Asymptomatic Pleural Empyema And Chronic Pleural Effusion Diagnosed By Bi-Digital O-Ring Test

Abstract

Objective:

One of the main features of pleural empyema are clinical signs indicating the presence of infection in the pleural space - fever, chest pain, cough. Although sometimes variable in intensity, symptoms are usually severe. Chest X-ray aspect is not always typical so that thoracentesis is sometimes performed with delay. The aim was to assess the value of the BiDigital O-Ring Test (BDORT) method in the diagnostics of the asymptomatic pleural empyema.

Concerning pleural effusions of different etiology, despite many performed diagnostic procedures, hystopathological confirmation is not always possible. Beside the possibility of false positive or false negative findings, course of the disease is sometimes in discrepancy with the diagnosis. The aim is also to assess the value of the BDORT in this subgroup of patients thus contributing to the overall diagnostic accuracy.

Method:

Report of two cases. In both patients indirect Bi-Digital O-Ring Test (BDORT) was performed both on patients and on their chest X-rays, based on the original work by Prof. Omura, Y.

Results:

(Case 1): 23-years old woman in good health, without history of respiratory diseases, whose chest X-ray showed bizarre opacity in the lateral third of the right hemithorax. BDORT showed a mixed aerobic and anaerobic bacterial infection. The reference substances used in this test were antibiotics: Ampicillin caps of 500 mg (Krka, Novo Mesto), Alfacet (Cephaklor) caps of 500 mg (ICN) and Orvagyl (Metronidazol) tbl of 400 mg (ICN). Based on the result of the BDORT, thoracentesis was done revealing the presence of purulent effusion in the pleural space.

(Case 2): 75-years old man in good health prior to current disease. The only symptoms were weight loss and the lea-sided pleural effusion. Analysis of the serous fluid obtained by thoracentesis was not conclusive. Thoracoscopy was done 5 months after the onset of the disease. Endoscopic aspect corresponded to pleural carcinomatosis and was confirmed histologically - Adenocarcinoma mucinosum (probably of gastric origin). In this patient, BDORT did not confirm any malignancy. Gastroscopic exploration did not confirm the existence of the malignant disease. There was no recurrence of the pleural effusion and 15 months after the onset of the disease, beside slight opacities by the lateral chest wall and over the diaphragm (that correspond to pleural sequels), normal chest X-ray aspect exists. CT-scan of the thorax indicates the existence of fibrin deposition in the pleural space without other abnormalities.

Conclusion:

Our results support the attitude that BDORT can be of great help in unclear clinical situations, rendering even more information than classical diagnostics. These findings justify the use of BDORT as the routine procedure in the diagnostics of lung diseases. In our patients results of the BDORT were in agreement with the course of the disease. Whether BDORT can replace numerous painful and time-consuming classical diagnostic procedures needs further confirmation.