Sunday, 24 November 2013

Pleural effusion – Diseases associated to Pleural effusion

The pleura is a thin tissue covered by a layer of cells (mesothelial cells) that surrounds the lungs and lines the inside of the chest wall.
B. Pleural effusion
It is a condition of collection of fluid within the pleural cavity as a result of heart failure, bleeding (hemothorax), infections, excessive or decreased fluid volume, etc.
B.3.2. Diseases associated to Pleural effusion
1. Polymyalgia rheumatica
Polymyalgia rheumatica is an inflammatory rheumatic disease that presents with bilateral pain and stiffness affecting mainly proximal muscles. According to the study by Hospital Infanta Elena, there is a report of a case of an 80 years old patient presenting polymyalgia rheumatica coinciding with pleuropericardial effusion. The patient had a very good response to treatment with rapid improvement in the symptomatology and laboratory findings. Polymyalgia Rheumatica is a common disease but it is rarely associated to pleuropericardial effusion(40).
2. Bilateral Ovarian Fibrothecoma
There is a report of a black African woman of 35 years old, seventh gravida and fourth parous, undergone a total abdominal hysterectomy with bilateral salpingoophorectomy for large bilateral ovarian masses associated with significant ascites, bilateral pleural effusion, and particular highly elevated tumor marker CA-125 (1835 UI/mL) in a pronounced general alteration condition(41).
3. Liver cirrhosis
Hepatic hydrothorax is the paradigmatic pleural effusion in liver cirrhosis.The estimated prevalence of this complication in patients with liver cirrhosis is 5 to 6%. Its pathophysiology involves movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects, according to the study by Hospital Universitari de Bellvitge(42).
4. Cardiac failure
In the study to compare the diagnostic utility of pleural fluid N-terminal pro-B-type natriuretic peptide (NT-proBNP), mid-region pro-atrial natriuretic peptide (MR-proANP) and mid-region pro-adrenomedullin (MR-proADM) for discriminating heart failure (HF)-associated effusions, found that
both NT-proBNP and the albumin gradient correctly identified more than 80% of those cardiac effusions misclassified as exudates by standard criteria(43).
5. Kidney failure
Acute kidney failure is associated to 5.1% of pleural effusion, according to the study by t
he University of The West Indies(44).
6. Autoimmune hypothyroidism (AIH)
there is areport of a case of AIH presented with massive proteinuria, haematuria, pleural fluid and arthritis simulating SLE(45).
7. Lung cancer
Pleural effusions are common in the setting of lung cancer. In the symptomatic patient with a reasonable life expectancy and pleural fluid pH of more than 7.3, chemical pleurodesis appears to be the most effective and least morbid therapy(46).
8. Tuberculosis (TB)
In a prospective study of 118 patients with pleural effusion, tuberculosis (TB) diagnosed in 112. In 84 patients the diagnosis of TB was made by detection of acid-fast bacilli by stain (auramine, Ziehl-Neelsen) or by culture of mycobacteria (Löwenstein-Jensen medium) in pleural fluid or pleural tissue (obtained by closed biopsy) or by the presence of caseating granulomas in histological sections(47).
9. Other diseases associated to Pleural effusion
According to the study by Zavod za klinicku imunologiju i reumatologiju Klinike za unutarnje bolesti Medicinskog fakulteta Sveucilista u Zagrebu, the most common conditions associated with eosinophilic pleural effusion (EPE) are malignancy, infections, post-traumatic and post-surgical conditions, hypersensitivity, systemic autoimmune diseases, congestive heart failure, cirrhosis, pulmonary embolus, asbestosis and drug induced EPE. Pleural effusion accompanying autoimmune diseases is most common in patients with systemic lupus erythematosus, rheumatoid arthritis, howewer it rarely occurs in patients with progressive systemic sclerosis and polymiositis. EPE has rarely been reported in association with Churg Strauss syndrome(48).
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