had mediastinal lymphadenopathy, 18 (22.5%) revealed pleural effusion and 6 (7.5%) presented with miliary TB. Sixty-two (77.5%) patients had CD4 T-lymphocytes count less than 200 cells/ul. Of these patients, only 1 (1.6%) had typical pattern. Eighteen (22.5%) patients had CD4 T-lymphocyte count more than 200 cells/ul, where 12 (66.7%) of them showed typical pattern. Patients with CD4 T-lymphocytes count of less than 200 cells/ul, were more likely to produce normal chest radiographs, middle and /or lower zones parenchymal opacities and mediastinal lymphadenopathy. The mean CD4 T-lymphocytes count were also found significantly lower. AIDS patients with pulmonary TB can present with both typical and atypical chest radiograph patterns. An AIDS patient who had CD4 T-lymphocytes count less than 200 cells/ul were more likely to present with atypical radiographic appearance of pulmonary TB. They required appropriate treatment and isolation until the diagnosis of pulmonary TB was confirmed.

Matched MeSH terms: Pleural Effusion
Nested PCR for the rapid detection of TB from pleural fluid at HUKM Malaysia

Salleh SA, Hussin S, Rahman MM

Pak J Biol Sci, 2008 Jul 01;11(13):1728-32.
PMID: 18819627

The aim of the present study is rapid detection of tuberculosis from pleural effusion of suspected patients. Molecular technique Nested Polymerase Chain Reaction (PCR) was used for the purpose. A total of 67 pleural fluid collected at Hospital University Kebangsaan Malaysia during May 2005 to October 2006 were sent to Microbiology Laboratory enrolled in the study. Detection rate of Mycobacterium tuberculosis in pleural effusion was 0% by acid-fast bacilli (AFB) staining and 1.5% by culture on Lowenstein-Jensen medium. Mycobacterium tuberculosis was detected by PCR in 9% of the cases. PCR of pleural fluid had 19% sensitivity and 96% specificity, compared to AFB staining (0% sensitivity and 100% specificity) and culture (4% sensitivity and 100% specificity). PCR also has 67% Positive Predictive Value (PPV) and 72% Negative Predictive Value (NPV) in detecting Mycobacterium tuberculosis. Culture ofpleural fluid has 100% PPV and 71% NPV while AFB staining has 0% PPV and 31% NPV. This preliminary study showed that PCR is a rapid method for detection of Mycobacterium tuberculosis in pleural fluid but its sensitivity is not up the marked.

Matched MeSH terms: Pleural Effusion/genetics*
Treatment of pulmonary tuberculosis [duplicate3]

Rajahram SG

Journal of the Malaya Branch of the British Medical Association, 1941;5:41-4.

Matched MeSH terms: Pleural Effusion
Fulltext Contralateral pleural effusion during chemotherapy for tuberculous pleural effusion

Puri MM, Arora VK

Med J Malaysia, 2000 Sep;55(3):382-4.
PMID: 11200723

A 25 year old woman developed a right pleural effusion 6 weeks after commencement of short course chemotherapy for left sided tuberculous pleural effusion. Since the patient improved following continuation of the same treatment, it is presumed to be a case of paradoxical response to anti-tuberculosis treatment.

Matched MeSH terms: Pleural Effusion/chemically induced*; Pleural Effusion/etiology*; Pleural Effusion/radiography
Fulltext Pleurovideoscopy in a general hospital

Norhaya MR, Dzawani M

Med J Malaysia, 2009 Mar;64(1):75-6.
PMID: 19852328 MyJurnal

A 48 a year old Malay gentleman, was investigated for recurrent unexplained right pleural effusion. Initial investigations showed exudative pleural effusion with neutrophil predominance. Tuberculosis (TB) workout were negative. Pleuroscopy showed multiple adhesions with granulomatous deposits at the parietal pleural surface. Adhesions were released by forceps. A chest tube was inserted. Intrapleural streptokinase instilled for three consecutive days. TB treatment was initiated. There was clinical and radiological improvement and he was discharged well after one week of hospitalization. He remained well at follow-up two months later.

Matched MeSH terms: Pleural Effusion/diagnosis*
Fulltext Successful treatment of a complex malignant pleural effusion with 1 mg alteplase instilled through a non-draining indwelling pleural catheter

Nik Abeed NN, Faisal M, Ng BH, Ban Yu-Lin A

BMJ Case Rep, 2021 Feb 19;14(2).
PMID: 33608330 DOI: 10.1136/bcr-2020-236116

Indwelling pleural catheter (IPC) is the treatment of choice in managing symptomatic recurrent malignant pleural effusion (MPE). Loculated effusions following insertion may occur due to infection, catheter malfunction or the inflammatory nature of MPE. Loculations may lead to ineffective drainage and make the IPC non-functional. We report a 56-year-old man with symptomatic loculated malignant pleural effusion with an IPC, successfully drained with a single dose of 1 mg recombinant tissue plasminogen activator alteplase. This is the lowest dose currently applied in our centre for efficient drainage and improvement of dyspnoea.

Matched MeSH terms: Pleural Effusion, Malignant/drug therapy*

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