Disorders of the Pleura |

Exudative Pleural Effusion in Congestive Heart Failure: Thoracoscopic and Histologic Features FREE TO VIEW

Valentina Pinelli, MD; Fiorenza Marugo; Donatella Intersimone; Franco Fedeli; Daniele Bertoli; Massimiliano Sivori; Pier Aldo Canessa
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S. Bartolomeo Hospital, Sarzana, Italy

Chest. 2015;148(4_MeetingAbstracts):427A. doi:10.1378/chest.2246152
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SESSION TITLE: Disorders of the Pleura

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 28, 2015 at 02:45 PM - 04:15 PM

PURPOSE: To describe endoscopic and histopathological findings in patients with evidence of cardiac disease (BNP plasma values >500 pg/ml) and an exudative pleural effusion (PE) .

METHODS: We evaluated 257 patients from January 2008 to December 2014, with undetermined exudative PE and with a BNP serum determination, who underwent medical thoracoscopy with a minimum of ten parietal pleural biopsies. Plasma BNP concentrations were measured at admission. We included only patients with BNP plasma levels > 500 pg/ml and an explorable pleural cavity. The final diagnosis of pleural disease was assessed by histological criteria. Endoscopic finding (TF) were graded as Type 1: faint pleural thickening (Fig.1) without focal lesions or change of the endoscopic pleural pattern Type2: thickening with significantly change of the pleural endoscopic pattern with or without nodules and plaques, Type 3: normal pleura. At least 10 biopsies were taken from each patient.

RESULTS: Of 257 patients with exudative PE, 16 (6.2%,) had a BNP plasma level > 500 pg/ml and explorable pleural cavity. Type 1 TF were observed in 7 patients (44%), Type 2 in 9 cases (56%). All patients with Type 1 TF had an histological diagnosis of chronic pleurisy characterized by mesothelial cell hyperplasia, polymorphic flogistic infiltration with lymphocyte predominance. (Fig.2) Patients with Type 2 TF had different histological diagnosis: 2 diagnosis of pleural tuberculosis, 1 pleural localization of Small Cell Cancer, 1 Mesothelioma, 1 Eosinophilic Pleuritis associated to eosinophilic pneumonia, 4 cases of Asbestosis associated to congestive heart failure.

CONCLUSIONS: A diagnosis of cardiac pleurisy is characterized by endoscopic evidence of diffuse faint pleural thickening and histopathological findings of mesothelial cell hyperplasia with polymorphic flogistic infiltration.

CLINICAL IMPLICATIONS: Suggeste medical thoracoscopy in indetermined exudative pleural effusion associated to congestive heart failure ( plasma BNP concentration > 500 pg/ml ).

DISCLOSURE: The following authors have nothing to disclose: Valentina Pinelli, Fiorenza Marugo, Donatella Intersimone, Franco Fedeli, Daniele Bertoli, Massimiliano Sivori, Pier Aldo Canessa

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