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

BACKGROUND: Thoracic empyema remains a serious problem despite the availability of modern diagnostic methods and appropriate antibiotics. The condition presents in many different forms and stages that require different therapeutic options. Video-assisted thoracic surgery (VATS) has become increasingly popular for use in the treatment of empyema. MATERIAL AND METHOD: From January 2005 to May 2009, VATS was performed in 36 patients with pleural empyema and for whom chest-tube drainage and antibiotic therapy had failed or the CT scan showed multiseptate disease. The perioperative clinical factors were analyzed for all the study patients. RESULT: All the patients underwent VATS, but it was necessary to convert to thoracotomy in one patient. The mean operation time was 90+/-38.5 min. For the operative evaluation, 11 patients were compatible with ATS stage III. The duration of chest-tube insertion was 11.9+/-5.8 (3~24) days. One patient did not improve and therefore this patient underwent additional open drainage. At discharge, costophrenic angle blunting was observed in 22 patients, pleural thickening was noted in 20 patients, both were noted in 17 patients and neither was noted in 11 patients. However, at follow-up, each of these changes was observed in 9, 7, 4 and 24 patients, respectively. All except one patient showed radiographic improvement. CONCLUSION: VATS is suitable for the treatment of early and fibrinopurulent thoracic empyema, and even in selected patients with stage III disease.
Anti-Bacterial Agents ; Drainage ; Empyema ; Empyema, Pleural ; Follow-Up Studies ; Humans ; Pleural Effusion ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy

Pancreaticopleural fistula (PPF) is a rare complication in patients with pancreatitis. Its symptoms are similar to those of empyema or pleural effusion; therefore, it is important to consider PPF in the differential diagnosis. Herein, we describe the diagnosis and treatment of PPF in a patient presenting with unusual empyema and delayed hemoptysis.
Diagnosis ; Diagnosis, Differential ; Empyema ; Fistula ; Hemoptysis ; Humans ; Magnetic Resonance Imaging ; Pancreatitis ; Pleural Diseases ; Pleural Effusion ; Thoracic Surgery, Video-Assisted ; Thoracoscopy

The characteristic features of Churg-Strauss syndrome are vasculitis, both intra- and extravascular granuloma formation with eosinophilic tissue infiltration, and strong association with asthma and peripheral eosinophilia. Churg-Strauss syndrome with pleural effusion is relatively common and only a few cases have previously been reported in Korea. We report a case of Churg-Strauss syndrome with pleural effusion confirmed by VATS.
Asthma ; Churg-Strauss Syndrome* ; Eosinophilia ; Eosinophils ; Granuloma ; Korea ; Pleural Effusion ; Thoracic Surgery, Video-Assisted ; Vasculitis

Schwannoma represents approximately 40% of neurogenic tumors arising in the mediastinum, and develops along the sympathetic or parasympathetic chain, intercostals nerve, and spinal ganglia. It is usually asymptomatic, and is confronted accidentally but can produce chest pain, cough and dyspnea. However, dyspnea with pleural effusion is rare in patients with benign schwannoma. We encountered two cases of benign schwannoma with pleural effusion. Both cases had similar initial symptoms and the characteristics of a mass but the characteristics of pleural effusion analysis were different. The benign schwannoma was confirmed in two cases using VATS (video-assisted tharawswpic surgery).
Chest Pain ; Cough ; Dyspnea ; Ganglia, Spinal ; Humans ; Mediastinum ; Neurilemmoma* ; Pleural Effusion* ; Thoracic Surgery, Video-Assisted

Video-assisted thoracic surgery (VATS) has developed very rapidly in these two decades, and has replaced conventional open thoracotomy as a standard procedure for some simple thoracic operations as well as an option or a complementary procedure for some other more complex operations. In this paper we will review its development history, the present status and the future perspectives.
Empyema ; surgery ; Esophageal Diseases ; surgery ; Esophagus ; pathology ; Humans ; Lung Neoplasms ; surgery ; Mediastinal Diseases ; surgery ; Pleural Effusion ; surgery ; Pneumothorax ; surgery ; Thoracic Surgery, Video-Assisted ; methods ; trends

The progression to minimally invasive techniques has been almost a natural evolution of the use of video-assisted thoracic surgery (VATS) from the investigation of pleural diseases, such as pneumothorax, and pleural effusion. Surgical resection is the primary treatment for early-stage non-small cell lung cancer (NSCLC). Minimally invasive thoracic surgery has been extensively used in the field of lung cancer. As the procedure has evolved and been studied, thoracoscopic lobectomy has been demonstrated to be a safe and oncologically effective strategy in the surgical management of patients with early stage NSCLC. VATS is a minimally invasive technique that has many advantages in postoperative pain and recovery time. Most surgeons perform VATS for lung cancer with three or more incisions. As the technique of VATS has evolved, single- or double-port VATS for lung cancer has been recently attempted and its advantages have been reported.
Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms* ; Lung* ; Pain, Postoperative ; Pleural Diseases ; Pleural Effusion ; Pneumothorax ; Thoracic Surgery* ; Thoracic Surgery, Video-Assisted

Atrial Fibrillation ; surgery ; Catheter Ablation ; adverse effects ; Female ; Humans ; Middle Aged ; Pleural Effusion ; pathology ; Postoperative Complications ; Pulmonary Veins ; surgery

It is very rare for an exocervical adenocarcinoma to metastasize to the lung parenchyma and pleura. A 54-year-old woman was admitted with dyspnea and left pleural effusion on chest X-ray. She had a history of exocervical adenocarcinoma 3 years previously and was treated with hysterectomy, chemotherapy, and radiation therapy. Last year, she was diagnosed with a left vestibular schwannoma and underwent subtotal mass removal surgery. After admission, metastatic adenocarcinoma of the pleura was diagnosed by video-assisted thoracic surgery biopsy. We herein report the rare case of exocervical adenocarcinoma that presented as a metastatic lesion to the pleura 3 years after the initial diagnosis.
Adenocarcinoma ; Biopsy ; Dyspnea ; Female ; Humans ; Hysterectomy ; Lung ; Middle Aged ; Neoplasm Metastasis ; Neuroma, Acoustic ; Pleura ; Pleural Effusion ; Pleural Neoplasms ; Recurrence ; Thoracic Surgery, Video-Assisted ; Thorax

Here, we report a case of pleural paragonimiasis that was confused with tuberculous pleurisy. A 38-year-old man complained of a mild febrile sensation and pleuritic chest pain. Radiologic findings showed right pleural effusion with pleural thickening and subpleural consolidation. Adenosine deaminase (ADA) activity in the pleural effusion was elevated (85.3 IU/L), whereas other examinations for tuberculosis were negative. At this time, the patient started empirical anti-tuberculous treatment. Despite 2 months of treatment, the pleural effusion persisted, and video-assisted thoracoscopic surgery was performed. Finally, the patient was diagnosed with pleural paragonimiasis based on the pathologic findings of chronic granulomatous inflammation containing Paragonimus eggs. This case suggested that pleural paragonimiasis should be considered when pleural effusion and elevated ADA levels are observed.
Adenosine Deaminase ; Adult ; Chest Pain ; Eggs ; Humans ; Inflammation ; Ovum ; Paragonimiasis* ; Paragonimus ; Pleural Effusion ; Sensation ; Thoracic Surgery, Video-Assisted ; Tuberculosis ; Tuberculosis, Pleural*