Clinical and imaging characteristics of acute pulmonary embolism with pleural effusion_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 DU Fei , ZHANG Li , CHEN Daigang , YANG Huajun

Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Zunyi (Third Affiliated Hospital of Zunyi Medical University), Zunyi, Guizhou 563000, P. R. China;

Corresponding author：

DU Fei, Email: fei632@163.com

Keywords：

Pulmonary embolism; Computed tomographic pulmonary angiography; Pleural effusion

DOI：

10.7507/1671-6205.201907095

Video：

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Objectives To investigate the clinical and imaging characteristics of pleural effusion in patients with acute pulmonary embolism (APE).Methods Computed tomographic pulmonary angiography (CTPA) scans and clinical data of suspected APE patients from January 2014 to December 2018 were analyzed.Results A total of 1024 suspected APE patients underwent CTPA examination in the imaging department of our hospital. Two hundred patients (19.5%) were diagnosed with APE. Imaging findings of pleural effusion were revealed in 70 cases (35.0%). The majority of APE patients without pleural effusion were males (82.3% vs. 64.3%, P<0.01), and the majority of APE patients with pleural effusion were females (35.7% vs. 17.7%, P<0.01). Most of the effusions were bilateral, small to moderate, with peripheral embolism (62.9%, P<0.05). Pulmonary consolidation, atelectasis and ground-glass opacity were common manifestations of CTPA. Compared with patients with simple pulmonary embolism, pulmonary embolism with pleural effusion was more common (62.9% and 33.8%, respectively, OR=3.279 and 95%CI 1.798 - 6.091, P<0.001). Diagnostic thoracic puncture was performed in 6 cases (8.6%). Pleural effusion was exudate in these 6 patients, with normal blood sugar and neutrophils predominated.Conclusions About one third of APE patients are associated with pleural effusion, which most presented with small and bilateral pleural effusions. The main embolism associated with pleural effusion is peripheral embolism. There is a significant correlation between pulmonary consolidation and pleural effusion. Pleural effusion is mostly exudate and neutrophils often predominate.

Citation： DU Fei, ZHANG Li, CHEN Daigang, YANG Huajun. Clinical and imaging characteristics of acute pulmonary embolism with pleural effusion. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(5): 474-477. doi: 10.7507/1671-6205.201907095 Copy

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2.	Sethwala A, Wang X, Sturm EE, et al. Predictive value of symptoms, signs and biomarkers on computed tomography pulmonary angiogram results. Intern Med J, 2018, 48(1): 55-59.
3.	中华医学会呼吸病学分会肺栓塞与肺血管病学组. 肺血栓栓塞症诊治与预防指南. 中华医学杂志, 2018, 98(14): 1060-1087.
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5.	Zhou X, Zhang Z, Zhai Z, et al. Pleural effusions as a predictive parameter for poor prognosis for patients with acute pulmonary thromboembolism. J Thromb Thrombolysis, 2016, 42(3): 432-440.
6.	Choi SH, Cha SI, Shin KM, et al. Clinical relevance of pleural effusion in patients with pulmonary embolism. Respiration, 2017, 93(4): 271-278.
7.	Kiris T, Yazici S, Koc A, et al. Prognostic impact of pleural effusion in acute pulmonary embolism. Acta Radiol, 2017, 58(7): 816-824.
8.	Wittram C, Maher MM, Yoo AJ, et al. CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics, 2004, 24: 1219-1238.
9.	Alonso Martinez JL, Anniccherico Sánchez FJ, Urbieta Echezarreta MA, et al. Central versus peripheral pulmonary embolism: analysis of the impact on the physiological parameters and long-term survival. N Am J Med Sci, 2016, 8: 134-142.
10.	Liu M, Cui A, Zhai ZG, et al. Incidence of pleural effusion in patients with pulmonary embolism. Chin Med J (Engl), 2015, 128(8): 1032-1036.
11.	Herédia V, Ramalho M, Zapparoli M, et al. Incidence of pulmonary embolism and other chest findings in younger patients using multidetector computed tomography. Acta Radiol, 2010, 51(4): 402-406.
12.	Gunnels JJ. Perplexing pleural effusion. Chest, 1978, 74(4): 390-393.
13.	Porcel JM, Madroñero AB, Pardina M, et al. Analysis of pleural effusions in acute pulmonary embolism: radiological and pleural fluid data from 230 patients. Respirology, 2007, 12(2): 234-239.
14.	Stein PD, Terrin ML, Hales CA, et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest, 1991, 100(3): 598-603.
15.	Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest, 1997, 112(4): 974-979.
16.	Lobo JL, Zorrilla V, Aizpuru F, et al. Clinical syndromes and clinical outcome in patients with pulmonary embolism: findings from the RIETE registry. Chest, 2006, 130(6): 1817-1822.
17.	贾练, 刘春涛, 唐永江, 等. 肺血栓栓塞症并发大量胸腔积液误诊一例. 中国呼吸与危重监护杂志, 2016, 15(2): 186-188.
18.	Levy O, Fux D, Bartsikhovsky T, et al. Clinical relevance of bilateral pleural effusion in patients with acute pulmonary embolism[J/OL]. Intern Med J, 2019. [2019-10-29]. https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.14671.
19.	Light RW. Pleural effusion in pulmonary embolism. Semin Respir Crit Care Med, 2010, 31(6): 716-722.
20.	Romero CS, Hernández BL, Soler MJ, et al. Biochemical and cytologic characteristics of pleural effusions secondary to pulmonary embolism. Chest, 2002, 121(2): 465-469.

1. Bĕlohlávek J, Dytrych V, Linhart A. Pulmonary embolism, partⅠ: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol, 2013, 18(2): 129-138.
2. Sethwala A, Wang X, Sturm EE, et al. Predictive value of symptoms, signs and biomarkers on computed tomography pulmonary angiogram results. Intern Med J, 2018, 48(1): 55-59.
3. 中华医学会呼吸病学分会肺栓塞与肺血管病学组. 肺血栓栓塞症诊治与预防指南. 中华医学杂志, 2018, 98(14): 1060-1087.
4. Light RW. Clinical practice: pleural effusion. N Engl J Med, 2002, 346(25): 1971-1977.
5. Zhou X, Zhang Z, Zhai Z, et al. Pleural effusions as a predictive parameter for poor prognosis for patients with acute pulmonary thromboembolism. J Thromb Thrombolysis, 2016, 42(3): 432-440.
6. Choi SH, Cha SI, Shin KM, et al. Clinical relevance of pleural effusion in patients with pulmonary embolism. Respiration, 2017, 93(4): 271-278.
7. Kiris T, Yazici S, Koc A, et al. Prognostic impact of pleural effusion in acute pulmonary embolism. Acta Radiol, 2017, 58(7): 816-824.
8. Wittram C, Maher MM, Yoo AJ, et al. CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics, 2004, 24: 1219-1238.
9. Alonso Martinez JL, Anniccherico Sánchez FJ, Urbieta Echezarreta MA, et al. Central versus peripheral pulmonary embolism: analysis of the impact on the physiological parameters and long-term survival. N Am J Med Sci, 2016, 8: 134-142.
10. Liu M, Cui A, Zhai ZG, et al. Incidence of pleural effusion in patients with pulmonary embolism. Chin Med J (Engl), 2015, 128(8): 1032-1036.
11. Herédia V, Ramalho M, Zapparoli M, et al. Incidence of pulmonary embolism and other chest findings in younger patients using multidetector computed tomography. Acta Radiol, 2010, 51(4): 402-406.
12. Gunnels JJ. Perplexing pleural effusion. Chest, 1978, 74(4): 390-393.
13. Porcel JM, Madroñero AB, Pardina M, et al. Analysis of pleural effusions in acute pulmonary embolism: radiological and pleural fluid data from 230 patients. Respirology, 2007, 12(2): 234-239.
14. Stein PD, Terrin ML, Hales CA, et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest, 1991, 100(3): 598-603.
15. Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest, 1997, 112(4): 974-979.
16. Lobo JL, Zorrilla V, Aizpuru F, et al. Clinical syndromes and clinical outcome in patients with pulmonary embolism: findings from the RIETE registry. Chest, 2006, 130(6): 1817-1822.
17. 贾练, 刘春涛, 唐永江, 等. 肺血栓栓塞症并发大量胸腔积液误诊一例. 中国呼吸与危重监护杂志, 2016, 15(2): 186-188.
18. Levy O, Fux D, Bartsikhovsky T, et al. Clinical relevance of bilateral pleural effusion in patients with acute pulmonary embolism[J/OL]. Intern Med J, 2019. [2019-10-29]. https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.14671.
19. Light RW. Pleural effusion in pulmonary embolism. Semin Respir Crit Care Med, 2010, 31(6): 716-722.
20. Romero CS, Hernández BL, Soler MJ, et al. Biochemical and cytologic characteristics of pleural effusions secondary to pulmonary embolism. Chest, 2002, 121(2): 465-469.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical and imaging characteristics of acute pulmonary embolism with pleural effusion

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