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OBJECTIVE: To assess the value of discriminant analysis as a method of optimizing the discriminant power of routine parameters in differentiating between malignant and non-malignant pleural effusions. METHODS: Retrospective review of the medical records of 245 patients with exudative pleural effusion. RESULTS: The most powerful predictor of the malignant etiology of pleural effusion was a function that consisted of seven variables: age (years); effusion volume (coded as up to one third = 1, up to two thirds = 2, massive = 3); sedimentation rate (mm/h); monocyte count in the peripheral blood (cells/mm3); bloodstained exudate (coded as yes = 1, no = 2); and glucose (mg/dL) and iron (microg/dL) concentration in pleural fluid. This function showed a sensitivity of 77%, specificity of 85%, positive predictive value (PPV) of 76%, negative predictive value (NPV) of 86%, and was able to give an 82% rate of correct classification. In patients aged 50 years or younger, the NPV ranged between 91 and 98%, whereas in those older than 60 years, the PPV was 89%. CONCLUSION: The calculated discriminant function is a simple, rapid, and inexpensive method for screening patients with pleural effusion for malignant etiology.

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Chest ultrasound, a diagnostic technique used mainly by radiologists, is useful for managing pleural effusion. Sonography and computed tomography (CT) are complementary, although the former is more accessible to clinicians because it is safe and easy to use and because results are available quickly. We evaluated the utility of chest sonograms in a respiratory medicine unit managed by pneumologists. During the period under study, requests for CT scans to manage complicated pleural effusions decreased as the use of sonograms increased. We conclude that ultrasound imaging is useful in the hands of pneumologists who use the technique to diagnose pleural effusions.

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La ecografía torácica es una técnica diagnóstica útil para el tratamiento del derrame pleural, que es realizada fundamentalmente por radiólogos. La ecografía y la tomografía computarizada son complementarias, si bien la rapidez de los resultados, la inocuidad y la sencillez de manejo hacen de la ecografía la técnica más accesible a los clínicos. En este sentido se ha valorado la utilidad de la ecografía torácica en una unidad de técnicas respiratorias manejada por neumólogos. Durante el período estudiado, la solicitud de tomografía computarizada para el tratamiento de los derrames pleurales complicados ha disminuido, al mismo tiempo que se incrementaban el número de ecografías torácicas realizadas. Concluimos que la ecografía, en manos de neumólogos que realizan procedimientos diagnósticos pleurales, es una herramienta útil (AU)

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BACKGROUND: Eosinophilic pleural effusion (EPE) is a relatively rare clinical condition. Repeated thoracenteses (RTs) are normally considered a frequent cause of EPE. Yet, to our knowledge, there is no firm evidence (apart from anecdotal case reports) supporting such a statement. OBJECTIVE: To investigate potential relationships between the number, type (with or without pleural biopsy) and time elapsed between RTs and the number of eosinophils present in pleural fluid samples. METHODS: We reviewed retrospectively 273 pleural fluid samples belonging to 120 patients (79 males, 41 females), attended in our institution from 1992 to 2000, whose clinical management had required RTs. Apart from the anthropometric and clinical data of each patient, we included the following variables in the analysis: number of thoracenteses performed in each individual, number of pleural biopsies carried out at each thoracentesis and time between consecutive thoracenteses. We also recorded the total (and differential) leukocyte count, red blood cell count, as well as the main biochemical, microbiological and histological data of both the pleural fluid and peripheral blood samples. RESULTS: We did not observe any significant change in the percentage of eosinophils in relation to the number of thoracenteses performed per patient. This lack of relationship was also observed in the subgroup of patients who required one (or more) pleural biopsies (n = 111) (regardless of the number of biopsies). Our results suggest that RTs are not an important risk factor for the development of EPE, regardless of the time elapsed between two thoracenteses. CONCLUSION: We believe, therefore, that multiple punctures should not longer be considered a prevalent cause of pleural eosinophilia.

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We report five cases of thyroid carcinoma with tracheal invasion. In two patients infiltration was found during thyroid exeresis. Diagnosis was based on respiratory signs such as hemoptysis and stridor in the other three patients. The pathologic diagnosis was papillary carcinoma for four patients and follicular carcinoma for one, the only man in the series. Treatment by thyroidectomy, tracheal resection and end-to-end anastomosis with node removal was followed by long-term survival. A search for tracheal involvement during thyroidectomy and clinical suspicion were the keys to a good prognosis for these patients.

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Se presentan 5 pacientes con carcinoma de tiroides y afección traqueal. En dos de ellos el hallazgo de la infiltración traqueal fue intraoperatorio durante la exéresis del tiroides.En los restantes pacientes el diagnóstico se realizó por la presencia de síntomas respiratorios como la hemoptisis y el estridor. El diagnóstico anatomopatológico fue de carcinoma papilar en cuatro casos y un carcinoma folicular que correspondió al único varón de la serie. El tratamiento con tiroidectomía, resección traqueal y anastomosis terminoterminal, con vaciamiento ganglionar se siguió de una larga supervivencia. La búsqueda de la afectación traqueal durante la tiroidectomía y la sospecha clínica fueron decisivas para el buen pronóstico de estos pacientes (AU)

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This study was conducted to assess the prevalence of eosinophilia in 358 consecutive samples of pleural fluid (all cases corresponded to first thoracentesis), to review the cause of eosinophilic pleural effusions, and to determine whether the presence of eosinophils increases the likelihood of nonmalignant underlying disorders. Eosinophilic pleural effusions were identified in 45 patients (12.6%): malignant underlying conditions were diagnosed in 11 patients (24.4% with eosinophilic effusions) and benign aetiologies were found in 27 patients. Benign aetiologies included uncomplicated paraneumonic effusion in 10 patients, tuberculosis in seven, complicated paraneumonic in five, liver cirrhosis in three, hydronephrosis in one and pulmonary thromboembolism in one. Seven pleural effusions were idiopathic. There was no difference in the prevalence between eosinophilic and noneosinophilic effusions according to the different diagnoses. With parameters of sensitivity, specificity, pretest and post-test probability and positive and negative predictive values for any prevalence figure using the Bayes' theorem and for any value of eosinophils (both in percentage or absolute numbers) in the pleural fluid (receiver operating characteristic curve) an adequate predictor of benign disease was not found. It is concluded that pleural eosinophilia at the initial thoracentesis cannot be considered as a predictor of an underlying benign disorder.

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Malignant melanoma has a tendency to metastasize to the lung in the course of tumor growth. Many such cases have been described in the literature, although cases of endobronchial metastasis of this type of tumor revealed during fiberoptic bronchoscopy are difficult to find. We report three cases of extension of the primary tumor to the lung, diagnosed by fiberoptic bronchoscopy during which biopsy specimens were obtained. After tissue inspection, the initial suspicion of metastasis of malignant melanoma was confirmed. We review the prevalence, radiologic presentation, prognosis and treatment options for this type of metastasis.

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