BTS guidelines for the investigation of a unilateral pleural effusion in adults

Maskell, Nick A; Butland, Richard JA

doi:10.1136/thorax.58.suppl_2.ii8

Cited by 191 publications

(135 citation statements)

References 101 publications

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“…The British Thoracic Society (BTS) recommends either thoracoscopy or image-guided biopsy (using CT or ultrasound) as the next line of investigation in the event of a non diagnostic, blind pleural aspirate [16]. A CT-guided biopsy is safe, and sensitive [17] but a pleural fluid drainage or pleurodesis cannot be done in the same sitting.…”

Section: Discussionmentioning

confidence: 99%

Medical Thoracoscopy vs Closed Pleural Biopsy in Pleural Effusions: A Randomized Controlled Study

Haridas¹,

Chetambath

2014

JCDR

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Section: Discussionmentioning

confidence: 99%

Medical Thoracoscopy vs Closed Pleural Biopsy in Pleural Effusions: A Randomized Controlled Study

Haridas¹,

Chetambath

2014

JCDR

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“…Near patient testing of pleural fluid pH is an important component of this assessment for the diagnosis of pleural infection (including tuberculosis), rheumatoid pleural effusion, and esophageal rupture (3), and the prognostic assessment of malignant effusion (1,(4)(5)(6)(7). Measurement of pleural fluid pH is advocated in the literature and in management guidelines from professional societies (including the American and British Thoracic Societies [3,[8][9][10][11]) as part of first-line pleural fluid analysis.…”

mentioning

confidence: 99%

Clinically Important Factors Influencing the Diagnostic Measurement of Pleural Fluid pH and Glucose

Rahman

Mishra

Davies³

et al. 2008

Am J Respir Crit Care Med

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Rationale: Accurate pleural fluid pH and glucose measurement is a key component in the diagnosis and management of patients with pleural effusion. Standardized methods of pleural fluid collection have not been defined. Objectives: To assess the effect of common clinical factors that may distort measurement accuracy of pleural fluid pH and glucose. Methods: Ninety-two exudative pleural aspirates were collected in commercially available blood gas syringes. Measurements and Main Results: Samples were analyzed immediately using a blood gas analyzer. The effects of residual air, lidocaine, heparin, and delay in analysis (24 h) on pH and glucose measurement accuracy were assessed. Pleural fluid pH was significantly increased by residual air (mean 6 SD, 0.08 6 0.07; 95% confidence interval [CI], 0.06 to 0.09; P , 0.001) and significantly decreased by residual lidocaine (0.2 ml; mean change in pH, 20.15 6 0.09; 95% CI, 20.13 to 20.18; P , 0.001) and residual heparin (mean change in pH, 20.02 6 0.05; 95% CI, 20.01 to 20.04; P 5 0.027). Pleural fluid pH was stable at room temperature for 1 hour and significantly increased at 4 (mean 6 SD, 0.03 6 0.07; 95% CI, 0.01 to 0.04; P 5 0.003) and 24 hours (0.05 6 0.12; 95% CI, 0.03 to 0.08; P , 0.001). Pleural fluid glucose concentration was not clinically significantly altered by residual air, lidocaine (up to 0.4 ml), or 24-hour analysis delay. Conclusions: Accuracy of measured pleural pH is critically dependent on sample collection method. Residual air, lidocaine, and analysis delay significantly alter pH and may impact on clinical management. Pleural fluid glucose concentration is not significantly influenced by these factors. Protocols defining appropriate sampling and analysis methods are needed.

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“…Approximately 50% of cases are due to malignancy (particularly lymphoma), 25% to trauma (particularly during surgery), and the remainder is from miscellaneous causes such as tuberculosis, sarcoidosis, and amyloidosis (Turton 1987). Chyle contains high levels of triglyceride (110 mg/dL), an essential feature for diagnosis (Maskell and Butland 2003). The methods for imaging the thoracic duct include not only lymphangiography but also magnetic resonance lymphography (Takahashi et al 2003); magnetic resonance lymphography was used in our patient to evaluate the thoracic duct.…”

Section: Discussionmentioning

confidence: 99%