Academic Respiratory Unit, Bristol Medical School, Translational Health Sciences, Bristol, UK.
Published: November 2018
AI Article Synopsis
Article Abstract
The vast majority of undiagnosed unilateral pleural effusions have fluid sent for cytological analysis. Despite widespread use, there is uncertainty about its sensitivity to diagnose malignant pleural effusions (MPEs). Our aim was to ascertain the utility of cytology using a large prospective cohort.Consecutive patients presenting with an undiagnosed unilateral pleural effusion were recruited to this UK-based study. All had pleural fluid sent for cytological analysis. Cytological sensitivity was based on the final diagnosis at 12 months, confirmed by two consultants.Over 8 years, 921 patients were recruited, of which 515 had a MPE. Overall sensitivity of fluid cytology to diagnose malignancy was 46% (95% CI 42-58%). There was variation in sensitivity depending on cancer primary, with mesothelioma (6%) and haematological malignancies (40%) being significantly lower than adenocarcinomas (79%). MPEs secondary to ovarian cancer had high pick-up rates (95%). In asbestos-exposed males with exudative effusions, the risk of MPE was 60%, but cytological sensitivity was 11%.This is the largest prospective study of pleural fluid cytology and informs discussions with patients about the likely requirement for investigations following thoracentesis. In patients presenting with a clinical suspicion of mesothelioma, cytological sensitivity is low, so more definitive investigations could be performed sooner.
Background: Pulmonary carcinoids are rare neuroendocrine tumors accounting for less than 1% of all lung cancers. They are classified into two subcategories; typical and atypical carcinoids with the latter tending to grow faster. Historically, open thoracotomy was the standard approach for pulmonary resection.
The solitary fibrous tumor of the pleura (SFTP) is a rare intrathoracic neoplasm that commonly originates from the subpleural mesenchymal cells of the visceral pleura and accounts for less than 5% of all pleural tumors. We reported a case of a 54-year-old man with a two-week history of hypoglycemia, a six-month history of productive cough and fatigue, and chronic right chest pain. Radiological techniques revealed a giant intra-thoracic mass with hypervascularization, and pathological staining was carried out to make a definitive diagnosis of SFTP.
Unilateral paralysis of the oblique abdominal muscles is often caused by non-cancerous conditions, but this case report highlights a rare instance linked to malignant pleural mesothelioma (MPM) in a male patient in his 70s.
The patient experienced position-dependent bulging in the left abdomen and umbilical displacement after initially receiving chemotherapy and radiation therapy for MPM, with CT scans confirming muscle atrophy and nerve impairment.
The findings suggest that thorough abdominal examinations in different positions are crucial for diagnosing tumor-related nerve issues, leading to the proposal of a new syndrome termed "tumor-induced oblique abdominal muscle paralysis syndrome" to enhance diagnostic processes in similar cases.
Introduction The human lungs are located in the pleural cavity, divided by fissures into lobes, facilitating respiration movements. It acts as a barrier to prevent the spread of infection to adjacent lobes. The pulmonary hilum in each lung contains pulmonary vessels, bronchial vessels, and the bronchus.
Introduction: The characteristics and clinical relevance of pleural effusion (PLEF) in acute pulmonary embolism (APE) are not fully understood.
Methods: A single-centre, retrospective study was performed of patients admitted with APE classified according to the subsequent development or not of PLEF. A model was built to predict PLEF and its impact on 30-day all-cause mortality was investigated.
