Eosinophilic pleural effusion

Eosinophilic pleural effusion accounts for 5 to 10% of all clear liquid pleurisies. Its pathogenic significance is unclear and its relation to the causative diagnosis of pleural eosinophilia is diversely evaluated. In this study, 86 cases of eosinophilic pleural effusion observed at the Ariana Pneumophthisiology Hospital over a 5-year period are reviewed. At first aspiration, the proportion of pleural fluid eosinophils varied from 12% to 85% (54% on average). Blood eosinophilia was present in 60% of the patients. The main cause of effusion was tuberculosis (39.6%, but many other diseases were observed; despite numerous investigations, no cause could be found in 23.2% of the cases. The discovery of a pleural eosinophilia has an impact on the probable cause of the pleurisy, and this can be determined by applying Bayes' rule. The probability of tuberculous being the cause falls from 70.3% for clear liquid pleurisies generally to 44.6% for eosinophilic pleurisy. The probability of cancer as a cause falls from 4.5% to 0.66%; whereas that of "idiopathic" pleurisy rises from 13.5% to 59.56%. These findings are concordant with Adelman's conclusions. In other words, the finding of a pleural eosinophilia decreases the probability of tuberculous or malignant pleural effusion and increases the probability of benign or "idiopathic" effusion. Clinicians confronted with an eosinophilic pleural effusion should be particularly careful and accurate since this diagnosis may spare the patient an unnecessary exploratory thoracotomy and an unwarranted antituberculous treatment.     

Eosinophilic pleural effusion by dirofilariasis]

A 44-year-old man visited our hospital because of right chest pain. Pleural effusion in the right lung was detected on a chest radiograph. A chest CT scan demonstrated no abnormal lesions in either lung field, but passive atelectasis due to the pleural effusion was present. Since many eosinophils were found in the exudative pleural effusion, a parasitic infection was suspected. An enzyme-linked immunosorbent assay test led to a diagnosis of eosinophilic pleural effusion by dirofilariasis. Pleural effusion disappeared spontaneously and the level of anti-Dirofilaria immitis antibody decreased. Continued careful observation is necessary in such cases.     

Eosinophilic pleural effusion complicating allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is primarily a disease of patients with cystic fibrosis or asthma, who typically present with bronchial obstruction, fever, malaise, and expectoration of mucus plugs. We report a case of a young man with a history of asthma who presented with cough, left-sided pleuritic chest pain and was found to have lobar atelectasis and an eosinophilic, empyematous pleural effusion. Bronchoscopy and sputum cultures grew Aspergillus fumigatus, and testing confirmed strong allergic response to this mold, all consistent with a diagnosis of ABPA. This novel and unique presentation of ABPA expands on the differential diagnosis of eosinophilic pleural effusions.     

Eosinophilic pleural effusion associated with dantrolene administration]

A 42-year old man was admitted to our hospital for evaluation of pleural effusion in the right hemithorax. He had been treated for spastic paraplegia with dantrolene sodium for 28 months. The pleural fluid consisted of sterile exudates with a very high eosinophil count, and peripheral blood eosinophilia was noted. Thoracoscopy revealed no apparent abnormalities and a pleural biopsy specimen showed only non-specific inflammation. Two weeks after discontinuing dantrolene therapy, the pleural effusion disappeared. The toxicity of dantrolene in patients with pleural effusion must be taken into consideration when long-term dantrolene therapy is given.     

Eosinophilic pleural effusion related to taking valproic acid

Eosinophilic pleural effusions have multiple aetiologies. We report on the case of a 40-year-old man who experienced an eosinophilic pleural effusion with blood hypereosinophilia that occurred nine weeks after a treatment with valproic acid was introduced. Usual aetiologies of eosinophilic pleural effusion were excluded. Once valproic acid was discontinued, both pleural effusion and blood eosinophilia decreased rapidly. The persistence of a residual pleural effusion required the introduction of oral corticosteroids, which resulted in the effusion disappearing completely and rapidly. Valproic acid is a rare cause of eosinophilic pleural effusion. The effusion usually regresses when treatment is discontinued but short-term oral corticotherapy may be necessary in order to heal the patient.     

Eosinophilic pleural effusion associated to Churg and Strauss syndrome

Eosinophilic pleural effusion (EPE) is defined as pleural eosinophilia greater than 10%. EPE can be seen in almost all conditions that can cause pleural effusion, but some aetiologies have to be investigated due to their frequency or potential severity. The most common aetiology of EPE is the presence of air or blood in the pleural cavity. Other frequent aetiologies include bacterial pneumonia, tuberculosis, parasitic disease and certain drugs. Although often considered to be a sign of a benign condition, pleural eosinophilia may be associated with malignancies. EPE may also indicate the presence of Churg and Strauss syndrome. We report the case of a 27-year-old man, in whom the exploration of EPE led to the diagnosis of Churg and Strauss syndrome with the association of asthma, blood and alveolar eosinophilia, myopericarditis and positive antineutrophil cytoplasmic antibodies (ANCA). This case report enables us to discuss the different causes of EPE and to illustrate how it may be a manifestation of Churg and Strauss syndrome.     

Eosinophilic pleural effusion: a review of 36 cases

36 cases of eosinophilic pleural effusion (EPE) are reviewed. The etiologies were: traumatic 25%, congestive heart failure (CHF) 14%, infectious 8.5%, idiopathic 8.5% and miscellaneous 11%. 33% (12 patients) had a tumoral etiology, yet in only 1 patient could all additional etiologies for EPE be ruled out. Hence, the conclusion is that EPE is rarely caused by a tumoral etiology, and that other etiologies should be considered. The comparison of pleural fluid and peripheral blood findings disclosed no significant difference among the various subgroups.     

Eosinophilic pleural effusion after gastric variceal obliteration with cyanoacrylate

Pleuropulmonary complications after endoscopic injection sclerotherapy for treatment of esophagogastric varices are not uncommon but are usually mild and self-limited. Herein we report a male patient with liver cirrhosis who underwent endoscopic injection sclerotherapy, using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil for obliteration of gastric varices. After the procedure, he developed moderate amount of left pleural effusion that persisted for a period of time and required thoracentesis and medical treatment. We believed that the inadvertent retrograde reflux of the embolized glue and ethiodized oil via the portosystemic venous collateral into the left pleura might be the possible mechanism for the development of left pleural effusion as the droplets of ethiodized oil were seen along the left pleura on the imaging studies.     

Multidrug-resistant tuberculosis at Srinagarind Hospital,Khon Kaen,Thailand

Pulmonary tuberculosis is a very common infectious disease in Thailand. Multidrug-resistant tuberculosis (MDR-TB) is the most serious form of the disease. Failure to control resistant tuberculosis is associated with its resurgence. The objective of this study was to analyze the drug susceptibility pattern of M. tuberculosis and to study the clinical characteristics and outcome of patients diagnosed with MDR-TB at Srinagarind Hospital. Between January 1995 and December 2000, 899 isolates of M. tuberculosis were recovered. Rifampicin (RIF) resistance was the most common finding (8.2%). Twenty-two patients (2.4%) were infected with MDR-TB. Other susceptibility results showed resistance to isoniazid (INH) (4.2%), ethambutol (EMB) (4.3%), streptomycin (SM) (3.7%), kanamycin (Kana) (3.0%), and ofloxacin (Oflox) (2.3%). Twenty MDR-TB patients were retrospectively reviewed. The mean age was 37 years (range: 17 to 64). The male to female ratio was 3:1. The mean duration of symptoms before treatment was 3.8 months (range: 3 days to 2 years). The commonest comorbidity was HIV-infection (7 patients). Eleven patients (55%) had a past history of treatment with anti-TB drugs. In addition to INH and RIF resistance, many organism also resisted EMB (35%), SM (30%), Oflox (30%), and Kana (10%). Only five patients (25%) responded to medical treatment. Seven patients (35%) died, and the other eight were unavailable for an evaluation of clinical outcome. Although the prevalence of MDR-TB was not high in Srinagarind Hospital, the treatment was costly and the outcomes were poor. Preventing new cases of MDR-TB by using effective treatment strategies for patients with drug-sensitive TB is a priority.     

恶性胸膜间皮瘤致嗜酸细胞性胸腔积液1例报告并文献复习

目的提高对嗜酸细胞性胸腔积液的认识。方法对一例由恶性胸膜间皮瘤所致嗜酸细胞性胸腔积液的临床资料进行分析,并结合文献复习。结果嗜酸细胞性胸腔积液首次报道于1984年,其病因很复杂,由肿瘤引起的并不多见,机理也不十分清楚,大多预后良好。结论虽然嗜酸细胞性胸腔积液的病因大多数是良性的,但我们不能忽略恶性的情况,应尽可能查找原因,以免贻误病情。     

Eosinophilic pleural effusions

Eosinophilic pleural effusions, defined as a pleural effusion that contains at least 10% eosinophils, may be caused by almost every condition that can cause pleural disease. Eosinophilic pleural effusion occurs most commonly during conditions associated with the presence of blood or air in the pleural space, infections, and malignancy. Drug-induced pleural effusions, pleural effusions accompanying pulmonary embolism, and benign asbestos pleural effusions are also among the common causes of eosinophilic pleural effusion. No etiology is found in as many as one third of patients. Because studies evaluating different diagnostic approaches with eosinophilic pleural effusions are lacking, the authors suggest that certain noninvasive and invasive diagnostic tools must be used based on the patient's clinical characteristics.     

2010年英国胸科学会成人单侧胸腔积液诊断指南解读

目前已知胸腔积液病因有50余种,其中包括局限于胸膜或原发于肺部的疾病、系统性疾病、脏器功能异常和药物诱发的胸腔积液等.胸腔积液的发病机制为胸腔内液体生成增多和(或)胸腔内液体吸收减少,其病理生理改变随基础病因不同而有所不同,由于单侧胸腔积液病因多种多样,故系统性诊断非常必要,应该在尽可能减少不必要的侵袭性操作的基础上尽快明确诊断.