Search Results (534)

Background: Thoracentesis is pivotal in managing pleural effusion (PE), particularly in invasive mechanical ventilation (IMV), with documented improvements in respiratory mechanics, oxygenation, and hemodynamic parameters. However, its efficacy may vary based on effusion type and drained volume. Methods: A retrospective longitudinal study was conducted at a high-complexity care center in Cali, Colombia (2019–2024), including 93 (IMV) patients who underwent therapeutic thoracentesis (TT). Respiratory and hemodynamic parameters were assessed before and up to 24 h post-procedure. Stratified analysis was performed by drained volume, fluid type, and left ventricular ejection fraction (LVEF). Results: TT yielded significant improvements in fraction of inspired oxygen (FiO₂) (−4%), positive end expiratory pressure (PEEP) (−0.5 cmH₂O), and Oxygen arterial Pressure Index/Inspired Oxygen Fraction (PaO₂/FiO₂-ratio) (+27.1), with greater impact for volumes ≥500 mL and transudative PE. Patients with LVEF ≤ 40% showed increased mean arterial pressure (MAP) and PaO₂. Complication rates were low (<4%). Conclusions: TT is safe and effective in critically ill IMV patients, particularly for transudative PE and drained volumes ≥500 mL, as well as in subjects with LVEF ≤ 40%. Its positive impact on oxygenation and ventilation supports its therapeutic utility in critical care. Full article

Background: Necrotizing pneumonia is a severe complication of Mycoplasma pneumoniae pneumonia (MPP) in children. Early recognition remains challenging because initial clinical manifestations are often non-specific, highlighting the need for a practical tool for early risk stratification. Methods: We conducted a single-center retrospective study of hospitalized children with MPP. Data from 2015–2023 were used for model development, and patients enrolled in 2024 were reserved for temporal validation. We compared candidate machine-learning algorithms and selected a parsimonious random forest model using routinely available variables obtained during the early hospitalization period. Model performance was evaluated using discrimination, calibration, and decision curve analysis, and model interpretability was assessed using SHapley Additive exPlanations (SHAP). Results: The random forest model showed good discriminatory performance in internal validation and retained acceptable performance in the 2024 temporal cohort. Calibration indicated reasonable agreement between predicted and observed risks. Decision curve analysis suggested potential clinical value as a supportive tool for early risk stratification. SHAP analysis highlighted fever duration, C-reactive protein, pleural effusion, alanine aminotransferase, and gamma-glutamyl transferase as the main contributors to model prediction. Conclusions: We developed and temporally validated a clinical prediction model for necrotizing pneumonia in children hospitalized with MPP. The model may support early risk stratification using routinely available clinical data, but it is intended to complement rather than replace clinical judgment. External prospective validation is required before routine clinical implementation. Full article

Background and Clinical Significance: Left atrial myxoma is the most common benign primary cardiac tumor and is associated with embolic and hemodynamic complications. Complete surgical excision is the treatment of choice, while postoperative cardiovascular rehabilitation is essential for functional recovery. Case Presentation: We report the case of a 75-year-old woman with arterial hypertension, dyslipidemia, and chronic venous insufficiency (Clinical–Etiological–Anatomical–Pathophysiological (CEAP) class 2), and chronic hepatitis B virus (HBV) infection who underwent surgical excision of a left atrial myxoma and was subsequently admitted three weeks postoperatively for phase II cardiovascular rehabilitation. The postoperative course was complicated by transient atrial fibrillation, peripheral edema, pleural effusion, and progressive purpuric lesions of the lower limbs. Laboratory and immunological evaluation revealed positive cryoglobulins, markedly elevated rheumatoid factor (1058 UI/mL) and IgM levels (715 mg/dL), reduced complement levels (C3, C4), normocytic normochromic anemia, microscopic hematuria, and elevated ALT (156 U/L), AST (142 U/L), total bilirubin (1.4 mg/dL), and INR (1.6), suggestive of hepatic inflammatory activity. HBV status was scheduled for evaluation through Gastroenterology referral (HBV DNA viral load, serological markers: HBsAg, HBeAg, anti-HBe), as our Cardiology Rehabilitation Clinic lacks the possibility of evaluation. After systematic exclusion of alternative etiologies, secondary cryoglobulinemic vasculitis in the context of chronic HBV infection with biochemical evidence of hepatic activity was considered the most plausible diagnosis. Conclusions: This case highlights the complexity of managing elderly patients after cardiac tumor surgery, particularly in the presence of systemic comorbidities. Early recognition of extracardiac complications and an individualized, multidisciplinary strategy are essential to optimize outcomes. Full article

Background/Objectives: AI-based tools for chest radiograph interpretation are increasingly used as decision-support systems, yet their performance must be validated in local clinical environments before deployment. This study evaluated the diagnostic performance of qXR (Qure.ai, v3.2) for detecting pulmonary nodules, cardiomegaly, and pleural effusion in adult patients at Hospital Clínica Bíblica, San José, Costa Rica. Methods: Three radiologists independently interpreted 225 chest radiographs, providing the reference standard. qXR outputs were compared against radiologist assessments for each finding. The sensitivity, specificity, Cohen’s kappa, and area under the ROC curve (AUC) were calculated. Due to the convenience-stratified sampling design, predictive values were not used for clinical interpretation. Results: For pulmonary nodules, qXR achieved a sensitivity of 0.71, specificity of 0.90, Cohen’s kappa of 0.51, and AUC of 0.80. For pleural effusion, sensitivity and specificity were both 0.86, with a kappa of 0.63 and AUC of 0.86. Cardiomegaly showed the lowest agreement, with a sensitivity of 0.64, specificity of 0.91, kappa of 0.57, and AUC of 0.77. Conclusions: qXR demonstrated moderate diagnostic agreement with radiologist assessments for pulmonary nodules and pleural effusion, and lower agreement for cardiomegaly under local imaging conditions. These results reflect technical concordance between the AI system and individual radiologists and do not constitute evidence of clinical utility or real-world impact. Context-specific validation is essential prior to integrating AI tools into routine radiological workflows. Full article

Background: Contrast-enhanced ultrasound (CEUS) recently emerged as a valuable imaging modality for evaluating pleuropulmonary diseases. By combining morphological information from conventional B-mode ultrasound with real-time assessment of microvascular perfusion, CEUS can provide functional insights that improve diagnostic accuracy, guide interventions, and support patient surveillance. Methods: This review summarizes the current evidence on the use of CEUS in major pleuropulmonary disorders, including pneumonia, pleural effusion, pulmonary embolism, neoplasms, and COVID-19-related lung injury. The most relevant clinical studies and meta-analyses were analyzed, focusing on CEUS parameters, diagnostic performance, and integration with other imaging techniques. Results: CEUS enables the differentiation between inflammatory, ischemic, and malignant lesions through qualitative and quantitative analyses of enhancement patterns. Early and homogeneous enhancement is typical of inflammatory or infectious processes, whereas heterogeneous or delayed enhancement with early washout strongly suggests malignancy or ischemia. In pneumonia and pleural infections, CEUS identifies non-perfused or necrotic areas, guiding drainage and evaluating therapeutic responses. In pulmonary embolism, it reveals avascular consolidations corresponding to infarction, even when CT angiography is inconclusive. For peripheral lung tumors, CEUS assesses angiogenesis and vascular supply, correlating perfusion parameters with histopathology, and improving biopsy targeting. Furthermore, in COVID-19 pneumonia, CEUS can detect microvascular alterations related to thrombosis and fibrosis. Conclusions: CEUS is a safe, noninvasive, and radiation-free technique that provides unique real-time information on pulmonary perfusion. Its integration with conventional ultrasound enhances diagnostic precision, optimizes interventional guidance, and allows for dynamic monitoring of treatment response. Future developments in quantitative analysis, artificial intelligence, and targeted contrast agents are expected to further expand CEUS clinical applications in pleuropulmonary imaging. Full article

Objective: This study aims to investigate the correlation between blood leukocyte, CRP, LDH, and cytokine levels and the severity of illness in children with adenovirus pneumonia. Methods: A total of 100 children with adenovirus pneumonia (55 mild cases and 45 severe cases) who were treated at Guangzhou Women and Children’s Medical Center from January 2022 to January 2024, and 40 healthy children as a control group, were selected. Clinical data, some laboratory test data, and serum cytokine levels detected by flow cytometry were collected, and statistical methods were used to analyze the correlation between relevant indicators and the severity of the illness. Results: The research showed that among general clinical manifestations, the proportions of children with fever, dyspnea, pleural effusion, and moist rales in the severe group were all higher than those in the mild group (p < 0.05). Among the collected laboratory test data, indicators such as WBC, neutrophils, and LDH were significantly higher than in the mild group and the control group (p < 0.05) and were positively correlated with the severity of the disease. Regarding the tested cytokines, most children with adenovirus pneumonia showed elevated levels, and cytokines such as IL-6, IL-2, and IL-8 were significantly positively correlated with the disease. In the ROC curve analysis, NEU 6.03 × 10⁹/L (sensitivity 82.2%, specificity 72.7%, AUC 0.830) and IL-6 41.823 pg/mL (sensitivity 75.6%, specificity 81.8%, AUC 0.833) demonstrated certain value in the early identification of children with severe disease. Conclusion: In this study, laboratory indicators (C-reactive protein, lactate dehydrogenase, neutrophils, etc.) and changes in the levels of specific cytokines (TNF-β, IL-2, IL-6, IL-8, etc.) in children with adenovirus pneumonia were closely related to the severity of the disease. Notably, neutrophil count and interleukin-6 were significantly positively correlated with disease severity and had high AUC values, suggesting they may be important parameters for early prediction of the progression of mild adenovirus infection to severe disease. Full article

Background: Malignant pleural effusion (MPE) represents a frequent and clinically challenging manifestation of advanced malignancy, particularly in metastatic non-small cell lung cancer (NSCLC). Its management requires integration of diagnostic imaging, symptom-directed therapeutic strategies, and, increasingly, molecular profiling technologies. Recent advancements in this field based on liquid medium (so-called liquid biopsy) have achieved a significant increase in sensitivity, enhancing our ability to investigate biofluids and suggesting their potential integration into standard diagnostic practices, far beyond the canonical plasma biopsies. Fluid obtained from MPE after cytological sample centrifugation is rich in cell-free DNA and less susceptible to nucleic acid degradation during processing, improving overall diagnostic accuracy. Methods: This narrative review summarizes current evidence on the clinical management of malignant pleural effusions in patients with metastatic NSCLC, integrating imaging, procedural management, and molecular profiling from a multidisciplinary tumor board perspective. The primary objective was to synthesize contemporary knowledge with particular attention to the feasibility, reliability, and reproducibility of pleural fluid-based molecular testing. Results: MPE poses diagnostic and therapeutic challenges for all members of the multidisciplinary tumor board, traditionally associated with an adverse prognosis. However, recent advances in cytopathology, histopathology, and liquid-based techniques demonstrate that MPE could be an important source of prognostic or predictive information. At the same time, optimal patient management requires careful integration of imaging findings and procedural strategies (such as pleurodesis or indwelling pleural catheters) with individualized systemic therapy selection. Cell-free DNA in pleural effusions is a promising field of exploration and study, potentially suitable for future guideline implementation, after validation in adequately powered studies, contributing to improving patient management, particularly useful in fragile subsets. Conclusions: The management of MPE in advanced NSCLC is evolving toward a multidisciplinary, precision-oriented model that integrates clinical evaluation, imaging, procedural interventions, and molecular testing. Liquid biopsy technology has gained enough analytical robustness and clinical feasibility to be a useful tool in routine analysis. Biofluid-based molecular testing may have outstanding potential, contributing to improving patient management, avoiding repetitive procedures, and optimizing the overall efficiency and cost-effectiveness of diagnostic practices. Moreover, collaborative projects among different specialties help in consolidating trust in the tumor board decision-making process. Full article

Background: This study aimed to evaluate the etiology, clinic and laboratory features of acute pancreatitis (AP) in children retrospectively. We also aimed to determine the effects of clinical, laboratory and radiological markers on length of hospital stay (LOS). Materials and methods: This study was conducted of 133 patients diagnosed with AP. Patients were divided into two groups based on LOS: ≤7 days and >7 days. Demographic, clinical, laboratory and radiological parameters, as well as time to initiation of feeding, were analyzed. Results: The mean age of patients was 11.2 ± 4.8 years, and 54.1% were male. The most common etiologies were obstructive (30.8%) and idiopathic (29.3%). Drug-induced and traumatic causes were significantly more prevalent in patients with a hospital stay of more than seven days (p = 0.001). Radiological findings other than pancreatic edema (peripancreatic fluid, pleural effusion, or ascites) were significantly associated with prolonged LOS (p = 0.002). A positive correlation was observed between LDH and LOS (r = 0.253, p = 0.031). LOS was significantly shorter in patients who initiated oral feeding within 48 h (p < 0.001). Conclusions: LOS in pediatric AP is influenced by laboratory parameters, radiological findings, and the timing of feeding initiation. Identifying early prognostic indicators, particularly in the pediatric patient group, may guide individualized management and improve clinical outcomes. Full article

Delayed effects of acute radiation exposure (DEARE), including radiation pneumonitis (lung-DEARE), develop weeks to months after radiation exposure. Pathway-targeted biomarkers that capture early oxidative stress and cell death could improve risk stratification and provide objective measures of mitigator efficacy. The objective was to test whether molecular lung imaging predicts long-term survival and mitigator response after irradiation. Rats received 13.5 Gy leg-out partial-body irradiation with a subset treated with the radiation-injury mitigator lisinopril. Rats underwent lung imaging at weeks 2 and 4 post-irradiation with ^99mTc-duramycin (cell death) and ^99mTc-HMPAO (oxidative stress). Plasma mitochondrial damage-associated molecular patterns (mtDAMPs) were also measured. Irradiation reduced survival with animals evidencing significant pleural effusion as an indication of radiation pneumonitis, which was mitigated with lisinopril as previously shown. Lung uptake of both imaging biomarkers increased in irradiated rats between weeks 2 and 4, consistent with worsening cell death and oxidative stress. Rats that succumbed by day 120 exhibited significantly larger increases in both biomarkers than the survivors. A predictive test was developed that predicted death by day 120 with ~70% sensitivity and specificity. Plasma mtDAMPs (ND1/2 and ATPase 6/8) increased following irradiation, and the D-loop increase from week 2 to 3 separated outcomes (increase in nonsurvivors versus decrease in survivors). Both imaging and mtDAMPs data from lisinopril-treated animals showed blunted responses. Early dual-tracer molecular lung imaging predicted long-term survival after radiation exposure and tracked mitigation with lisinopril. Circulating mtDAMPs may provide complementary systemic information to further strengthen early risk stratification after radiation exposure. Full article

Background: Pancreaticopleural fistula is a rare complication of chronic pancreatitis resulting from pancreatic duct disruption, typically presenting with pleural effusion and predominant respiratory symptoms. Bilateral pleural involvement is exceptionally uncommon and poses significant diagnostic and therapeutic challenges. Case Presentation: A 56-year-old man with a history of chronic alcohol abuse presented with progressive dyspnea and mild epigastric pain. Imaging revealed bilateral pleural effusions, an atrophic pancreas with a markedly dilated main pancreatic duct containing calculi, and a fistulous tract extending from the pancreatic body through the esophageal hiatus into the mediastinum. Magnetic resonance cholangiopancreatography confirmed the diagnosis of chronic calculous pancreatitis complicated by a pancreaticopleural fistula. After unsuccessful conservative management, the patient underwent distal pancreatectomy, resection of the fistulous tract, and Roux-en-Y pancreatojejunostomy. The postoperative course was uneventful, with complete resolution of pleural effusions and sustained clinical improvement. Conclusions: This case highlights the importance of considering pancreaticopleural fistula in patients with unexplained pleural effusions and minimal abdominal symptoms, particularly in the context of chronic pancreatitis. Bilateral involvement, although rare, should not preclude timely diagnosis. Appropriate diagnostic studies by computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography are crucial for establishing the diagnosis. Surgical management offers definitive treatment in patients with ductal obstruction and calculous disease, resulting in excellent long- term outcomes. Full article

Background/Objectives: The COVID-19 pandemic complicated the diagnosis of Ventilator-Associated Pneumonia (VAP), leading to empiric antibiotic overuse due to the difficulty in distinguishing viral progression from bacterial superinfection. However, it remains unclear whether COVID-19-associated VAP displays a distinct antimicrobial resistance profile compared to classical VAP. Methods: This monocentric, retrospective cohort study primarily investigated differences in clinical phenotypes and antibiotic resistance profiles between patients with VAP-COVID (n = 26) and non-COVID-VAP (n = 26). Logistic regression was used to identify factors associated with the COVID-19 phenotype and predictors of antimicrobial resistance. As a secondary objective, we evaluated the diagnostic efficacy of a multiplex Point-of-Care PCR (POC-PCR) system (n = 22) compared to standard culture (n = 26) regarding turnaround time and resistance detection. Results: Patients with VAP-COVID exhibited significantly higher resistance rates to carbapenems (76.9% vs. 50%, p = 0.04) and fluoroquinolones (88.5% vs. 61.5%, p = 0.02) despite fewer traditional risk factors at admission. The clinical profile of the VAP-COVID group was distinguished by a significantly lower incidence of parapneumonic pleural effusion (19.2% vs. 84.6%, p < 0.001) and a higher median Neutrophil-to-Lymphocyte Ratio (41.36 vs. 9.63, p < 0.001). Regarding diagnostic speed, POC-PCR significantly reduced the time to result validation compared to standard culture (~1 h vs. ~62.5 h, p < 0.001). Conclusions: VAP in COVID-19 patients presents a distinct microbiological profile characterized by higher antimicrobial resistance. In this context, the integration of rapid molecular diagnostics may support earlier microbiological guidance compared to standard methods. Full article

Urinothorax, the presence of urine in the pleural space, is an exceptionally rare cause of pleural effusion, with fewer than 100 cases described in the literature. It most often follows trauma or urological procedures, though obstructive uropathy is also a recognized mechanism. We report an 83-year-old man with chronic kidney disease and benign prostatic hyperplasia who presented with acute dyspnea and a massive right-sided pleural effusion. Thoracentesis yielded clear yellow fluid with an ammonia-like odor, while imaging revealed chronic bladder outlet obstruction with bilateral hydroureteronephrosis. Despite inconclusive scintigraphy, the effusion resolved completely after urinary decompression with Foley catheterization, confirming the diagnosis. This case underscores the diagnostic challenges of urinothorax, which may be overlooked due to its rarity and variable biochemical profile, and highlights the importance of correlating clinical, radiologic, and pleural fluid findings. Early recognition is crucial, as timely relief of urinary obstruction provides both definitive diagnosis and curative treatment. Full article

Primary effusion-based lymphomas are uncommon and may pose significant diagnostic challenges. Fluid overload-associated large B-cell lymphoma is a recently recognized entity in the 5th edition of the World Health Organization Classification of Hematolymphoid Tumors and should be included in the differential diagnosis of effusion-based lymphomas, particularly in elderly immunocompetent patients with conditions that predispose to fluid overload. Background and Clinical Significance: We report a case of fluid overload-associated large B-cell lymphoma to add to the limited literature and highlight distinguishing features from other primary effusion lymphomas. Case Presentation: A 77-year-old male with end-stage renal disease on hemodialysis and heart failure with reduced ejection fraction was admitted for respiratory failure and found to have a right-sided pleural effusion. Two pleural fluid specimens examined several weeks apart revealed sheets of large atypical lymphoid cells positive for CD20, Pax-5, CD79a, CD45, MUM1, BCL2, BCL6 (weak) and negative for TTF1, CD68, MOC31, BER EP4, WT1, Calretinin, CD3, CD138, CD30, and cMYC. Human Herpesvirus-8 and Epstein–Barr virus were negative. Staging showed a few mildly fluorodeoxyglucose-avid mediastinal lymph nodes which were benign. Ultimately, the patient was diagnosed with fluid overload-associated large B-cell lymphoma and treated with rituximab, cyclophosphamide, vincristine sulfate, and prednisone, but passed away three months after diagnosis. Conclusions: Fluid overload-associated large B-cell lymphoma is a new and important diagnostic consideration in effusion-based lymphomas. It may be mistaken for other conditions such as primary effusion lymphoma or other diffuse large B-cell lymphomas. The presence of a Human Herpesvirus-8-negative effusion-based lymphoma in an elderly immunocompetent patient without nodal or tissue involvement should prompt consideration of fluid overload-associated large B-cell lymphoma. Full article

Background: Thoracoamniotic shunting (TAS) is a well-established fetal therapy for severe pleural effusions complicated by hydrops. Although survival in selected cases exceeds 60%, retained or migrated shunts can pose significant postnatal management challenges. Case presentation: We report a neonate with intrathoracic migration of a Somatex^® shunt placed at 26 weeks’ gestation for hydropic pleural effusion. Although initially asymptomatic, the infant developed recurrent pleural effusions requiring multiple readmissions. Thoracoscopic retrieval on day 76 of life allowed safe removal despite dense adhesions, leading to complete clinical resolution. Discussion: Retained thoracoamniotic shunts may remain asymptomatic or cause recurrent effusions, pneumothorax, or other complications. This case highlights the limitations of conservative management in the presence of clinical deterioration and supports timely surgical removal. Standardized criteria for intervention are lacking and urgently needed. Conclusions: In infants with retained TAS, recurrence of effusions or respiratory compromise should prompt active removal. Thoracoscopic retrieval is a safe and effective minimally invasive option. Full article

Background and Clinical Significance: Mantle cell lymphoma (MCL) frequently involves bone marrow, gastrointestinal tract, and hepatosplenomegaly, whereas pleural effusions are uncommon. Cases requiring invasive mechanical ventilation and thoracic drainage are rare. We report a case of MCL with persistent massive pleural effusions requiring invasive mechanical ventilation and bilateral continuous thoracic drainage. Case Presentation: A 71-year-old woman presented with dyspnea and was found to have bilateral pleural effusions and generalized lymphadenopathy. Shortly after admission, she developed acute respiratory failure due to pleural effusions and required invasive mechanical ventilation. Right-sided continuous thoracic drainage was initiated. Thereafter, more than 1 L of pleural fluid was drained each day. Flow cytometry of the pleural fluid showed CD5-positive B cells with kappa light-chain restriction. Bone marrow examination revealed abnormal lymphocyte infiltration. Cervical lymph node biopsy demonstrated diffuse proliferation of medium-sized, abnormal B lymphocytes with an immunophenotype of CD5⁺, CD19⁺, CD20⁺, cyclin D1⁺, SOX11⁺, and κ⁺, with a Ki-67 index of 20%, confirming MCL, stage IV. Immunochemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) was commenced under mechanical ventilation. Shortly thereafter, left-sided continuous thoracic drainage was also initiated. However, in response to immunochemotherapy, the bilateral pleural effusions gradually subsided, enabling extubation, and there was no reaccumulation after removal of both chest tubes. Furthermore, generalized lymphadenopathy regressed, and bone marrow examination revealed resolution of lymphoma infiltration, resulting in complete remission. Conclusions: De novo MCL complicated by persistent massive pleural effusions requiring invasive mechanical ventilation and bilateral continuous thoracic drainage is rare. A thorough diagnostic workup followed by prompt initiation of immunochemotherapy can arrest pleural output, enable extubation, and be lifesaving. Clinicians should recognize that MCL rarely presents with persistent massive pleural effusions. Full article