Although eosinophilic pleural effusion (EPE) has been a subject of numerous studies, its clinical significance still remains unclear. The aim of our study was to evaluate: 1) the relative incidence and aetiology of EPE; 2) the predictors of malignancy in patients with EPE; and 3) the relationship between repeated thoracentesis and pleural fluid eosinophilia.A retrospective analysis of 2,205 pleural fluid samples from 1,868 patients treated between 1995 and 2007 was performed.We identified 135 patients with EPE (7.2% of all patients with pleural effusion) and 153 EPE samples. The most common condition associated with EPE was malignancy (34.8%) followed by infectious (19.2%), unknown (14.1%), post-traumatic (8.9%) and miscellaneous (23.0%) pleural effusions. The incidence of malignancy was significantly higher in patients with a lower (f40%) pleural fluid eosinophil percentage. 40 patients with EPE underwent a second thoracentesis. In 16, eosinophilia was present in both pleural fluid samples, 14 revealed pleural fluid eosinophilia only after the second thoracentesis and 10 had eosinophilia only in the first pleural fluid sample.Pleural fluid eosinophilia should not be regarded as a predictor of nonmalignant aetiology. Probability of malignancy is lower in effusions with a high eosinophil percentage. The incidence of EPE in patients undergoing second thoracentesis is not different to that found during the first thoracentesis.KEYWORDS: Eosinophilic pleural effusion, eosinophils, pleural effusion, pleural fluid, pleural fluid eosinophilia E osinophilic pleural effusion (EPE) is usually defined as a pleural effusion (PE) that contains o10% of eosinophils [1,2]. The relative incidence of EPE has been estimated at between 5% and 16% of all PEs [1,[3][4][5], but the clinical significance of pleural fluid eosinophilia remains unclear. Some early studies have shown that pleural fluid eosinophilia is associated with a decreased risk of a malignant aetiology [1]. However, later studies did not confirm these observations [3][4][5]. Another interesting and unresolved issue is a potential causative relationship between the presence of air and/or blood in the pleural space and pleural fluid eosinophilia [1,[6][7][8].Since pleural fluid eosinophilia is uncommon, our knowledge concerning EPE is based on small series and case reports. The majority of reports published before 1982 have been analysed by ADELMAN et al. [1]. However, the results of the studies published in the subsequent 15 yrs questioned some of the conclusions of their analysis.To re-evaluate some of the important issues concerning EPE, we performed an analysis of a large series of samples of PE in our institution (Dept of Internal Medicine, Pneumology and Allergology Medical University of Warsaw, Warsaw, Poland). The specific goals of our study were to: 1) assess the relative incidence and aetiology of EPE; 2) search for the predictors of malignancy in patients with EPE; and 3) evaluate the relationship between the first and repeated thoracentesis and ple...

Human lungs are constantly exposed to a large number of Aspergillus spores which are present in ambient air. These spores are usually harmless to immunocompetent subjects but can produce a symptomatic disease in patients with impaired antifungal defense. In a small percentage of patients, the trachea and bronchi may be the main or even the sole site of Aspergillus infection. The clinical entities that may develop in tracheobronchial location include saprophytic, allergic and invasive diseases. Although this review is focused on invasive Aspergillus tracheobronchial infections, some aspects of allergic and saprophytic tracheobronchial diseases are also discussed in order to present the whole spectrum of tracheobronchial aspergillosis. To be consistent with clinical practice, an approach basing on specific conditions predisposing to invasive Aspergillus tracheobronchial infections is used to present the differences in the clinical course and prognosis of these infections. Thus, invasive or potentially invasive Aspergillus airway diseases are discussed separately in three groups of patients: (1) lung transplant recipients, (2) highly immunocompromised patients with hematologic malignancies and/or patients undergoing hematopoietic stem cell transplantation, and (3) the remaining, less severely immunocompromised patients or even immunocompetent subjects.

Pleural fluid ADA and IFN-gamma are both sensitive and specific biomarkers of tuberculous pleurisy. Their diagnostic accuracy across the different studies shows a smaller variability than that of other tests, for example NAATs. There is also no convincing evidence that IGRAs are superior to pleural fluid ADA or IFN-gamma measurement. Hence, the role of ADA and IFN-gamma in the differential diagnosis of tuberculous pleurisy is pivotal.

ObjectiveThe aims of this study were to assess the sensitivity of various magnetic resonance imaging (MRI) sequences for the diagnosis of pulmonary nodules and to estimate the accuracy of MRI for the measurement of lesion size, as compared to computed tomography (CT).MethodsFifty patients with 113 pulmonary nodules diagnosed by CT underwent lung MRI and CT. MRI studies were performed on 1.5T scanner using the following sequences: T2-TSE, T2-SPIR, T2-STIR, T2-HASTE, T1-VIBE, and T1-out-of-phase. CT and MRI data were analyzed independently by two radiologists.ResultsThe overall sensitivity of MRI for the detection of pulmonary nodules was 80.5% and according to nodule size: 57.1% for nodules ≤4mm, 75% for nodules >4-6mm, 87.5% for nodules >6-8mm and 100% for nodules >8mm. MRI sequences yielded following sensitivities: 69% (T1-VIBE), 54.9% (T2-SPIR), 48.7% (T2-TSE), 48.7% (T1-out-of-phase), 45.1% (T2-STIR), 25.7% (T2-HASTE), respectively. There was very strong agreement between the maximum diameter of pulmonary nodules measured by CT and MRI (mean difference -0.02 mm; 95% CI –1.6–1.57 mm; Bland-Altman analysis).ConclusionsMRI yielded high sensitivity for the detection of pulmonary nodules and enabled accurate assessment of their diameter. Therefore it may be considered an alternative to CT for follow-up of some lung lesions. However, due to significant number of false positive diagnoses, it is not ready to replace CT as a tool for lung nodule detection.