However, high FADA levels can also occur in other disease conditions and particularly in empyemas, lymphomas, carcinomas and parapneumonic effusions due to proliferation of large numbers of neutrophils and lymphocytes in these conditions, resulting in false-positive results and misdiagnosis.
17] found that parapneumonic effusions were the most frequent reason for a high FADA, followed by carcinomas (with pleural metastatic lesions) and lymphomas.
Causes of an exudate Frequent * Tuberculosis * Malignancy * Parapneumonic effusions Infrequent * Rheumatoid and other autoimmune disorders * Post-myocardial infarct syndrome * Post-coronary artery bypass * Asbestos-related effusion * Pancreatitis * Drugs (Table 3)
In addition to the elevated LDH and low pH values, parapneumonic effusions are neutrophil predominant.
Pleural fluid PCR method for detection of Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae in pediatric parapneumonic effusions
Use of fibrinolytic agents in the management of complicated parapneumonic effusions
Therapy of parapneumonic effusions
in children: Video-Assisted Thoracoscopic Surgery versus conventional thoracostomy drainage.
Other reported complications are bronchopleural fistula, pulmonary abscesses, parapneumonic effusions
, empyema, pyopneumothorax(15,16), bronchial reactivity(17), eosinophillic alveolitis(18), ARDS(15,19) and severe multi-organ failure(20).
In fact, pooled data in the American College of Chest Physicians consensus statement on the treatment of parapneumonic effusions
suggest that mortality is actually higher with VATS (4.
In an earlier but similar study from another children's hospital in the country, Buckingham et al (2) reported that the proportion of cases of complicated parapneumonic effusions
caused by S aureus increased from 6% in the period 1996 to 2000 (all of which were methicillin susceptible) to 30% in 2001 (all methicillin resistant).
Thirty-seven pleural fluids were clinically classified as exudates (n = 26; 10 patients with malignancies, 13 with pneumonic and parapneumonic effusions
, 3 with Dressler syndrome) or as transudates [n = 11; 10 patients with congestive heart failure and 1 with (pseudo)Meigs syndrome].
1) Parapneumonic effusions
, tuberculosis, and Pneumocystis carinii are other common causes.