Rheumatoid Pleurisy Presenting as Black Pleural Effusion

Jacob, Amith George; George, Amrutha Mary; John, Teny M.

doi:10.1378/chest.1983626

Cited by 3 publications

(5 citation statements)

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“…Patients with hemorrhagic phenomenon secondary to malignancies (such as PNSCC) or other causes (such as rheumatoid pleurisy, thoracic endometriosis) have BPE because of the hemolytic breakdown of blood. This is evident by the presence of hemosiderin-laden macrophages found in multiple case reports [21,36,42] . PPF is the second most reported (28%) cause of BPE.…”

Section: Discussionmentioning

confidence: 93%

“…Data of 32 patients with black pleural effusion patients extracted and reported from 31 eligible articles are summarized in Tables 1 and 2 concerning demographics and admission to hospital diagnosis [6–9,12–38] . The flow of information through the different phases of our systematic review is depicted in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Eight patients had a right-sided BPE, whereas 2 had bilateral and 4 had left-sided BPE. Decortication was carried out in 3 patients, and recurrence after initial drainage was observed in 6 cases [6,9,18,19,21,22,25,27,28,30,33,34,36,38] . Eight (57%) among the discharged patients had BPE secondary to PPF [6,18,22,25,27,30,33,34] .…”

Section: Discussionmentioning

confidence: 99%

“…This is evident by the presence of hemosiderin-laden macrophages found in multiple case reports. [21,36,42] PPF is the second most reported (28%) cause of BPE. PPF itself is a rare condition with an unknown incidence.…”

Section: Tablementioning

confidence: 99%

“…Decortication was carried out in 3 patients, and recurrence after initial drainage was observed in 6 cases. [6,9,18,19,21,22,25,27,28,30,33,34,36,38] Eight (57%) among the discharged patients had BPE secondary to PPF. [6,18,22,25,27,30,33,34] Only 1 patient with PPF among a total of 9 such cases died, indicating a relatively better prognosis compared with malignancy-induced black pleural effusion, with mortality rates of 11.1% and 21.4%, respectively.…”

Section: Outcomes/prognosismentioning

confidence: 99%

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Etiology, pathological characteristics, and clinical management of black pleural effusion

et al. 2022

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Background: Pleural effusion is characterized by excessive fluid collection in the pleural cavity. Black pleural effusion (BPE) is a rare entity with only limited scientific data. We aimed to review the current literature on black pleural effusion to characterize demographics, etiology, clinical presentation, pathological findings, available treatment strategies, and prognosis of this rare condition.Methods: We performed a systematic review of case reports and series and synthesized data on demographics, manifestations, management, and outcomes of patients with BPE. We searched Cochrane Library, PubMed, SCOPUS, and Google Scholar for any date until January 10, 2021. All studies (n = 31) that reported black pleural effusion in patients were added to the review. Prospective Register of Systematic Reviews registration number: CRD42020213839. Summary and descriptive analysis was performed on Jamovi version 1.2.Results: The mean age of 32 patients with BPE was 53 years, with male predominance (69%). The commonest risk factor was smoking (n = 9) followed by alcohol intake (n = 8). Dyspnea was the commonest symptom (n = 24, 75%). Pleural fluid was mostly exudative (n = 21). The commonest associated diagnosis was malignancy (n = 14), with 50% secondary to metastatic melanoma. The commonest intervention was therapeutic thoracocentesis (n = 25, 78%), and the effusion recurred in half of the cases where recurrence was reported (n = 13). In our review, we found the mortality rate to be at 20.8% (n = 20.8%). 58.3% of the patients were successfully treated and discharged home (n = 14). Conclusion:Although rare, BPE appears to be a relevant symptom as it seems to be frequently associated with modifiable risk factors and underlying malignancy. Our systematic review substantiates a vital research gap as observational research is imperative to characterize BPE further and form a basis for designing tailored diagnostic, preventive, and therapeutic strategies for BPE.Abbreviations: BPE = black pleural effusion, PNSCC = pulmonary non-small cell carcinoma, PROSPERO = Prospective Register of Systematic Reviews.

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Section: Discussionmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%