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2015 ; 94
(17
): e800
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Diagnostic pitfalls of discriminating lymphoma-associated effusions
#MMPMID25929933
Chen HJ
; Huang KY
; Tseng GC
; Chen LH
; Bai LY
; Liang SJ
; Tu CY
; Light RW
Medicine (Baltimore)
2015[May]; 94
(17
): e800
PMID25929933
show ga
High serum lactate dehydrogenase (LDH) level, immunologic defects, enlarged
mediastinal lymph nodes, and frequent hydration and diuresis in lymphoma patients
may affect the development of pleural effusion (PE). The study was to assess the
clinical utility of "Light criteria" and the "recommended algorithm for
investigating PEs" in patients with lymphoma.The characteristics of 126 PEs of
lymphoma patients who underwent diagnostic thoracentesis between January 1, 2003,
and April 30, 2012, were reviewed. Using Light criteria, 29 (23%) PEs were
incorrectly classified. The sensitivity for exudates in Light criteria was 88%
and the specificity was only 44%. In 32 transudates, PE LDH correlated with blood
LDH concentration (P?0.001, r?=?0.66). Nine transudates were misclassified as
exudates (50%; 9/18) just due to PE LDH more than two-thirds the upper limits.
Among the 56 bilateral PEs, 33 (59%) were exudates. Ten (63%) polymorphonuclear
(PMN)-predominant exudative PEs were malignant. Infective PEs were often
mononuclear (67%) rather than PMN predominant.When a patient has lymphoma with
either unilateral or bilateral PE, thoracentesis for microbiological testing and
cytology is imperative. Carefully clinical correlation in addition to the result
from Light criteria and differential cell count is essential for prompt
management.