BACKGROUND: The measurement of adenosine deaminase(ADA) level in pleural fluid is useful in the diagnosis of tuberculous(TB) pleural effusion. However, ADA is also elevated in other diseases such as malignancy, bacterial infections, empyema, and collagen vascular disease, ADA alone has limited value. The object of this study is to determine diagnostic usefulness of the combined use of ADA value with lymphocyte/neutrophil ratio(L/N ratio) rather than the use of ADA alone. METHOD: We evaluated 198 patients(age=55.9+/-12.9, M/F=2.7:1) with pleural effusion who had admitted in Gyeong-sang National University Hospital from Jan. 1999 to Dec. 2001. retrospectively. Patients were divided into four diagnostic groups: TB pleural effusion(n=91), parapneumonic effusion(n=65), malignant effusion(n=21), and transudative effusion(n=13). The ADA level, differential cell count, biochemistry, cytology, and microbiology of each diagnostic groups were evaluated. The sensitivity, specificity, negative predictive value(npv), positive predictive value(ppv) and efficiency were calculated at each ADA values and combined ADA value with various L/N ratios. RESULT: The ADA level in TB pleural effusion was significantly higher than that of parapneumonic effusion, malignant pleural effusion, and transudative effusion(p<0.05). Sensitivity, specificity, ppv, npv and efficiency at ADA>or=50 IU/L in the diagnosis of TB pleural effusion were 89.0%, 82.2%, 81.0%, 89.8% and 85.5% respectively. When ADA>or=50 IU/L was combined with lymphocyte/neutrophil ratio>or=0.75, sensitivity, specificity, ppv, npv, and efficiency were 83.5%, 96.3%, 95.0%, 87.9% and 90.5% respectively. Specificity, ppv and efficiency were increased with combination of ADA value and L/N ratio. CONCLUSION: Combination of ADA value and L/N ratio in pleural effusion is more useful than ADA value alone in the diagnosis of TB pleural effusion.
Adenosine Deaminase* ; Adenosine* ; Bacterial Infections ; Biochemistry ; Cell Count ; Collagen ; Diagnosis ; Empyema ; Humans ; Pleural Effusion* ; Pleural Effusion, Malignant ; Retrospective Studies ; Tuberculosis ; Vascular Diseases

BACKGROUND: pH measurement is an important test in assessing the etiology of pleurisy and in identifying complicated parapneumonic effusion. Although the blood gas analyzer is the' gold standard method' for pleural pH measurement, pH meter & pH strip methods are also used for this purpose interchangably. However, the correlation among the pH data measured by the three different methods needs to be evaluated. In this study, we measured the pH of pleural fluid with the three different methods respectively and evaluated the correlation among the measured data. METHODS: From August 1999 to March 2000, were measured the pleural fluid pH in 34 clinical samples with three methods-blood gas analyzer, pH meter, and pH strip. In the blood gas analyzer and pH meter methods, the temperature of plerual fluid was maintained around 0℃ in air-tight condition before analysis and measurement was performed within 30 minutes after collection. As for the pH strip method, the pleural fluid pH was checked in the ward immediately after tapping and in the clinical laboratory of our hospital. This part is unclear. RESULTS: The causes of pleural effusion were tuberculosis pleurisy in 16 cases, malignant pleural effusion 5 cases, parapneumonic effusion 9 cases, empyema 3 cases, and congestive heart failure 1 case. The pH of pleural fluid (mean±SD) was 7.34±0.12 with blood gas analyser, 7.52±0.25 with pH meter, 7.37±0.16 with pH strip of immediate measurement and 6.93±0.201 with pH strip of delayed measurement. The pH measured by delayed pH strip measurement was lower than those of other methods(p<0.05). The correlation of the results between the blood gas analyzer and pH meter(p=0.002, r=0.518) and the blood gas analyzer and pH strip of immediate measurement(p<0.001, r=0.607). CONCLUSION: In the determination of pH of pleural fluid, pH strip method could be a simple and reliable method under immediate measurement conditions after fluid tapping.
Empyema ; Heart Failure ; Hydrogen-Ion Concentration* ; Methods* ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy ; Tuberculosis

BACKGROUND: In contrast to tuberculous pleurisy, tuberculous empyema is a chronic active infectious disease of the pleural cavity that is frequently accompanied by cavitary or advanced pulmonary lesions. The condition requires long-term anti-tuberculous medication with external drainage. The clinical features and treatment outcome of tuberculous empyema are unclear despite the high prevalence of tuberculosis in Korea. METHODS: From January 1991 through April 2004, 17 patients diagnosed with tuberculous empyema in Kyungpook National University Hospital were enrolled in this study. Their medical records and chest radiographs were reviewed. RESULTS: Twelve patients(71%) had a history of tuberculosis and six of the 12 patients were under current anti-tuberculous medication. Productive cough, fever, and dyspnea were the main complaints. There was no predominance between the right and left lungs. Nine patients(53%) had far-advanced pulmonary tuberculosis, two(12%) had a cavitary lesion, and seven(41%) had a pyopneumothorax on the chest radiograph. All eight cases in whom the data of pleural fluid WBC differential count was available showed polymorphonuclear leukocyte predominance. Eight patients(47%) had other bacterial infections as well. The overall rates of a positive sputum AFB smear and culture for M. tuberculosis were 71% and 64%, respectively. The positive AFB smear and culture rates for M. tuberculosis from the pleural fluid were 33% and 36%, respectively. Twelve of the 16 patients(75%) were treated successfully. Three underwent additional surgical intervention. Two patients (12%) died during treatment. CONCLUSION: Tuberculous empyema is frequently accompanied by advanced pulmonary lesions, and polymorphonuclear leukocytes are predominant in the pleural fluid. Other accompanying bacterial infections in the pleural cavity are also common in tuberculous empyema patients. Therefore, tuberculous empyema should be considered in differential diagnosis of patients with polymorphonuclear leukocyte-predominant pleural effusion. In addition, more active effort will be needed to achieve a bacteriological diagnosis in the pleural fluid.
Bacterial Infections ; Communicable Diseases ; Cough ; Diagnosis ; Diagnosis, Differential ; Drainage ; Dyspnea ; Empyema ; Empyema, Tuberculous* ; Fever ; Gyeongsangbuk-do ; Humans ; Korea ; Lung ; Medical Records ; Neutrophils ; Pleural Cavity ; Pleural Effusion ; Prevalence ; Radiography, Thoracic ; Sputum ; Treatment Outcome ; Tuberculosis ; Tuberculosis, Pleural ; Tuberculosis, Pulmonary

Malignant neoplasm associated with long-standing pleuritis or empyema is rare but a critical complication. Among 67 cases which were reported in English and Japanese literatures the cause of empyema was considered tobe tuberculosis in 51 cases. The most common malignant disease associated with the long-standing pleural disease was non-Hodgkin lymphoma (NHL), and the majority of the malignant lymphomas were B-cell type. Detection of the malignancy combined with an empyema is difficult, however, chest radiograph or CT may show the evidence of malignant pleural disease. We report a case of pathologically proven T-cell type malignant NHL associated with chronic tuberculous empyema in a 66-year-old male patient.
Aged ; Asian Continental Ancestry Group ; B-Lymphocytes ; Empyema ; Empyema, Tuberculous* ; Humans ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Male ; Pleural Diseases ; Pleurisy ; Radiography, Thoracic ; T-Lymphocytes* ; Tuberculosis

Malignant neoplasm associated with long-standing pleuritis or empyema is rare but a critical complication. Among 67 cases which were reported in English and Japanese literatures the cause of empyema was considered tobe tuberculosis in 51 cases. The most common malignant disease associated with the long-standing pleural disease was non-Hodgkin lymphoma (NHL), and the majority of the malignant lymphomas were B-cell type. Detection of the malignancy combined with an empyema is difficult, however, chest radiograph or CT may show the evidence of malignant pleural disease. We report a case of pathologically proven T-cell type malignant NHL associated with chronic tuberculous empyema in a 66-year-old male patient.
Aged ; Asian Continental Ancestry Group ; B-Lymphocytes ; Empyema ; Empyema, Tuberculous* ; Humans ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Male ; Pleural Diseases ; Pleurisy ; Radiography, Thoracic ; T-Lymphocytes* ; Tuberculosis

BACKGROUND: Medical thoracoscopy (MT) is a minimally invasive, endoscopic procedure for exploration of the pleural cavity under conscious sedation and local anesthesia. MT has been performed at the Seoul National University Hospital since February 2014. This paper summarizes the findings and outcomes of MT cases at this hospital. METHODS: Patients who had undergone MT were enrolled in the study. MT was performed by pulmonologists, using both rigid and semi-rigid thoracoscopes. During the procedure, patients were under conscious sedation with fentanyl and midazolam. Medical records were reviewed for clinical data. RESULTS: From February 2014 to January 2016, 50 procedures (47 cases) were performed (diagnostic MT, 26 cases; therapeutic MT, 24 cases). The median age of patients was 66 years (59–73 years), and 38 patients (80.9%) were male. The median procedure duration from initial incision to insertion of the chest tube was 37 minutes. The median doses of fentanyl and midazolam were 50 µg and 5 mg, respectively. All procedures were performed without unexpected events. Of the 26 cases of pleural disease with an unknown cause, 19 were successfully diagnosed using MT. Additionally, diagnostic MT provided clinically useful information in the other six patients. Therapeutic MT was very effective for treatment of malignant pleural effusion or empyema. The median number of days with chest tube drainage was 6 (3 days for diagnostic MT and 8 days for therapeutic MT). CONCLUSION: MT is a useful and necessary procedure for both diagnosis and treatment of pleural diseases.
Anesthesia, Local ; Chest Tubes ; Conscious Sedation ; Diagnosis ; Drainage ; Empyema ; Fentanyl ; Humans ; Male ; Medical Records ; Midazolam ; Pleural Cavity ; Pleural Diseases* ; Pleural Effusion, Malignant ; Seoul ; Thoracoscopes ; Thoracoscopy*

OBJECTIVE: To determine which computed tomography (CT) imaging features predict pleural malignancy in patients with advanced epithelial ovarian carcinoma (EOC) using video-assisted thoracic surgery (VATS), pathology, and cytology findings as the reference standard. METHODS: This retrospective study included 44 patients with International Federation of Obstetrics and Gynecology (FIGO) stage III or IV primary or recurrent EOC who had chest CT < or =30 days before VATS. Two radiologists independently reviewed the CT studies and recorded the presence and size of pleural effusions and of ascites; pleural nodules, thickening, enhancement, subdiaphragmatic tumour deposits and supradiaphragmatic, mediastinal, hilar, and retroperitoneal adenopathy; and peritoneal seeding. VATS, pathology, and cytology findings constituted the reference standard. RESULTS: In 26/44 (59%) patients, pleural biopsies were malignant. Only the size of left-sided pleural effusion (reader 1: rho=-0.39, p=0.01; reader 2: rho=-0.37, p=0.01) and presence of ascites (reader 1: rho=-0.33, p=0.03; reader 2: rho=-0.35, p=0.03) were significantly associated with solid pleural metastasis. Pleural fluid cytology was malignant in 26/35 (74%) patients. Only the presence (p=0.03 for both readers) and size (reader 1: rho=0.34, p=0.04; reader 2: rho=0.33, p=0.06) of right-sided pleural effusion were associated with malignant pleural effusion. Interobserver agreement was substantial (kappa=0.78) for effusion size and moderate (kappa=0.46) for presence of solid pleural disease. No other CT features were associated with malignancy at biopsy or cytology. CONCLUSION: In patients with advanced EOC, ascites and left-sided pleural effusion size were associated with solid pleural metastasis, while the presence and size of right-sided effusion were associated with malignant pleural effusion. No other CT features evaluated were associated with pleural malignancy.
Ascites ; Biopsy ; Gynecology ; Humans ; Neoplasm Metastasis ; Obstetrics ; Ovarian Neoplasms ; Pleural Diseases ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleural Neoplasms ; Retrospective Studies ; Seeds ; Thoracic Surgery, Video-Assisted ; Thorax

Pleural involvement in paragonimiasis is relatively common, either unilateral or bilateral, and may occur without pulmonary parenchymal infiltrates. Common radiologic findings of pleural paragonimiasis are pleural effusion, pneumothorax, hydropneumothorax, empyema and pleural thickening. However, pleural calcification as a manifestation of paragonimiasis is a rare condition. We report two cases of paragonimiasis manifested only as pleural calcifications which were confirmed pathologically.
Empyema ; Hydropneumothorax ; Paragonimiasis* ; Pleural Effusion ; Pneumothorax

BACKGROUND: The cell mediated immunity has an important role in the pathogenesis of tuberculosis. sIL-2R has been known as a sensitive marker of T lymphocyte activation. Elevated serum levels of sIL-2R have been found in patients with lymphoproliferative disorders, organ transplantation, autoimmune diseases, and various granulomatous diseases. Elevated levels of sIL-2R have been also found in the seam and pleural fluid of the patients with tuberculosis. To evaluate the diagnostic value of sIL-2R in the differentiation of tuberculous pleurisy and. nontuberculous pleurisy. We measured the level of sIL-2R in the sera and pleural fluids of 12 patients with tuberculous pleurisy and 32 patients with nontuberculous pleurisy. METHOD: Samples of pleural fluid and serum were centrifuged at 2500 rpm for 10 min to remove cell pellets. Soluble R-2R was measured with a sandwitch enzyme immunoassay using the Cellfree r Interleukin-2 Receptor Test kit( T-cell science, Inc. Cambridge, MA). RESULTS: The results obtained were as follows: 1) The sIL-2R level in pleural fluid of the patients with tuberculous pleurisy was higher than that of patients with nontuberculous pleurisy(P<0.005). 2) When the sIL-2R level above 5,000 u/ml in pleural fluid was used as the cut-off value to diagnose tuberculous pleurisy, it had a sensitivity of 84.6% and a specificity of 90.9%. 3) The sIL-2R level in the sera of the patients with tuberculous pleurisy was higher than that of patients with bacterial pleural effusions and normal control group(P<0.05) and there was no difference of levels compared with malignant pleural effusions and transudative pleural effusions(P>0.05). 4) In patients with tuberculous pleurisy, the mean concentration of sIL-2R in pleural fluid was higher than that in serum(P<0.005). CONCLUSION: These findings suggest that the measurement of elevated levels of pleural fluid sIL-2R in tuberculous pleurisy may be useful in the differential diagnosis between patients with tuberculous pleurisy and nontuberculous pleurisy.
Autoimmune Diseases ; Diagnosis, Differential ; Humans ; Immunity, Cellular ; Immunoenzyme Techniques ; Interleukin-2* ; Lymphocyte Activation ; Lymphoproliferative Disorders ; Organ Transplantation ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy* ; Sensitivity and Specificity ; T-Lymphocytes ; Transplants ; Tuberculosis ; Tuberculosis, Pleural*

Closed thoracostomy with UWSD* which is the most utilized procedure in chest surgery applies general thoracic disorders, trauma and after-thoracic surgery. The University hospital was involved on operating 2341 cases of closed thoracostomy with UWSD except chest tubing after-thoracic surgery for a full six years from January, 1991 to December, 1996. The rate of men and women out of the total 2341 cases was 3.5 : 1, the distribution by age showed that men were 36.6+/-21.0 years old, women were 47.0+/-20.2 years old and so that the total were 40.0+/-20.5 years old. As for indication, spontaneous, secondary and traumatic pneumothorax were the most common, in addition to hemothorax, hemopneumothorax, hydrothorax, hydropneumothorax, empyema, chylothorax. The most indwelling period of chest tubing is between eight and fourteen days for 974 cases and the average is 13.7+/-6.3 days, The average drainage amount immediately after thoracostomy was 537+/-88ml, and in 694 cases(46.0%), the drain amount was 201~500 ml. The rate of right and left tubing was 52.4 : 47.6, in 2071 cases(88.5%), the thoracostomy was the first chance and 2210 cases(94.4%) were treated with a single tube drainage. Almost all the patients complained of tube site pain, besides tube site infection, intercostal neuralgia, loss of tube function by the pleural adhesion, intrathoracic infection, incomplete reexpansion of defective lung, hemorrhage caused by the rupture of a blood vessel, subcutaneous emphysema, lung parenchymal rupture, diaphragmatic and intraabdominal trauma, reexpansionary pulmonary edema of one side lung and cellulitis were relapsed. 84.6% of all patients recovered with only closed thoracostomy and the rest of patient needed additional some necessary managements and so on to have successful results. There were two deaths(0.1%), caused by reexpansionary pulmonary edema, the cellulitis were complicated by thoracostomy with UWSD on an empyema patients to come to death(due to sepsis). * UWSD = under water seal drainage.
Blood Vessels ; Cellulitis ; Chylothorax ; Drainage ; Empyema ; Female ; Hemopneumothorax ; Hemorrhage ; Hemothorax ; Humans ; Hydropneumothorax ; Hydrothorax ; Lung ; Male ; Neuralgia ; Pneumothorax ; Pulmonary Edema ; Rupture ; Subcutaneous Emphysema ; Thoracostomy* ; Thorax