Pleurisy of unexpected etiology: a foreign body within the pleural cavity

peer reviewedFollowing three brief clinical reports, we review the literature concerning a rare cause of exudative pleural effusion: the presence of a foreign body in the pleural cavity. Frequently iatrogenical, this rare etiology of pleural effusion must be envisaged when this complication develops after any invasive peri-thoracic surgery and must be included in the differential diagnosis of recurrent pleural effusions. These effusions have a favorable prognosis after withdrawal of the foreign body

Eosinophilic Pleural Effusion Induced by Paliperidone Palmitate: Case Report and Literature Review.

peer reviewedBACKGROUND: Eosinophilic pleural effusions are defined by an eosinophil count ≥ 10% in pleural fluid and represent approximately 10% of exudative pleural effusions. They are associated with a large spectrum of etiologies, both benign and malignant. Drug-induced eosinophilic pleural effusions remain rarely described. OBJECTIVE AND METHODS: After ruling out other causes with a careful diagnostic assessment, we retain paliperidone as the etiology, given the disappearance of the pleural effusion after drug discontinuation. RESULTS: We report the first case of eosinophilic pleural effusion induced by paliperidone palmitate treatment. CONCLUSION: After considering other etiologies, drug-induced eosinophilic pleural effusion should be sought

Y a-t-il une place pour les β-bloquants dans les maladies pulmonaires obstructives ?

peer reviewe

Clinical case of the month. MacLeod syndrome

peer reviewedMacLeod syndrome is a rare cause of localized hypertransradiancy of the lung. This syndrome is defined by radiological features: localized hypertransradiancy due to oligemia and presence of air-trapping on expiratory chest radiography. Involvement of one entire lung is called "unilateral hyperlucent lung". Whereas the etiology is different, the physiopathology is probably identical to that of the panacinar emphysema of chronic obstructive pulmonary disease. The syndrome is believed to be related to acute bronchiolitis during infancy. Clinical manifestations and prognosis depend mainly on the presence of other lesions due to the same infectious agent like bronchiectasis. Pulmonary function tests, chest CT-scan, ventilation and perfusion scintigraphy and, if necessary, bronchoscopy help the differential diagnosis and detect associated bronchiectasis

The "classic" triad presentation of mucinous bronchiolo-alveolar carcinoma

peer reviewedThe case of a 59-year-old female complaining of cough of recent onset, abundant salty expectoration and lung condensation is presented. This "triad" constitutes a rare but nearly pathognomonic presentation of mucinous bronchioloalveolar carcinoma (BAC) of the lung

Clinical benefit to programmed death-1 inhibition for non-small-cell lung cancer is associated with higher blood eosinophil levels

peer reviewed[No abstract available

White Blood Cells in Patients Treated with Programmed Cell Death-1 Inhibitors for Non-small Cell Lung Cancer.

peer reviewedPURPOSE: To investigate whether eosinophils and other white blood cell subtypes could be used as response and prognostic markers to anti-Programmed cell Death-1 or anti-PD-Ligand-1 treatments in non-small cell lung cancer patients. METHODS: We retrospectively analyzed data from the NSCLC patients consecutively treated at our hospital with a PD-1/PD-L1 inhibitor in monotherapy for advanced disease. A total of 191 patients were evaluated at three time-points to investigate any relation between tumor response and WBC counts. RESULTS: Baseline WBC and subtypes did not differ according to the type of response seen under treatment. A higher relative eosinophil count (REC) correlated with more objective responses (p = 0.019 at t1 and p = 0.014 at t2; OR for progression = 0.54 and 0.53, respectively) independently of the smoking status, PD-L1 status, and immune-related toxicity (IRT). Higher REC was also associated with a longer duration of treatment (p = 0.0096). Baseline absolute neutrophil count was prognostic (p = 0.049). At t1 relative lymphocytes, absolute and relative neutrophils, and neutrophil-to-lymphocyte ratio were prognostic (p = 0.044, p = 0.014, p = 0.0033, and p = 0.029, respectively). CONCLUSION: Our results show that in NSCLC patients anti-PD-1/PD-L1 therapy induces an early increase only in blood eosinophils, more prominent in responding patients and independent of the smoking status, PD-L1 status, and IRT. Eosinophils are also associated with a longer duration of treatment. Furthermore, our data support a prognostic role of neutrophils, lymphocytes, and their ratio for NSCLC patients with advanced disease treated with PD(L)-1 blockade

Probe-based confocal laser endomicroscopy for pleural malignancies diagnosis.

peer reviewedBACKGROUND AND OBJECTIVE: Probe based confocal laser endomicroscopy (pCLE) is an optical imaging technique allowing live tissue imaging at a cellular level. Currently, this tool remains experimental. Two studies regarding pleural disease have been published and suggest that pCLE could be valuable for pleural disease investigations. However, normal and malignant pleural pCLE features remain unknown. Therefore, we conducted a prospective trial of pCLE during medical thoracoscopy to study and describe the malignant and benign pleural pCLE features. METHODS: Every patient >18 years referred to our department for medical thoracoscopy was eligible. Medical thoracoscopy was performed under sedation, allowing spontaneous breathing. Five millilitres of fluorescein (10%) was intravenously administrated 5 min before image acquisition. The pCLE was introduced through the working channel of the thoracoscope and gently placed on the parietal pleura to record videos. Afterwards, biopsies were performed on the corresponding sites. Malignant and benign pleural pCLE features were precisely described and compared using 11 preselected criteria. RESULTS: A total of 62 patients were included in the analysis including 36 benign and 26 malignant pleura. Among our preselected criteria, 'abnormal tissue architecture' and 'dysplastic vessels' were strongly associated with malignancies (100% and 85% ss, 721% and 74% sp, respectively) whereas, the 'full chia seeds sign' and 'cell shape homogeneity' were associated with benignity (36% and 56% ss, 100% and 70% sp, respectively). No study-related adverse events occurred. CONCLUSION: Benign and malignant pleural involvement have clearly distinct pCLE features

IgG4-related pleural disease in a patient with a history of unknown origin acute pancreatitis: a case report and review of the literature.

Immunoglobulin G4-related disease is a rare autoimmune systemic disease with the capability of involving every organ. The disease is microscopically defined by a diffuse tissular inflammation with an infiltration of IgG4 positive plasma cells in the affected organs. IgG4 disease has an increasing incidence in the last few years with a growing interest in its pathophysiology still misunderstood to date. Despite the growing recognition of this pathology, the literature still does not allow to propose a simple diagnostic algorithm. In this article, we present a case of a 56-year-old man with a history of unknown etiology acute pancreatitis and a unilateral pleural effusion

Chronic thoracic pain

peer reviewedThe etiological diagnosis of chronic thoracic pain is wide, from benign mechanical disorders to tumors. Reaching the exact diagnosis in often time consuming. Despite the availability of new techniques of imagery, a meticulous clinical history and physical examination remain mandatory. They will lead the exploration. Idiopathic intercostal neuralgia does not exist