Plural effusion
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Understanding Pleural Effusion: Clinical Profiles, Diagnostic Challenges, and Management
Clinical Profiles and Etiology of Pleural Effusion
Pleural effusion, the accumulation of excess fluid in the pleural cavity, can arise from various underlying conditions. A cross-sectional study involving 100 patients identified that the majority of pleural effusions were exudative, with tuberculosis being the most common cause (65.15%), followed by malignancy (7.5%) and pneumonia (6.06%). Transudative effusions were less common, often associated with hepatic involvement (29.41%) and congestive cardiac failure (23.52%). Other causes included acute febrile illness, nephrotic syndrome, renal failure, hypoalbuminemia, pancreatitis, and adult respiratory distress syndrome.
Diagnostic Approaches for Malignant Pleural Effusion
Diagnosing malignancy in patients with exudative pleural effusion remains challenging. A study developed an artificial neural network (ANN) model to differentiate malignant from non-malignant effusions using routine pleural fluid findings. The ANN demonstrated high accuracy (89.7%), sensitivity (86.7%), and specificity (91.7%), outperforming traditional logistic regression models. This suggests that ANN could be a valuable non-invasive tool in clinical settings for diagnosing malignant pleural effusions.
Differentiating Tuberculous and Malignant Pleural Effusions
Differentiating between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) is crucial, especially in regions with high tuberculosis incidence. A study evaluated the diagnostic value of various markers, including cytokines, tumor markers, and biochemical markers. Interferon-gamma (IFN-γ) showed superior diagnostic performance with a sensitivity and specificity of over 91% at a cut-off value of >2.45 pg/mL. Other useful markers included TNF-α, IL-6, CYFRA 21-1, CEA, ADA, and Hs-CRP, which also helped in distinguishing TPE from MPE.
Pleural Effusion in Specific Conditions
Acute Type B Aortic Dissection
In patients with acute type B aortic dissection (ABAD), pleural effusion can complicate the clinical picture. A retrospective review of 105 patients found that larger bilateral effusions were associated with hypoalbuminemia, anemia, and inflammation, and were linked to longer intensive care unit stays. Left-sided effusions were particularly associated with older age, low diastolic blood pressure, and larger aortic diameter.
Sarcoidosis
Pleural effusion in sarcoidosis patients is relatively rare, occurring in 1.1-16.7% of cases. Thoracoscopic examinations with pleural biopsy have revealed damage to both visceral and parietal pleura, manifesting as hydrothorax, chylothorax, and hemothorax. It is important to consider concomitant diseases such as tuberculosis, mycosis, cardiac, renal, and hepatic failures, pulmonary embolism, pneumonia, and oncological diseases when diagnosing pleural effusion in sarcoidosis patients.
Conclusion
Pleural effusion is a multifaceted condition with various etiologies and diagnostic challenges. Understanding the clinical profiles and employing advanced diagnostic tools like ANN can significantly improve the accuracy of diagnosing malignant pleural effusions. Differentiating between TPE and MPE using specific markers is crucial for appropriate management. Additionally, recognizing the implications of pleural effusion in conditions like ABAD and sarcoidosis can aid in better patient outcomes.
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