Abstract
Background: PE due to congestive heart failure is not always a transudate, almost 12% of patients with cardiac disease have an exudative PE. Serum BNP > 500 pg/ml has high diagnostic accuracy in recognizing PE of cardiac origin nevertheless in some cases only more invasive procedures such as medical thoracoscopy (MT) can make a final etiological diagnosis. To our knowledge there are not report about the endoscopic and histological pattern of an exudative PE of cardiac origin
Aim: to describe endoscopic and histopathological findings in patients with evidence of cardiac disease (BNP plasma values >500 pg/ml) and an exudative PE.
Methods: We carry out a retrospective study of 202 MT performed in our hospital for undetermined exudative PE. Only patients with BNP > 500 pg/ml were included. Thoracoscopic findings (TF) were graded as Type 1: diffuse pleural thickening, Type2: non-specific pleural inflammation with or without nodules, Type 3: normal pleura. At least 10 pleural biopsies were taken from each patient.
Results: of 202 patients with exudative PE, 15 (7.4%) had a BNP plasma level > 500 pg/ml (Mean, SE: 891±204). Type 1 TF were observed in 13 patients (87%), Type 2 in 2 cases (13%). All patients with Type 1 TF had a faint pleural thickening and histopathological changes characterized by mesothelial cell hyperplasia, polymorphic flogistic infiltration with lymphocyte predominance. The 2 patients with type 2 TF had a final diagnosis of pleural tuberculosis
Conclusion: A diagnosis of cardiac pleurisy is characterized by endoscopic evidence of diffuse faint pleural thickening and histopathological findings of mesothelial cell hyperplasia with polymorphic flogistic infiltration.
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