Chest
Clinical InvestigationsA Prospective Study of Amylase-rich Pleural Effusions With Special Reference to Amylase Isoenzyme Analysis
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MATERIALS AND METHODS
Consecutive pleural fluid and corresponding serum samples from 200 patients seen in the Rotherham District General Hospital between Jan 1989 and Jan 1991 were analyzed for levels of total protein, glucose, amylase, and lactate dehydrogenase (LDH). Patients with a pleural fluid amylase level of more than 86 IU/L (upper limit of normal for serum) were identified as having an amylase-rich effusion, and if sufficient pleural fluid remained, an amylase isoenzyme determination was performed. The
RESULTS
The following tabulation listing numbers of cases shows the etiology of the 25 amylase-rich effusions:
Pancreatitis 4 Adenocarcinoma of the ovary 2 Metastatic carcinoma (unknown primary) 1 Non-Hodgkin's lymphoma 1 Chronic lymphatic leukemia 1 Bilateral hydronephrosis 1 Cirrhosis of the liver 1 Pulmonary tuberculosis 1
Among the benign causes for amylase-rich effusion not due to pancreatitis, parapneumonic effusion accounted for the majority (five cases); one patient had empyema. Of the four cases of
DISCUSSION
Amylase-rich pleural effusions are commonly associated with acute and chronic pancreatitis.2, 4, 5 Elevated serum amylase in association with a neoplasm was first described in 1951 by Weiss et al6 in a case of bronchogenic carcinoma, and subsequent descriptions of amylase-rich pleural effusions in bronchogenic carcinoma have been reported.7, 8 Although a few patients without malignancy have been described with nonpancreatic amylase-rich pleural effusions,2 no investigation of sequential
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2010, Journal of Emergency MedicineCitation Excerpt :However, as a diagnostic marker for acute pancreatitis, total serum amylase measurement lacks specificity, with estimates ranging from as low as 86% to 95% if the threshold level is taken to be more than three times the upper limit of normal (7,8). The reason for this lack of specificity is twofold; first, amylase is ordinarily found in several other organs, such as in the salivary glands, liver, biliary tree, duodenum, stomach, esophagus, lung, heart, and fallopian tubes, and second, amylase can be ectopically produced by a number of solid organ and hematological malignancies (9,10). Thus, hyperamylasemia has been reported in numerous other non-pancreatic conditions, including mumps, parotitis, perforated peptic ulcer, perforated appendicitis, intestinal obstruction, mesenteric infarction, pulmonary embolism, pneumonia, myocardial infarction, lung cancer, breast cancer, lymphoma, and several tubo-ovarian disorders (11,12).
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Manuscript received March 13; revision accepted April 29.