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Posts Tagged ‘pleural effusion’

What is the natural history of infective endocarditis vegetation ?

Posted in Uncategorized, tagged , , , , , , on January 12, 2011| Leave a Comment »

What happens to vegetation following  successful therapy ?

  1. It regresses almost completely  and become sterile
  2. It regresses about 50 % volume   but continue to harbor  live  viable bacteria
  3. Gets sterile   but  does not regress ,
  4. Vegetation vanishes completely .Gets dissolved circulation as micro particles.
  5. Appears slightly bulky.

Answer.

Each of the above statement can be true in different patients  at  / different times.  However No  1, is generally the dominant theme.

  • Most of the small vegetations disappear fully.
  • Large vegetations (>2 cm) almost never disappear fully .
  • Fungal vegetation is notoriously known  for a long haul battle
  • Systemic embolism is an important mode of  vegetation clearance from heart.
  • Size of vegetation is an independent indication for surgery .
  • Combination of vegetation with super added layer of  thrombus is common.The thrombus lyses in due course , mimicking thrombus regression.
  • Paradoxically healed vegetations may appear dense in  2 D echocadiography ,which may be wrongly interpreted as a growing vegetation.
  • The risk of recurrent vegetation formation remains till the raw area is completely endothelised.Hence antibiotics are given up to 4-6 weeks.

Persistent  culture negativity may be a  good index  for  successful management . But a negative blood culture  does not in any – way imply  absence of vegetation.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Retrieve&list_uids=7985602&dopt=abstractplus

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A new marker for transudate in pleural effusion

Posted in Cardiology - Clinical, cardiology -Therapeutics, Cardiology-Coronary artery disese, tagged , , , , , , on April 17, 2009| Leave a Comment »

Diagnostic issues in cardiac failure : A  febrile pleural effusion in a patient with LV dysfunction .

Is it a transudate or exudate ?  How to confirm the pleural effusion is primarily cardiac failure related ?

When the classical protein criteria is inadequate or prone for errors

Try this more specific marker  within the pleural fluid

N-Terminal Brain naruretic peptide

Pleural fluid NT-proBNP is very useful in establishing the diagnosis of HF-associated effusions, and it confirms this diagnosis . The measurement of NT-proBNP rather than serum to pleural protein gradient is recommended for identifying mislabeled cardiac transudates.

Reff :Biomarkers of Heart Failure in Pleural Fluid. Chest. 2009 Apr 10.

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Is there an antomical continuity between pleural space and pericardial space ?

Posted in Cardiology - Clinical, Infrequently asked questions in cardiology (iFAQs), tagged , , , , , , , , , , on September 28, 2008| 1 Comment »

                                 The pleura and pericardium are very close anatomical companions within the thorax. Both contain minimal levels of physiological fluid.  It is quiet common to find combined pleural and pericardial  effusion. While the commonest explanation for combination of pleural and pericardial effusion is inflammation of both  in systemic disorders like polyserositis or malignancy . In cardiac failure also both effusions can  occur explained by raised venous pressure.

But there has always been a curious relationship between these two spaces.

                         Is there a antomical or physiological link between these two spacs ?  In fact a large pleural effusion some times result in sympathetic pericardial  effusion.  Tapping of pleural effusion may regress this pericardial fluid as well.

                         This is purely a clinical observation and needs an explanation .It is  believed , there is  some  non functional lymphatic channels shared between pericardial  and pleural spaces.This may get opened up in pathology of either of them.

 

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