Dec 12, 2019 massive pleural effusion due to iggkappa subtype multiple myeloma. In women with a massive pleural effusion and ascites, markedly increased ca125 levels may lead to an erroneous diagnosis of ovarian cancer. The actual prognosis of patients with massive and nonmassive malignant pleural effusions has not been determined prospectively. Pleural effusion is commonly used as a catchall term to describe any abnormal accumulation of fluid in the pleural cavity. Pleural effusions are very common, and physicians of all specialties encounter them. A 40yearold man with massive right sided pleural effusion was referred for echocardiography to assess ventricular function. Massive ascites associated with a clinically significant pleural effusion caused by intraabdominal endometriosis is an even rarer phenomenon, with fewer than 15 cases described in the literature since the first report by brews in 1954 5,6. Patients routinely mention at least one of dyspnoea, cough nonproductive, or chest pain usu ally pleuritic. Just after the commencementof dialysis, a chest xray film. Refractory massive pleural effusion systemic erythematosus.
Massive pleural effusion due to iggkappa subtype multiple. Diagnostic approach to pleural effusion in adults american family. A reconstructed coronal image and b transaxial image showing a massive right pleural effusion and small highdensity areas of calcification of the pleura and diaphragmatic plaque. Pdf a pleural effusion is an excessive accumulation of fluid in the pleural space. Etiology and prognostic significance of massive pleural. Diagnostic tools of pleural effusion tuberculosis and respiratory. Hemorrhagic pleural effusion, especially in the right hemithorax rarely occurs as the sole presentation of pancreatitis.
Thoracic echocardiography revealed a small anterior and posterior pericardial effusion with no signs of cardiac tamponade. However, the majority of raassociated pleural effusions are small, unilateral and asymptomatic. A rational diagnostic workup, emphasizing the most common. D a 21yearold male of chinese ethnicity attended the institutions radiology department for an outpatient chest radiograph for right lower chest reduced air entry. Compared with non massive pleural effusions, massive pleural effusions were signi.
Most patients presenting with malignant pleural effusions have some degree of dyspnoea on exertion and their chest radiographs show moderatetolarge pleural effusions ranging from. Massive pleural effusion is often malignant in nature. The pleura is a thin membrane that lines the surface of your lungs and the inside of your chest wall. The mechanism underlying the development of pleural effusions during dasatinib therapy is currently unclear, and it is possible that pleural effusions are multifactorial. Prolonged right atrial collapse that exceeds onethird of the. Pleural effusion secondary to sarcoidosis can present unilaterally or bilaterally, with the right side 45% more often affected than the left 33% 4 for unclear reasons. An exudative pleural effusion with protein content above 30. Bronchopulmonary sequestration with massive pleural effusion.
Pleural effusions insights in chest diseases imedpub. The aim of this paper is to update the knowledge about pleural effusions, rather. Pdf massive pleural effusion in a young woman researchgate. A pleural effusion is due to the manifestations of another illness in general, pleural effusions can be divided into transudates caused by fluid leaking from blood vessels and exudates where fluid leaks from inflammation of the pleura and lung. A pleural effusion is usually diagnosed on the basis of medical history and physical exam, and confirmed by a chest xray. It had been suggested that ca125 titres above uml could differentiate benign from malignant conditions. The pleural effusion gradually resolved with empirical antimycobacterial treatment, leaving considerable pleural adhesion and thickening. A 62 yearold male presented with a progressing three week history of respiratory distress, tachypnoea, right sided chest stony dullness and mediastinal shift to the left. Bilateral massive pleural effusiona rare presentation of. Pleural effusion is defined as a fluid collection between the pleural.
As in meigs syndrome, ascitic fluid can reach the pleural cavity by transdiaphragmatic lymphatics. Massive pleural effusion and marked increase of ca125. The effusion is usually small, self limiting, and the pancreatic isoamylase level rarely exceeds 4000 iul. More than one half of these massive pleural effusions are caused by malignancy. Pleural effusion causes, symptoms, types, and treatments. Massive pleural fluid collection is commonly caused by malignancy and has an incidence of 11. Giant lymph node hyperplasia castlemans disease is a rare cause of pleural effusion. In our study population, patients with nonmassive malignant pleural effusions had a significantly better survival than those with massive malignant pleural effusions, with a median survival of 8 months 95% confidence interval, 79 compared with 5 months 95%. Thoracic ultrasound in the diagnosis of malignant pleural. In cases with massive pleural effusion, treatment by laser ablation of the feeding vessel seems to be more effective than is pleuroamniotic shunting, with fewer complications.
Some guidelines recommend correcting an inter national normalized. A pleural effusion is excess fluid that accumulates in the pleural cavity, the fluidfilled space that surrounds the lungs. Recommendations of diagnosis and treatment of pleural effusion. In our region, the aetiology and occurrence of massive pleural fluid collection have remained largely undetermined and therefore not known. This was found in the postmortem study of a cirrhotic patient with ascites and massive and recurrent hydrothorax. Massive pancreatic pleural effusion is believed to be caused by pancreatic duct disruption.
Massive pleural effusion postgraduate medical journal. Concurrently, he had an outpatient computed tomography. We report the case of a 51 yr old west indian male, who presented with a recurrent massive pleural effusion, due to a tumour arising from the pleura. While only 10% of patients have massive pleural effusions on presentation, malignancy is the most common cause of massive pleural effusion. A large or massive pleural effusion usually causes contralateral. Pleural effusions are commonly encountered in the clinical practise of both respiratory and nonrespiratory specialists. Nov 12, 2009 altering the dasatinib regimen from 70 mg twice daily to 100 mg daily reduces the risk of pleural effusion for patients taking dasatinib. The effusion frequently occurs without clinical evidence of pancreatitis, but occasoinally it may be associated with a pseudocyst of the pancreas. Conclusion in the absence of pleural effusion, the likelihood of spontaneous regression of bps is high and the prognosis is therefore favorable. It was causing inversion of the right atrium figure 1 and video 1 in systole and diastole figure 2, for most of the cardiac cycle.
This excess fluid can impair breathing by limiting the expansion of the lungs. The lack of specificity is mainly due to the limitations of the imaging modality. This article reports massive rightsided hemorrhagic pleural effusion as the sole manifestation of pancreatitis in a 16yearold iranian boy. A study was undertaken to assess the diagnostic accuracy of tus in differentiating malignant and benign pleural.
Compared with nonmassive pleural effusions, massive pleural effusions were signi. Sarcoidosis presenting with massive pleural effusion and. The patient referred to nemazee hospital, the main hospital of southern iran, with rightsided shoulder and chest. Interestingly, the pleural effusion occurred following recent treatment for minimal change disease and atrial. Massive pleural effusions in cirrhotic patients with. In most cases, the actual amount of pleural effusion is small to moderate, though some cases of massive pleural effusion have been reported. The patient was a nonimmunocompromised 35yearold japanese male with insidious onset of fever, chest pain and anorexia. Apichart songern, b piti ungareevittaya, c nipon chaisuriya, c nattiya teawtrakul, d pailin ratanawatkul, a and worawat chumpangern a. The modern diagnosis and management of pleural effusions. Three months later, the patient was found to have a massive right pleural effusion. Pdf massive ascites, pleural effusion, and diaphragmatic.
Analysis of the relevant clinical history, physical examination, chest radiography and diagnostic. It occurs due to the increase in permeability of the microcirculation or alteration in the pleural space drainage to lymph nodes. Sarcoidosis is a multisystem disorder, which most commonly affects the lung. When you have a pleural effusion, fluid builds up in the space between the layers of your pleura. How a pleural effusion presents depends on several factors such as the size of the effusion, the rate of fluid accumulation, comorbidities, and underlying respira tory reserve. A rational diagnostic workup, emphasizing the most common causes, will reveal the etiology in most cases. To elucidate the cause of the duct disruption, pancreas specimens resected from three cases of massive pancreatic pleural effusion were investigated histopathologi tally.
We present a case of massive bilateral pleural effusions in a patient with established rheumatoid pneumoconiosis caplan syndrome. The occurrence and management of fluid retention associated. Pdf pleural effusion is a clinical manifestation shared by several underlying pathologies. No related items previous article next article 25 broadway. Management of malignant pleural effusions european. Should pleural effusion develop, dasatinib should be interrupted until the condition resolves. Pleural effusions describe fluid between the two layer of tissue pleura that cover the lung and the lining of the chest wall.
An exudative pleural effusion with protein content above 30 gl in this case it was 56 gl. Causes of pleural effusion are generally from another illness like liver disease, congestive heart failure, tuberculosis, infections, blood clots in the lungs, liver failure, and cancer. January 20 1992 accepted after revision may 19 1992 the chest xray fig. Spontaneous wholelung torsion after massive pleural. It is widely recognized that sarcoidosis may affect the heart to cause pericardial effusions usually asymptomatic and small, conduction defects and cardiomyopathy. Massive right pleural effusion leading to cardiac tamponade. Jun 29, 2016 massive pleural fluid collection is commonly caused by malignancy and has an incidence of 11. Large pleural effusions ie, two thirds or more of the hemithorax without its complete obliteration were identified in 70 patients 9%, and massive pleural effusions ie, hemithorax was completely opacified were identified in 93 patients 12%. Pleural effusions are also seen with a range of malignancy, most commonly arisingfrom lung, breast, and ovarian cancers. A diagnosis of pleural effusion may be suggested by characteristic symptoms e. A large transudative pleural effusion, even tension hydrothorax, may develop, most frequently on the right side. Bronchopulmonary sequestration with massive pleural. A pleural aspiration showed black pleural fluid figure.
Sep 19, 2017 massive pleural effusions may produce significant cardiorespiratory compromise requiring urgent attention in ed, however, the majority are asymptomatic or produce minimal symptoms. Massive pleural effusionjeffrey kk fong and tien jin tan infections resulting in empyema will usually have a pleural effusion and smoothly thickened enhancing pleura figs. Etiology and prognostic significance of massive pleural effusions. Massive pleural effusion and marked increase of ca125 s f hussain, j grayez, a grigorian, j t green postgrad med j 2004. One and a half liters of pleural fluid were removed by thoracentesis, but after another month, followup chest roentgenogram showed opacification of threequarters of the right hemithorax fig 2. A similar etiologic spectrum between large and massive pleural effusions was. Massive pleural effusions may produce significant cardiorespiratory compromise requiring urgent attention in ed, however, the majority are asymptomatic or produce minimal symptoms. The group of patients with large massive malignant pleural effusions as a whole encompassed 58 patients with true malignant effusions and 31 with paramalignant effusions. The main causes of pe were specified in previous guidelines. Request pdf an autopsy case of ovarian hyperstimulation syndrome with massive pulmonary edema and pleural effusion ovarian hyperstimulation syndrome ohss is the most serious complication of. Severe dengue with massive pleural effusion requiring urgent intercostal chest tube drainage. Massive pleural effusion due to iggkappa subtype multiple myeloma.
Massive ascites, pleural effusion, and diaphragmatic implants in a patient with endometriosis. We also hypothesized that massive pleural effusion would be associated with a poorer prognosis in patients with malignant pleural effusions. Abnormal findings can be detected on posteroanterior radiogra phy in the presence of 200 ml of fluid, and. Massive pleural fluid collection in adult nigerians. Massie pleural ffusioneffre kk fong and tien in tan images in medicine answer. Weberchristian disease developing into mediastinitis and.
The differential diagnosis is based on the clinical. Only two case series, both with a small number of patients, have retrospectively assessed the etiology of massive pleural. Pleural effusions are common, with an estimated 11. Chronic massive pancreatic pleural effusion is an uncommon and often unrecognized clinical syndrome which results from an internal pancreatic fistula and usually presents as an exudative effusion of unknown cause. He underwent parietal pleurectomy and subtotal excision of the tumour. Patients with a history of pleural effusion risk factors should be monitored closely while taking dasatinib. A pleural effusion describes an excess of fluid in the pleural cavity, usually resulting from an imbalance in the normal rate of pleural fluid production or absorption, or both. Pleural effusions may be related to fluid retention resulting from nonspecific inhibition of plateletderived growth factor receptor. The patient referred to nemazee hospital, the main hospital of southern iran, with rightsided shoulder and chest pain accompanied.
Massive pleural effusion and marked of ca125 article pdf available in postgraduate medical journal 80 943. Massive pleural endometriosis european journal of cardio. The aetiology of the pleural effusion determines other associated signs and symptoms. An extremely high pancreatic isoamylase level in pleural fluid in this case it was 4771 iul at admission and rose to 25190 iul five days later. Feb 07, 2020 learn about pleural effusion fluid in the lung symptoms like shortness of breath and chest pain.
Massive pleural effusion due to pleural aa amyloidosis. He had no clinical, laboratory or radiological evidence of pulmonary tuberculosis or malignancy and. While thoracic ultrasound tus has been shown to be accurate in pleural fluid detection, its use in the diagnosis of malignant pleural disease has not been assessed. Once accumulated fluid is more than 300 ml, there are usually detectable clinical signs, such as decreased movement of the chest on the affected side, dullness to percussion over the fluid, diminished breath sounds on the affected side, decreased vocal resonance and. A 79yearold woman presented to the emergency department of our hospital and complained of left leg. The serum to pleural fluid protein or albumin gradients may help better categorize the occasional. His transthoracic echocardiogram revealed a large right pleural effusion. Mycobacterium aaviumintracellulare pleuritis wwith massive. Very high levels of tumour markers may be present in patients with benign pleural effusion, ascites, and chronic liver disease.
Etiology and pleural fluid characteristics of large and. A 56yearold man undergoing treatment for a prostatic acinar adenocarcinoma was referred to us in may, 2014, for assessment of a massive right pleural effusion figure. An interesting case of undiagnosed pleural effusion. A pleural effusion represents the disruption of the normal mechanisms of formation and drainage of fluid from the pleural space. The tumour associated ca125 antigen is widely used in monitoring ovarian carcinoma. C thoracoscopy reveals soft whitish matter on the right pleura, and plaque on the mediastinal pleura and diaphragm. However, a large, refractory pleural effusion, whether a transudate or. Condition exudative or transudative clinical clues. Bilateral massive pleural effusions caused by uremic pleuritis chiharu yoshii, shiho morita, masaki tokunaga, kazuhiro yatera, toshinari hayashi, tomotoshi imanaga, kayoko segawa, keyongwang and masamitsu kido abstract a 61yearold manwas started on hemodialysis in june 1998. In eight patients with cirrhotic ascites and pleural effusions, radioisotopes were introduced into the ascites fluid, and only in two of them, both with right massive and recurrent pleural effusion, was radioactivity detected in. Malignant pleural effusion mpe is a common clinical problem with described investigation pathways. Massive rightsided hemorrhagic pleural effusion due to. It is generally thought that malignancy is the most common cause of a pleural effusion occupying the entire hemithorax, especially in older patients.