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Sunday, 24 November 2013

Pleural disease – Pleural effusion – The Misdiagnosis

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.4.2. Misdiagnosis
1. Giant bronchogenic cyst
There is a report of a case of giant pulmonary bronchogenic cyst (18 cm × 15 cm × 10 cm) misdiagnosed with loculated pleural effusion. Later Histopathology studies revealed a giant bronchogenic cyst with abscess formation(49).
2. Amoebic liver abscess
There is a report of a 3 year old who had amoebic liver abscess but was wrongly diagnosed and treated for lobar Pneumonia with pleural effusion(50).
3. Extrapleural empyema
there is a report of 49-year-old man with diabetes mellitus and alcoholic liver cirrhosis presented with dyspnoea and fever. A chest computed tomography scan revealed three areas of loculated pleural effusion. Initially, the patient was thought to have an intrapleural empyema and during open drainage, the patient was diagnosed to have an extrapleural empyema(51).
4. False positive for malignancy
there is a report of a 23-year-old female with systemic lupus erythematosus is reported. The clinical features included fever, shortness of breath, lymphadenopathies, hepatosplenomegaly, pleural and pericardial fluids, ANA and Anti-DNA positivity. Pleural biopsy was false positive for malignancy on two occasions. High CA125 levels were detected in both serum and pleural fluid. Following prednisolone treatment, clinical and laboratory findings returned to normal(52). Other study report of a case of a patient with traumatic hemothorax, showing high pleural fluid concentrations of ferritin, tissue polypeptide antigen, and cancer antigen 125. This patient’s pleural fluid also contained high levels of bilirubin and many macrophages containing phagocytized red blood cells, suggesting a local metabolism of hemoglobin. Our case confirms that some tumoral markers can give false positive results and suggests that their significance must be evaluated differently in bloody pleural effusions as compared with non-bloody pleural effusions(53).
5. Boerhaave’s Syndrome
There is a report of a case of an atypical presentation of Boerhaave’s Syndrome in an elderly female who presented to the Emergency Department with dyspnea, right sided chest pain, right pleural effusion, and hypovolemic shock without an identifiable antecedent event. A chest radiograph revealed massive right hydropneumothorax. After placement of a chest tube, the patient was admitted to the intensive care unit. Only 36 hours after admission did the diagnosis of Boerhaave’s Syndrome become evident(54).

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Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca Sources
(49) http://www.ncbi.nlm.nih.gov/pubmed/21889908
(50) http://www.ncbi.nlm.nih.gov/pubmed/16805178
(51) http://www.ncbi.nlm.nih.gov/pubmed/11896906
(52) http://www.ncbi.nlm.nih.gov/pubmed/8793264
(53) http://www.ncbi.nlm.nih.gov/pubmed/7673622
(54) http://www.ncbi.nlm.nih.gov/pubmed/1439110


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All rights reserved. Any reproducing of this article must have the author name and all the links intact. "Let Take Care Your Health, Your Health Will Take Care You" Kyle J. Norton I have been studying natural remedies for disease prevention for over 20 years and working as a financial consultant since 1990. Master degree in Mathematics, teaching and tutoring math at colleges and universities before joining insurance industries. Part time Health, Insurance and Entertainment Article Writer.