Diagnostic Value of Pleural Fluid Cytology in Occult Boerhaave's Syndrome

Drury, Michael; Anderson, William D.; Heffner, John E.

doi:10.1378/chest.102.3.976

Cited by 39 publications

(21 citation statements)

References 16 publications

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“…Candida species were indicated when yeasts exhibiting single budding with pseudohyphae (constricted at the ends and attached like links of sausage) or true hyphae (parallel walls and unattached) were found. Ingested material was indicated when particles containing cell wall or skeletal muscle were found as reported previously (17).…”

Section: Methodsmentioning

confidence: 90%

Isolation of Candida Species is an Important Clue for Suspecting Gastrointestinal Tract Perforation as a Cause of Empyema

Ishiguro¹,

Takayanagi²,

Ikeya

et al. 2010

Intern. Med.

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Background Empyema due to Candida species is a rare entity, and the significance of isolation of Candida species from the pleural effusion is not fully understood. Objective To elucidate the clinical features of Candida empyema. Methods We retrospectively reviewed the cases of 128 patients with culture-positive empyema. Results These 128 patients included 7 whose cause of empyema was esophago-or gastropleural fistula. Empyema was due to Candida species in 5 of the 7 patients. Primary diseases of these 5 patients were spontaneous esophageal rupture in 3 patients, esophageal rupture due to lung cancer invasion in 1 patient, and gastric ulcer perforation in 1 patient. None of these 5 patients had esophageal candidiasis. Among the 121 other patients with empyema not due to esophago-or gastropleural fistula, no patient had empyema due to Candida. Conclusion We believe that the empyema in these 5 patients was caused by normal commensal Candida species entering the pleural cavity when the fistula between the gastrointestinal tract and pleural cavity was formed. Isolation of Candida species can be an important clue for suspecting gastrointestinal tract perforation as a cause of empyema.

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Section: Methodsmentioning

confidence: 90%

Isolation of Candida Species is an Important Clue for Suspecting Gastrointestinal Tract Perforation as a Cause of Empyema

Ishiguro¹,

Takayanagi²,

Ikeya

et al. 2010

Intern. Med.

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“…The food particles can be detected by gross examination of the thoracic drainage,[15] or by cytological examination. [16] It has been suggested that the cytological detection of food material is enhanced by high speed centrifugation of the pleural fluid. The food particles may not be detectable on gram stain or wet preparations.…”

Section: Discussionmentioning

confidence: 99%

“…The food particles may not be detectable on gram stain or wet preparations. [1016] Drainage of previously swallowed tracer fluids like methylene blue or barium may also help to confirm the diagnosis in some patients. [6]…”

Section: Discussionmentioning

confidence: 99%

Cytomorphology of Boerhaave's syndrome: A critical value in cytology

2013

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Spontaneous esophageal perforation into the pleural cavity (Boerhaave's syndrome) is a rare life-threatening condition, which requires early diagnosis and urgent management. The diagnosis of such critical condition in many cases is delayed because of atypical clinical presentation, resulting in increased morbidity and mortality. Cytological examination of pleural fluid can provide early, fast and accurate diagnosis of such critical condition and help in better and early management of this disease. We describe a case of an 81-year-old female with esophageal perforation who presented with a left sided pleural effusion. The correct diagnosis was established in this case by observing gastrointestinal-like fluid characteristics of the thoracic drainage upon cytological and chemical analyses and the rupture was confirmed by esophagography. The cytological examination of pleural fluid revealed benign reactive squamous cells, fungal organisms, bacterial colonies, and vegetable material consistent with a ruptured esophagus. Cytological examination of pleural fluid is a rapid and accurate technique that can help in establishing the diagnosis of this challenging entity and guide initiation proper management of this unusual entity.

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“…Macroscopic assessment and/or cytology often reveal undigested food particles, which confirms gastrointestinal-tract perforation. 13 The chemistry of the pleural fluid usually shows low pH and high amylase level.…”

Section: Discussionmentioning

confidence: 99%