• Tuberculosis and Respiratory Diseases
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• v.53 no.5
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• pp.530-541
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• 2002

Background : Pleural fluid adenosine deaminase (ADA) activity can be helpful in a differntial diagnosis of an exudative pleural effusion because it is increased in a tuberculous pleural effusion. The ADA activity is determined mainly by the lymphocyte function. Age-associated immune decline is characterized by a decrease in T-lymphocyte function. For that reason, the pleural fluid ADA level would be lower in older patients with exudative pleural effusion. This study focused on the influence of age on the pleural fluid ADA activity in patients with exudative pleural effusion. Methods : A total of 81 patients with exudative pleural effusion were enrolled in this study. In all patients, the pleural fluid ADA activity was measured using an automated kinetic method. Results : The mean age of the patients was $52.7{\pm}21.2$ years. In all patients with exudative pleural effusion, the pleural fluid ADA activity revealed a significant difference between young patients (under 65 years of age) and old patients (p<0.05), and showed a negative correlation with age (r=-0.325, p<0.05). In the 60 patients with a tuberculous pleural effusion, the pleural fluid ADA activity revealed a significant difference between the young and older patients : $103.5{\pm}36.9$ IU/L in young patients Vs. $72.2{\pm}31.6$ IU/L in old patients (p<0.05), and showed a negative correlation with age (r=-0.384, p<0.05). In the 21 patients with non-tuberculous exudative pleural effusion, the pleural fluid ADA activity of the young patients and old patients was similar : $23.7{\pm}15.3$ IU/L in young patients Vs. $16.1{\pm}10.2$ IU/L in old patients (p>0.05), and did not show any correlation with age (r=-0.263, p>0.05). The diagnostic cutoff value of pleural fluid ADA activity for tuberculous pleural effusion was lower in the older patients (25.9 IU/L) than in the younger patients (49.1 IU/L) or all patients (38.4 IU/L) with exudative pleural effusion. Conclusion : Tuberculous pleural effusion is an important possibility to consider in older patients with a clinical suspicion of a tuberculous pleural effusion, although no marked increase in the pleural fluid ADA activity is usually detected. For a diagnosis of a tuberculous pleural effusion in old patients, the cutoff for the pleural fluid ADA activity should be set lower.

• Tuberculosis and Respiratory Diseases
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• v.54 no.5
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• pp.563-569
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• 2003

Background : Pleural effusions with high amylase levels are reported frequently in patients with pancreatic diseases, a rupture of the esophagus and a malignancy. However, there is no data available on the clinical features of an amylase-rich pleural effusion in Korea. This report describes the causes of the high amylase levels in a pleural effusion and analyzes its association with malignancy. Methods : The records of patients with an amylase-rich pleural effusion who were assessed at the Gyeongsang National University Hospital from January 1998 to August 2002 were examined retrospectively, and the distribution of amylase levels in those patients, the causative diseases, and the histological type in the case of a malignancy were analyzed. Among the 532 patients whose pleural effusion was evident on a chest X-ray, there were 36 cases with an amylase-rich pleural effusion. The amylase levels were determined by an enzyme method (Hitach 747 autoanalyzer). Results : Of the 36 patients with an amylase-rich pleural effusion, there were 18 patients(50%) associated with a malignancy, 8 patients(22%) with a parapneumonic effusion, 7 patients(19%) with pancreatic disease, and 3 patients with other causes. The amylase level in a pleural effusion due to pancreatic disease was much higher than that due to other causes(p<0.01). Among the malignant pleural effusions with high amylase levels, the origin of the malignancy was a primary lung cancer in 13 cases and metastatic lung cancer in 5 cases. The histological types of malignant causes were adenocarcinoma in 10 cases(56%), squamous cell carcinoma in 2 cases(11%) and unknown type of carcinoma in 6 cases. The amylase level in the adenocarcinoma cases was much higher than that in the other cell type carcinomas(p<0.01). There was no significant association between the amylase level and the glucose level among the malignant cases with amylase-rich pleural effusion(p=0.21). Conclusion : The most frequent cause of an amylase-rich pleural effusion was a malignancy. Primary lung cancer and adenocarcinoma were the most common malignancies and histological types associated with a malignant pleural effusion with high amylase levels. The amylase level in a pleural effusion secondary to pancreatic disease was much higher than from any other causes.

• The Journal of Internal Korean Medicine
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• v.35 no.3
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• pp.366-372
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• 2014

Objectives: This is a report of a case of a stage IV non-small-cell lung cancer (NSCLC) patient whose malignant pleural effusion & respiratory symptoms have been relieved with Korean medicinal prescription, modified Yieum-jeon. Methods: A 56-year-old male diagnosed with stage IV NSCLC suffering malignant pleural effusion with complaints of cough, sputum, bilateral leg edema, dysphagia, post neck and left scapular pain was treated with modified Yieum-jeon and acupuncture during 16days. After treatment, blood lab and chest X-ray were used to follow the condition of malignant pleural effusion & pulmonary symptoms. Results: Malignant pleural effusion and pulmonary symptoms were improved with modified Yieum-jeon intake without any related adverse side effects. Conclusions: This study suggests Yieum-jeon may play a positive role in improving the malignant pleural effusion symptoms in advanced lung cancer cases.

• Tuberculosis and Respiratory Diseases
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• v.74 no.6
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• pp.286-290
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• 2013

Pigtail catheter drainage is a common procedure for the treatment of pleural effusion and pneumothorax. The most common complications of pigtail catheter insertion are pneumothorax, hemorrhage and chest pains. Cerebral air embolism is rare, but often fatal. In this paper, we report a case of cerebral air embolism in association with the insertion of a pigtail catheter for the drainage of a pleural effusion. A 67-year-old man is being presented with dyspnea, cough and right-side chest pains and was administered antibiotics for the treatment of pneumonia. The pneumonia failed to resolve and a loculated parapneumonic pleural effusion developed. A pigtail catheter was inserted in order to drain the pleural effusion, which resulted in cerebral air embolism. The patient was administered high-flow oxygen therapy and recovered without any neurologic complications.

• Tuberculosis and Respiratory Diseases
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• v.57 no.3
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• pp.289-291
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• 2004

Malignant melanoma develops from melanocytes and frequently metastases to other organs. Common metastatic sites are other skin, lymph nodes, lung, liver, brain and bone in decreasing order of frequency. Malignant pleural effusion is less frequent manifestation of thoracic metastasis. We experienced a 57-year-old man with pleural effusion who received radical resection with local flap on left foot due to acral lentiginous melanoma 3 years ago. He had progressive chest pain and left massive pleural effusion. The pleural cytology and biopsy showed malignant melanoma. After closed thoracostomy and talc pleurodesis, he refused further immunotherapy and chemotherapy and discharged.

• Tuberculosis and Respiratory Diseases
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• v.75 no.4
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• pp.161-164
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• 2013

Eosinophilic pleural effusion (EPE) is defined as a pleural effusion that contains at least 10% eosinophils. EPE occurs due to a variety of causes such as blood or air in the pleural space, infection, malignancy, or an autoimmune disease. Undifferentiated connective tissue disease (UCTD) associated with eosinophilic pleural effusion is a rare condition generally characterized by the presence of the signs and symptoms but not fulfilling the existing classification criteria. We report a case involving a 67-year-old man with UCTD and EPE, who has been successfully treated with a single intrapleural corticosteroid injection.

• Clinical and Experimental Pediatrics
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• v.48 no.2
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• pp.221-223
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• 2005

Congenital pleural effusions are uncommon. The majority of cases are due to chylothorax, hydrops fetalis, and infection. Effusions of this nature are, for the most part, self-limited. We experienced a rare case of a congenital unilateral pleural effusion due to an extralobar sequestraion with pulmonary lymphangiectasia. Pleural effusion was found by antenatal ultrasonography and confirmed by CT scans and CT angiography of the chest in the neonatal period. The patient underwent an open thoracotomy where extralobar sequestraion located between the diaphragm and the left lower lobe was removed. His postoperative course was uncomplicated and there was complete resolution of the pleural effusion.

• Childhood Kidney Diseases
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• v.27 no.1
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• pp.46-53
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• 2023

Pleuroperitoneal communication (PPC) is a rare mechanical complication of peritoneal dialysis (PD), which causes dialysate to move from the peritoneal cavity to the pleural cavity, resulting in pleural effusion. Typically, PPC is discovered through pleural effusion in PD patients who are not in volume overload status. A unique characteristic of the pleural effusion caused by PPC is that it is not resolved by increasing ultrafiltration by dialysis. In this report, we present a 7-year-old girl with PD after birth with the history of various infectious PD-related complications, presenting with fever ongoing for 6 months. PPC-associated pleuritis was suspected as the cause of fever, which eventually developed after long-term PD and induced complicated pleural effusion, lung inflammation, and prolonged fever for 6 months.

• Tuberculosis and Respiratory Diseases
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• v.87 no.2
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• pp.194-199
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• 2024

Background: In recent years, medical thoracoscopy has been well established to play an important role in undiagnosed pleural effusion; however, this procedure is underutilized due to limited availability of the instruments it requires. This study analysed the outcome of single port rigid thoracoscopy in patients with undiagnosed pleural effusions. Methods: This study retrospectively analysed the outcomes of all patients with undiagnosed pleural effusion presenting to our centre between 2016 to 2020 who underwent single port rigid medical thoracoscopy as a diagnostic procedure. Results: In total, 92 patients underwent single port rigid medical thoracoscopy. The most common presenting symptom was shortness of breath. A majority of the patients had lymphocytic exudative pleural effusion. The average biopsy sample size was 18 mm, and no major complication was reported in any of the patients. Conclusion: Single port rigid thoracoscopy is a safe and well-tolerated procedure that yields a biopsy of a larger size with high diagnostic yield. Moreover, the low cost of the instruments required by this procedure makes it particularly suited for use in developing countries.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.243-246
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• 2005

Pleural effusion represents a rare complication of acute hepatitis A infection. Twelve year-old girl was admitted with complaints of general weakness, nausea and icteric sclerae. She also complained of right chest pain. Right decubitus view of chest radiograph showed pleural fluid accumulation. Laboratory findings were as follows: AST/ALT 1692/1970 IU/L, total/direct bilirubin 4.48/3.66 mg/dL and HA IgM Ab (+). On the seventh day of hospitalization, her general condition was much improved and chest radiography showed resolved pleural effusion.