Contarini’s syndrome refers to the occurrence of bilateral pleural effusion which has different causes for each hemithorax. Based on extensive literature search, this is a rare finding and to date, only two published cases have recorded tuberculous effusion on one side. In this paper, the authors aim to present a case of Contarini’s syndrome, and to give emphasis that such condition with different etiologies exists and should be considered in managing bilateral effusion. This is a case of a 69-year-old female with a 7-week history of dyspnea, 2-pillow orthopnea, fever, and right-sided chest discomfort. Patient sought consultation and was prescribed with Diclofenac and Cefalexin with no relief. Patient was then admitted and intubated due to worsening dyspnea. Patient was managed as COVID-19 confirmed critical with viral myocarditis, CAP-HR, and diabetic ketoacidosis. Initial chest x-ray showed right-sided pleural effusion. Thoracentesis was done and revealed exudative pleural fluid (PF) with WBC of 20,000 with neutrophilic predominance and negative RT-PCR MTB. Cytology revealed acute inflammatory pattern. Klebsiella pneumoniae ESBL was isolated. Antibiotics were shifted to levofloxacin and meropenem. Repeat chest x-ray showed left-sided pleural effusion. Thoracentesis was done and revealed exudative PF with WBC of 1,680 with neutrophilic predominance. No organism was isolated. RT-PCR for MTB was detected. Thus, anti-TB therapy was initiated. However, ETA TB culture showed resistance to isoniazid, rifampicin, and pyrazinamide. Patient was referred to PMDT for MDR-TB treatment. Bilateral effusion has resolved with no recurrence, and with uneventful removal of bilateral chest tubes. Patient was eventually extubated and transferred to the ward. Patient however developed HAP, was re-intubated and eventually expired due to the septic shock from VAP. This case report highlights the importance of weighing risk versus benefit in deciding to perform bilateral thoracentesis when there is a clinical suspicion of an alternate or concurrent diagnosis.

Malignant pleural effusion (MPE) refers to the accumulation of pleural fluid caused by metastasis from primary pleural malignancies or tumors originating elsewhere. It is associated with a poor prognosis. Current treatment strategies primarily include systemic anti-tumor therapy and local management of MPE based on the primary tumor. Numerous studies have documented diverse approaches for the local control of MPE. This review summarizes recent advances in local treatment strategies for primary tumor-related MPE, highlighting emerging pharmacological agents and innovative techniques.
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Humans ; Pleural Effusion, Malignant/drug therapy*

: Contarini’s syndrome refers to the occurrence of bilateral pleural effusion which has different causes for each hemithorax. Based on extensive literature search, this is a rare finding and to date, only two published cases have recorded tuberculous effusion on one side. In this paper, the authors aim to present a case of Contarini’s syndrome, and to give emphasis that such condition with different etiologies exists and should be considered in managing bilateral effusion. : This is a case of a 69-year-old female with a 7-week history of dyspnea, 2-pillow orthopnea, fever, and right-sided chest discomfort. Patient sought consultation and was prescribed with Diclofenac and Cefalexin with no relief. Patient was then admitted and intubated due to worsening dyspnea. Patient was managed as COVID-19 confirmed critical with viral myocarditis, CAP-HR, and diabetic ketoacidosis. Initial chest x-ray showed right-sided pleural effusion. Thoracentesis was done and revealed exudative pleural fluid (PF) with WBC of 20,000 with neutrophilic predominance and negative RT-PCR MTB. Cytology revealed acute inflammatory pattern. Klebsiella pneumoniae ESBL was isolated. Antibiotics were shifted to levofloxacin and meropenem. Repeat chest x-ray showed left-sided pleural effusion. Thoracentesis was done and revealed exudative PF with WBC of 1,680 with neutrophilic predominance. No organism was isolated. RT-PCR for MTB was detected. Thus, anti-TB therapy was initiated. However, ETA TB culture showed resistance to isoniazid, rifampicin, and pyrazinamide. Patient was referred to PMDT for MDR-TB treatment. Bilateral effusion has resolved with no recurrence, and with uneventful removal of bilateral chest tubes. Patient was eventually extubated and transferred to the ward. Patient however developed HAP, was re-intubated and eventually expired due to the septic shock from VAP. This case report highlights the importance of weighing risk versus benefit in deciding to perform bilateral thoracentesis when there is a clinical suspicion of an alternate or concurrent diagnosis.
Pleural effusion ; Thoracentesis ; COVID-19

INTRODUCTION: Pleural infections are a significant cause of mortality. Intrapleural fibrinolytic therapy (IPFT) utilising alteplase and dornase is a treatment option for patients unsuitable for surgery. The optimal dose of alteplase is unknown, and factors affecting treatment success in an Asian population are unclear. We sought to determine the factors affecting treatment success in Tan Tock Seng Hospital, Singapore and evaluate the efficacy of lower doses of IPFT. METHOD: A retrospective analysis of patients with pleural infections treated with IPFT between July 2016 and November 2023 was performed. Treatment success was defined as survival without surgery at 3 months. Data, including patient demographics; comorbidities; RAPID (renal, age, purulence, infection source and dietary factor) scores; and radiological characteristics, were extracted from medical records and analysed. Linear mixed effects model and logistic regression were performed to determine factors affecting treatment success. RESULTS: A total of 131 cases were analysed. Of these, 51 (38.9%) reported positive pleural fluid culture, and the most common organism was Streptoccocus anginosus. Mean age was 65 years (standard deviation [SD] 15.5). Mean time from chest tube insertion to first dose of IPFT was 10.2 days (SD 11.5). Median starting dose of alteplase was 5 mg. Treatment success was reported in 112 cases (85.5%). There were no significant differences between the alteplase dose and radiological clearance. Patient age (odds ratio [OR] 0.94, confidence interval [CI] 0.89-0.98) and interval between chest tube insertion to first dose (OR 0.95, CI 0.91-0.99) were statistically significant variables for the treatment success. CONCLUSION Lower starting doses of alteplase remain effective in the treatment of pleural infection. Early IPFT may result in better outcomes.
Humans ; Tissue Plasminogen Activator/therapeutic use* ; Retrospective Studies ; Aged ; Fibrinolytic Agents/therapeutic use* ; Male ; Female ; Middle Aged ; Thrombolytic Therapy/methods* ; Treatment Outcome ; Singapore ; Pleural Effusion/drug therapy* ; Pleural Diseases/drug therapy* ; Cohort Studies ; Chest Tubes ; Deoxyribonuclease I ; Recombinant Proteins

BACKGROUND: A prognostic nutritional index (PNI) developed by nutritional status and inflammation are closely associated with poor prognosis in malignant tumors. However, the predictive impact of PNI in patients with malignant pleural effusion (MPE) remains inconclusive. The study aimed to determine the predictive value of PNI in prognosis and spontaneous pleurodesis among patients with MPE. METHODS: The patients diagnosed with advanced non-small cell lung cancer (NSCLC) with MPE in West China Hospital between January 2015 and December 2022 were reviewed and allocated randomly to development set(60%) and validation set(40%). After collecting clinical data, peripheral blood inflammation indices and calculating systemic inflammation indices, the effects of PNI on prognosis and spontaneous pleurodesis have been evaluated by Cox proportional hazards models, Kaplan-Meier method and Nelson-Aalen cumulative risk curve. RESULTS: In total, 261 patients diagnosed NSCLC with MPE were selected (development set: n=157; validation set: n=104), of whom 58.2% were aged <65 years, 53.6% were male and 95.8% were diagnosed with adenocarcinoma. The dichotomous cut-off value for PNI was 44.1, respectively. Compared with lower PNI (PNI<44.1) cases, patients with higher PNI (PNI≥44.1) showed significantly longer overall survival (36.5 vs 24.3 mon, P=0.02) and higher incidence of spontaneous pleurodesis (P=0.009). According to the multivariate Cox analysis, higher PNI was associated with good prognosis and successful spontaneous pleurodesis (P<0.05). According to the results of Cox regression analysis, the PNI-prognosis and PNI-spontaneous pleurodesis models are determined, the receiver operating characteristic (ROC) curves are drawn, and the area under the curves (AUC) value of development set are 0.694 (95%CI: 0.620-0.776) and 0.673 (95%CI: 0.590-0.737). CONCLUSIONS PNI is a reliable biomarker of prognosis and spontaneous pleurodesis in patients with MPE. Attention to the patient's nutritional status and inflammation may improve the prognosis and efficacy of pleural effusion.
Humans ; Male ; Female ; Middle Aged ; Carcinoma, Non-Small-Cell Lung/mortality* ; Lung Neoplasms/mortality* ; Aged ; Prognosis ; Pleurodesis ; Pleural Effusion, Malignant/mortality* ; Nutrition Assessment ; Adult ; Nutritional Status

OBJECTIVES: To investigate the risk factors for performing bronchoalveolar lavage (BAL) in children with Mycoplasma pneumoniae pneumonia (MPP) and pulmonary consolidation, and to construct a predictive model for performing BAL in these children. METHODS: A retrospective analysis was performed for the clinical data of 202 children with MPP who were hospitalized in the Department of Pediatrics, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, from August 2019 to September 2022. According to whether BAL was performed, they were divided into BAL group with 100 children and non-BAL group with 102 children. A multivariate logistic regression analysis was used to identify the risk factors for performing BAL in MPP children with pulmonary consolidation. Rstudio software (R4.2.3) was used to establish a predictive model for performing BAL, and the receiver operator characteristic (ROC) curve, C-index, and calibration curve were used to assess the predictive performance of the model. RESULTS: The multivariate logistic regression analysis demonstrated that the fever duration, C-reactive protein levels, D-dimer levels, and presence of pleural effusion were risk factors for performing BAL in MPP children with pulmonary consolidation (P<0.05). A nomogram predictive model was established based on the results of the multivariate logistic regression analysis. In the training set, this model had an area under the ROC curve of 0.915 (95%CI: 0.827-0.938), with a sensitivity of 0.826 and a specificity of 0.875, while in the validation set, it had an area under the ROC curve of 0.983 (95%CI: 0.912-0.996), with a sensitivity of 0.879 and a specificity of 1.000. The Bootstrap-corrected C-index was 0.952 (95%CI: 0.901-0.986), and the calibration curve demonstrated good consistency between the predicted probability of the model and the actual probability of occurrence. CONCLUSIONS The predictive model established in this study can be used to assess the likelihood of performing BAL in MPP children with pulmonary consolidation, based on factors such as fever duration, C-reactive protein levels, D-dimer levels, and the presence of pleural effusion. Additionally, the model demonstrates good predictive performance.
Child ; Humans ; Mycoplasma pneumoniae ; Retrospective Studies ; C-Reactive Protein/analysis* ; Pneumonia, Mycoplasma/diagnosis* ; Bronchoalveolar Lavage ; Pleural Effusion

Humans ; Mesothelioma/pathology* ; Mesothelioma, Malignant ; Pleural Neoplasms/diagnosis* ; Pleural Effusion, Malignant ; Pleural Effusion/pathology*

OBJECTIVES: To study the clinical characteristics of plastic bronchitis (PB) in children and investigate the the risk factors for recurrence of PB. METHODS: This was a retrospective analysis of medical data of children with PB who were hospitalized in Children's Hospital of Chongqing Medical University from January 2012 to July 2022. The children were divided into a single occurrence of PB group and a recurrent PB group and the risk factors for recurrence of PB were analyzed. RESULTS: A total of 107 children with PB were included, including 61 males (57.0%) and 46 females (43.0%), with a median age of 5.0 years, and 78 cases (72.9%) were over 3 years old. All the children had cough, 96 children (89.7%) had fever, with high fever in 90 children. Seventy-three children (68.2%) had shortness of breath, and 64 children (59.8%) had respiratory failure. Sixty-six children (61.7%) had atelectasis and 52 children (48.6%) had pleural effusion. Forty-seven children (43.9%) had Mycoplasma pneumoniae infection, 28 children (26.2%) had adenovirus infection, and 17 children (15.9%) had influenza virus infection. Seventy-one children (66.4%) had a single occurrence of PB, and 36 cases (33.6%) had recurrent occurrence of PB (≥2 times). Multivariate logistic regression analysis showed that involvement of ≥2 lung lobes (OR=3.376) under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts (OR=3.275), and concomitant multi-organ dysfunction outside the lungs (OR=2.906) were independent risk factors for recurrent occurrence of PB (P<0.05). CONCLUSIONS Children with pneumonia accompanied by persistent high fever, shortness of breath, respiratory failure, atelectasis or pleural effusion should be highly suspected with PB. Involvement of ≥2 lung lobes under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts, and concomitant multi-organ dysfunction outside the lungs may be risk factors for recurrent occurrence of PB.
Female ; Male ; Child ; Humans ; Child, Preschool ; Multiple Organ Failure ; Retrospective Studies ; Bronchitis/etiology* ; Dyspnea ; Pleural Effusion ; Pulmonary Atelectasis ; Plastics ; Respiratory Insufficiency

BACKGROUND: Thyroid function abnormality (TFA) is one of the common adverse reactions in patients with advanced non-small cell lung cancer (NSCLC) treated with immunotherapy, but the risk factors of TFA and its relationship with efficacy are not completely clear. The purpose of this study was to explore the risk factors of TFA and its relationship with efficacy in patients with advanced NSCLC after immunotherapy. METHODS: The general clinical data of 200 patients with advanced NSCLC in The First Affiliated Hospital of Zhengzhou University from July 1, 2019 to June 31, 2021 were collected and analyzed retrospectively. χ² test and multivariate Logistic regression were used to explore the risk factors of TFA. Kaplan-Meier curve was drawn and Log-rank test was used for comparison between groups. Univariate and multivariate Cox analysis was used to explore the efficacy factors. RESULTS: A total of 86 (43.0%) patients developed TFA. Logistic regression analysis showed that Eastern Cooperative Oncology Group Performance Status (ECOG PS), pleural effusion and lactic dehydrogenase (LDH) were factors influencing TFA (P<0.05). Compared with normal thyroid function group, the median progression-free survival (PFS) of patients in the TFA group was significantly longer (19.0 months vs 6.3 months, P<0.001), and the objective response rate (ORR) (65.1% vs 28.9%, P=0.020) and disease control rate (DCR) (100.0% vs 92.1%, P=0.020) of the TFA group were better than those of the normal thyroid function group. Cox regression analysis showed that ECOG PS, LDH, cytokeratin 19 fragment (CYFRA21-1) and TFA were factors influencing prognosis (P<0.05). CONCLUSIONS ECOG PS, pleural effusion and LDH may be risk factors affecting the occurrence of TFA and TFA may be a predictor of the efficacy of immunotherapy. Patients with advanced NSCLC who have TFA after immunotherapy may obtain better efficacy.
Humans ; Carcinoma, Non-Small-Cell Lung/therapy* ; Retrospective Studies ; Thyroid Gland ; Lung Neoplasms/therapy* ; Immunotherapy/adverse effects* ; Pleural Effusion

BACKGROUND: Malignant pleural effusion is one of the common clinical manifestations of patients with lung adenocarcinoma. Patients with pleural effusion at the initial diagnosis of lung adenocarcinoma usually indicate poor prognosis. Epidermal growth factor receptor (EGFR) mutations mainly occur in patients with lung adenocarcinoma. Patients with different mutant subtypes have different prognosis. The clinical characteristics and prognostic factors of patients with EGFR mutated lung adenocarcinoma of different molecular subtypes combined with pleural effusion at initial diagnosis are still unclear. This study was designed to explore the clinical characteristics and prognostic factors of these patients in order to provide management recommendations for them. METHODS: A retrospective analysis of the clinical characteristics, treatment, outcomes and progression-free survival (PFS) of first-line treatment in patients with EGFR mutated lung adenocarcinoma combined with pleural effusion at initial diagnosis admitted to Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital from January 2012 to June 2021 was performed. Pearson's chi-square test or Fisher's exact test were performed for comparison between groups. Kaplan-Meier method was performed for survival analysis and Cox proportional risk regression model was performed for multivariate analysis. RESULTS: 76 patients met the inclusion criteria in this study. The incidences of EGFR classical mutations 19del, 21L858R and non-classical mutations were 46.0%, 38.2% and 15.8%, respectively among these patients. There was no significant difference between the three mutations in terms of gender, age, presence of dyspnea at presentation, whether other distant metastases were combined, site of pleural effusion, volume of pleural effusion, presence of other combined effusions, tumor-node-metastasis (TNM) stage, presence of other gene mutations, and treatment of pleural effusion (P>0.05). In patients with EGFR classical mutations 19del or 21L858R or non-classical mutations subtype, the proportion of chemotherapy in first-line regimens were 17.1%, 20.7% and 58.3%, respectively (P=0.001); and first-line disease control rates were 94.3%, 75.9% and 50%, respectively (P=0.003); pleural effusion control rates were 94.3%, 79.3% and 66.7%, respectively (P=0.04); PFS were 287 d, 327 d and 55 d, respectively (P=0.001). Univariate analysis showed that EGFR mutation subtype, control of pleural effusion, first-line treatment agents, and first-line treatment efficacy were significantly associated with PFS (P<0.05). Cox multifactorial analysis showed that only EGFR mutation subtype and first-line treatment efficacy were independent prognostic factors for PFS (P<0.05). CONCLUSIONS PFS was significantly better for classical mutations than for non-classical mutations in patients with EGFR mutated lung adenocarcinoma combined with pleural effusion at initial diagnosis. Improving the efficacy of first-line therapy is the key to improve the prognosis of these patients.
Adenocarcinoma of Lung/genetics* ; ErbB Receptors/genetics* ; Humans ; Lung Neoplasms/pathology* ; Mutation ; Pleural Effusion/complications* ; Prognosis ; Retrospective Studies