SESSION TYPE: Pleural Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: A case presentation of a 67 year old man with eosinophilic left pleural effusion.
CASE PRESENTATION: A 67 year old man presented with dyspnea on exertion and nonproductive cough for 3 weeks. He also had right leg edema for two months despite diuretic therapy. He had undergone right total hip replacement four months prior. He denied any fevers or weight loss. He had no history of frequent respiratory infections or chronic respiratory disease. His home medications included metformin, glyburide, aspirin, and pregabalin. His past medical and surgical history is significant for diabetes mellitus and right total hip replacement. He is a retired engineer. Denied any alcohol or drug use. He has a remote history of tobacco use as a teenager. No family history of malignancy or lung disease. On physical examination , vital signs were blood pressure 120/80 mmHg, respiratory rate 16 breaths/minute, pulse 110 beats/minute, oxygen saturation 98% on room air and afebrile. He appeared older than stated age. Lung exam revealed absent breath sounds and dullness to percussion of the lower one half of left lung field. He was noted to have 1+ right tibial edema. Remainder of exam was unremarkable. Laboratory investigations including comprehensive metabolic panel, CBC, ESR, ANA, and rheumatoid factor were unremarkable. He had a BNP of 125 and d-dimer of 412. CT chest angiogram showed a small contralateral lung nodule and no evidence of pulmonary thromboembolism or mediastinal adenopathy. No endobronchial lesions identified on bronchoscopy. He underwent thoracentesis for recurrent left pleural effusion. Cytology revealed numerous eosinophils (91%) with reactive mesothelial cells and no evidence of malignancy.
DISCUSSION: Eosinophilic pleural effusion (EPE) is defined as a pleural effusion containing ≥ 10% eosinophils. It accounts for 5-16% of pleural effusions. The differential diagnosis for EPE includes malignancy, infection, post-traumatic, pneumothorax, pulmonary embolism, autoimmune disease transudative, and asbestosis. Approximately 20% of cases are idiopathic. The pleural fluid should be evaluated for infection and malignant cells. Further investigations include bronchoscopy, contrast enhance spiral CT of the chest and CT angiography. If negative,video-assisted thoracoscopy, medical thoracoscopy, or open thoracotomy can be considered.
CONCLUSIONS: Eosinophilic pleural effusion can be a manifestation of a wide variety of diseases. A systematic approach should be used to identify the underlying disease.
1) R. Krenke, J. Nasilowski, P. Korczynski, et al. Incidence and aetiology of eosinophilic pleural effusion. Eur Respir J. 2009 Nov;34(5):1111-7. Epub 2009 Apr 22.
2) I. Kalomenidis, R. Light Eosinophilic pleural effusions. Current Opinion in Pulmonary Medicine. 9(4):254-260, July 2003.
DISCLOSURE: The following authors have nothing to disclose: Soniya Patel, Daniel Gerardi
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