Pleural effusion in acute pulmonary embolism in Bahrain: Radiological and pleural fluid characteristics

Abstract

Background and Objectives:Pleural effusion is seen in around half of the cases of pulmonary embolism (PE). There are no data on the incidence of pleural effusion in cases of PE in the Kingdom of Bahrain. This study was done to determine the frequency and radiological features of pleural effusion in cases of acute PE and also to characterize the pleural fluid biochemistry and cell type in patients subjected to diagnostic thoracentesis.Methods:This was a retrospective, observational single-center study. All the data of patients subjected to computed tomography pulmonary angiography (CTPA) in suspected cases of acute PE over a 4-year period were analyzed.Results:A total of 1756 patients were subjected to CTPA from January 2013 to December 2016. A diagnosis of acute PE was made in 200 patients (11.4%). Pleural effusion was identified in 70 cases (35%). Majority of the effusions were small to moderate in size, bilateral, and associated with peripheral emboli. Consolidation, atelectasis, and ground glass attenuation were common associated findings on CTPA in these patients. Consolidation was more common in patients of PE associated with pleural effusion as compared to those with PE alone (62.85% and 33.8%, respectively, odds rato: 3.279 and 95% confidence interval: 1.798–6.091, P < 0.001). Diagnostic thoracentesis was done in 6 (8.6%) of the cases. All the patients had an exudative effusion with normal glucose values and neutrophil predominance.Conclusion:PE was associated with pleural effusion in around one-third of the patients in Bahrain. The effusions were mainly small and bilateral. The emboli in cases associated with pleural effusion were mostly peripheral. Consolidation was the parenchymal abnormality detected on CTPA which was significantly associated with the presence of pleural effusion. Most of the pleural effusions were not suitable for thoracentesis. In patients subjected to fluid analysis, the effusions were exudative, neutrophilic predominant, and associated with normal glucose levels.

Incidence and Prognostic Role of Pleural Effusion in Patients with Pulmonary Embolism: A Systematic Review and Meta-Analysis

“…The sample sizes of these studies ranged from 22 to 3391 and were published between 1978 and 2022. Among the included studies, 29 examined the incidence of pleural effusion in PE, of which 6 were prospectively designed, while the remaining 23 were retrospective [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. Data on short-term mortality (30-day or in-hospital mortality) in PE patients with or without pleural effusion were available in 7 cohort studies [ 40 , 41 , 42 , 43 , 44 , 45 , 46 ].…”

“…The incidence of pleural effusion in PE was expressed as proportions with 95% confidence intervals (CIs) and displayed as a forest plot using the random-effects model that accounted for the potential variation among the included studies [ 17 ]. Considering that the location and size of pleural effusion in PE is still controversial, the incidence of unilateral pleural effusion and small pleural effusion in PE was also analyzed [ 18 , 19 ]. In addition, we performed a meta-analysis to assess the effect of pleural effusion on PE prognosis for a subset of comparable studies.…”

Prevalence and clinical significance of pleural effusion in patients with acute pulmonary embolism: a retrospective study

“…Based on a retrospective analysis of more than 3,000 consecutive thoracentesis, PE was the cause of pleural effusion in just 1.6% of cases (19). Pleural effusion in APE is typically mild and bilateral, and most cases are not suitable for thoracentesis, making it more difficult to diagnose (20).…”

Pleural Effusions in Pulmonary Emboli: A Single Centre Experience

“…Panjwani et al screened 1756 CTPAs over a three-year period with a diagnosis of acute PE in 200 patients (11.4%) [ 10 ]. Pleural effusions were identified in 70 (35%).…”