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Vol. 51. Issue 12.
Pages 632-636 (December 2015)
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Vol. 51. Issue 12.
Pages 632-636 (December 2015)
Original
Resultados del seguimiento a largo plazo de pacientes con derrame pleural no diagnosticado
Long-term Outcome of Patients With Undiagnosed Pleural Effusion
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Gulsah Gunluoglua,
Corresponding author
gunluoglu@yahoo.com

Autor para correspondencia.
, Aysun Olcmenb, Mehmet Zeki Gunluogluc, Ibrahim Dincerb, Adnan Sayarb, Gungor Camsaria, Veysel Yilmaza, Sedat Altina
a Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Chest Diseases, Bu çalışma Türk Toraks Derneği 17. Yıllık Kongresinde 3.4.2014 tarihinde ‘Sözel Sunum’ olarak sunulmuştur, Estambul, Turquía
b Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Thoracic Surgery, Bu çalışma Türk Toraks Derneği 17. Yıllık Kongresinde 3.4.2014 tarihinde ‘Sözel Sunum’ olarak sunulmuştur, Estambul, Turquía
c Medipol University Faculty of Medicine, Thoracic Surgery, Bu çalışma Türk Toraks Derneği 17. Yıllık Kongresinde 3.4.2014 tarihinde ‘Sözel Sunum’ olarak sunulmuştur, Estambul, Turquía
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Tables (3)
Tabla 1. Diagnósticos finales tras seguimiento
Tabla 2. Aspecto de las muestras iniciales de exudado de pacientes con mesotelioma maligno y otras afecciones
Tabla 3. Diagnósticos de pacientes con derrame reacumulado durante el seguimiento
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Resumen
Introducción

En algunos pacientes no es posible establecer la causa del derrame pleural exudativo. Se han analizado los resultados del seguimiento a largo plazo de pacientes con derrame pleural no diagnosticado.

Métodos

Se evaluó retrospectivamente a pacientes con derrame pleural exudativo a los que se les había realizado una biopsia pleural mediante cirugía toracoscópica videoasistida (VATS) entre 2008 y 2012 como parte de los procedimientos diagnósticos. En el estudio se incluyó a 53 pacientes con diagnóstico de pleuritis inespecífica y con datos de seguimiento disponibles.

Resultados

Se incluyó a 40 varones y 13 mujeres (promedio de edad, 53,9±13,9años). La mediana de tiempo de seguimiento fue de 24meses. Durante el seguimiento no se llegó a un diagnóstico en 27 pacientes (51%) y se alcanzó diagnóstico clínico en los 26 pacientes restantes (49%). A 2 pacientes (3,7%) se les diagnosticó neoplasia maligna (mesotelioma maligno). Otras enfermedades diagnosticadas fueron derrame paraneumónico en 12 casos, insuficiencia cardíaca congestiva en 8 casos y otras afecciones en 4 pacientes. El volumen del derrame en la exploración inicial y la reacumulación de fluido tras VATS se asociaron a neoplasia maligna (p=0,004 y 0,0001, respectivamente).

Conclusión

Aunque la probabilidad es baja, los pacientes con derrame pleural exudativo y sin diagnóstico tras una biopsia pleural mediante VATS pueden tener neoplasia maligna. Es necesario controlar cuidadosamente a los pacientes con un volumen de derrame inicial alto que reaparece tras la exploración.

Palabras clave:
Derrame pleural exudativo
Pleuritis inespecífica
Cirugía toracoscópica videoasistida
Pleuritis idiopática
Abstract
Introduction

The cause of exudative pleural effusion cannot be determined in some patients. The longterm outcomes of patients with undiagnosed pleural effusion were analyzed.

Methods

Patients with exudative pleural effusion whose diagnostic procedures included pleural biopsy using video-assisted thoracoscopic surgery carried out between 2008 and 2012 were evaluated retrospectively. Patients diagnosed with non-specific pleuritis were included. Fifty-three patients with available follow-up data were included in the study.

Results

Forty men and 13 women (mean age 53.9±13.9years) were included. Median follow-up time was 24months. No diagnosis was given in 27 patients (51%), and a clinical diagnosis was given in 26 patients (49%) during the follow-up period. Malignant disease (malignant mesothelioma) was diagnosed in 2 (3.7%) patients. Other diseases were parapneumonic effusion in 12, congestive heart failure in 8, and miscellaneous in 4 patients. Volume of effusion at the time of initial examination and re-accumulation of fluid after video-assisted thoracoscopic surgery were associated with malignant disease (P=.004 and .0001, respectively).

Conclusion

Although the probability is low, some patients with exudative pleural effusion undiagnosed after pleural biopsy via video-assisted thoracoscopic surgery may have malignant disease. Patients with an initially large volume of effusion that re-accumulates after examination should be closely monitored.

Keywords:
Exudative pleural effusion
Nonspecific
pleuritis
Video-assisted thoracoscopic surgery
Idiopathic pleuritis

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