Chest
Volume 121, Issue 2, February 2002, Pages 465-469
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Clinical Investigations
Pleural Disease
Biochemical and Cytologic Characteristics of Pleural Effusions Secondary to Pulmonary Embolism

https://doi.org/10.1378/chest.121.2.465Get rights and content

Study objectives

To characterize the biochemical and cytologic constituents of pleural effusions secondary to pulmonary embolism.

Design

A descriptive clinical study.

Setting

A community teaching hospital with 750 beds, which acts as a tertiary referral center for several subspecialties.

Patients and interventions

Patients with pleural effusions secondary to pulmonary embolism who underwent diagnostic thoracentesis during the last 7 years were retrospectively studied. Pleural fluid mesothelial hyperplasia was revised and compared with that found in patients with pleural effusions of different origin.

Results

Pleural effusions from all 60 patients with pulmonary embolism were exudates, and in 40 patients (67%) contained erythrocyte counts > 10,000/μL. A bloody appearance was not related to the use of anticoagulant therapy before thoracentesis. Polymorphonuclear leukocytes were predominant in 36 patients (60%); in 11 patients (18%), a proportion of eosinophils > 10% was found. Mesothelial hyperplasia was significantly higher in patients with pulmonary embolism than in patients in the control group (p < 0.01).

Conclusions

In the absence of trauma, a bloody or eosinophilic effusion with a marked mesothelial hyperplasia should prompt a workup to rule out embolism. The finding of transudative pleural fluid chemistries in these patients should not be assumed to be secondary to embolism before ruling out other causes of transudative effusion.

Section snippets

Materials and Methods

We retrospectively reviewed the medical records and chest radiographs of all patients with a definitive diagnosis of pulmonary embolism who underwent diagnostic thoracentesis during the last 7 years. The chest radiographs were reviewed to assess the size and location of the pleural effusion, and the associated findings. A definitive diagnosis of pulmonary embolism was considered when an abnormal angiographic finding (pulmonary angiography or contrast-enhanced spiral CT scanning) showed distinct

Results

Sixty patients (37 men and 23 women; mean age, 60 ± 14 years; range, 31 to 88 years) complied with the conditions of the study. Twenty-five patients (42%) were smokers (mean, 42 pack/years).

One or more associated diseases were evident in 47 patients (78%; Table 1). No patients presented with signs of congestive heart failure when thoracentesis was performed; however, seven patients were receiving diuretic therapy for hypertension or previous congestive heart failure.

Pleural effusions were

Discussion

This study demonstrates the uniform exudative character of pleural effusions due to pulmonary embolism. Until 1976, most authors classified effusions due to pulmonary embolism as exudates.11121314 However, Bynum and Wilson4 published that year a study in which more than one third of the 26 patients included could have transudates. Since then, this study has been repeatedly referred to and, as far as we know, never contested in spite of significant methodologic limitations: first, in an

References (24)

  • DF Worsley et al.

    Chest radiographic findings in patients with acute pulmonary embolism: observation from the PIOPED study

    Radiology

    (1993)
  • LJ Bynum et al.

    Characteristics of pleural effusions associated with pulmonary embolism

    Arch Intern Med

    (1976)
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