Managing Pleural Disease in Acute Medicine (I): Pleural Effusion

2007 ◽  
Vol 6 (3) ◽  
pp. 114-120
Author(s):  
Nazir I. Lone ◽  
◽  
George Antunes ◽  
Keyword(s):  
Clinical Practice ◽  
Pleural Effusion ◽  
Pleural Space ◽  
Diagnostic Approach ◽  
Initial Assessment ◽  
Common Finding ◽  
Pleural Disease ◽  
Pleural Effusions ◽  
Acute Medicine ◽  
Recent Developments

A pleural effusion is the accumulation of fluid in the pleural space. It is a relatively common finding in clinical practice. The diagnostic approach to the patient presenting with a pleural effusion is aimed at defining the effusion as a transudate or an exudate. This review summarises the initial assessment and investigation of pleural effusions diagnosed during the acute medical take, and who should be referred for specialist advice. In addition, recent developments, including the measurement of NT-proBNP levels and diagnostic markers for mesothelioma, are presented.

scholarly journals A Case with Severe Endometriosis, Ovarian Hyperstimulation Syndrome, and Isolated Unilateral Pleural Effusion after IVF

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Negjyp Sopa ◽  
Elisabeth Clare Larsen ◽  
Anders Nyboe Andersen
Keyword(s):  
Pleural Effusion ◽  
Ovarian Hyperstimulation Syndrome ◽  
Common Finding ◽  
Ovarian Hyperstimulation ◽  
Pleural Effusions ◽  
Luteal Support ◽  
Vitro Fertilization ◽  
Fluid Production ◽  
The Right

We present a very rare case of right-sided isolated pleural effusion in a patient with severe endometriosis who, in relation to in vitro fertilization (IVF), developed ovarian hyperstimulation syndrome (OHSS). Earlier laparotomy showed grade IV endometriosis including endometriotic implants of the diaphragm. The patient had no known risk factors for OHSS and only a moderate number of oocytes aspirated. She received, however, repeated hCG injections for luteal support. The patient did not achieve pregnancy but was hospitalized due to pain in the right side of the chest and dyspnoea. A chest computed tomography (CT) showed a pleural effusion on the right side. Total of 1000 ml of pleural fluid was drained after a single thoracentesis. After three days, the symptoms and fluid production ceased. Ascites is a common finding in OHSS, but pleural effusions are rare. Further, isolated pleural effusions have not previously been described in a patient with endometriosis. We suggest that the repeated hCG injections induced effusions from the endometriotic lesions at the diaphragm and as a consequence this patient developed isolated hydrothorax.

Introduction to Pleural Disease

Chest Imaging ◽  
2019 ◽  
pp. 155-158
Author(s):  
Christopher M. Walker
Keyword(s):  
Pleural Effusion ◽  
Asbestos Exposure ◽  
Pleural Space ◽  
Pulmonary Vasculature ◽  
Pleural Disease ◽  
Pleural Thickening ◽  
Pleural Plaques ◽  
Pleural Surface ◽  
Pleural Neoplasm ◽  
Ct Features

The chapter titled introduction to pleural disease discusses the imaging and clinical features of diseases of the pleura. The pleural space is a potential space located between the visceral and parietal pleural surfaces. Pleural effusion and pneumothorax are the most common manifestations of pleural disease and are caused by a wide variety of disease processes. Pleural thickening may be related to benign or malignant processes. Bilateral discontinuous nodular pleural thickening is characteristic of pleural plaques. Pleural thickening with calcification may also be seen in fibrothorax. Malignant pleural disease may manifest with pleural effusion, pleural nodules or masses, or a combination of the two. There are several CT features suggestive of malignant pleural thickening including circumferential pleural thickening, pleural nodules or masses, involvement of the mediastinal pleural surface, and pleural thickening measuring greater than 1 cm in thickness. Metastatic disease is the most common pleural neoplasm. Mesothelioma is uncommon but remains the most common primary pleural malignancy and is almost always seen in patients with previous asbestos exposure. Pleural abnormalities must be differentiated from pulmonary processes. Pleural masses may exhibit obtuse angles with the adjacent pleural surfaces, displace rather than engulf adjacent pulmonary vasculature, and may exhibit the incomplete border sign.

Pleurodesis with Iodized Talc for Malignant Effusions Using Pigtail Catheters

1998 ◽  
Vol 32 (7-8) ◽  
pp. 739-742 ◽  
Author(s):  
Robert L Thompson ◽  
Jonathan C Yau ◽  
Ronald F Donnelly ◽  
Debra J Gowan ◽  
Frederick RK Matzinger
Keyword(s):  
Pleural Effusion ◽  
Tertiary Care ◽  
Pleural Space ◽  
Pigtail Catheter ◽  
Pleural Effusions ◽  
Talc Pleurodesis ◽  
Malignant Pleural Effusions ◽  
Kaplan Meier ◽  
A Prospective Study ◽  
The Cost

OBJECTIVE: To assess the efficacy of using an iodized talc slurry as a sclerosing agent instilled into the pleural space via a 12-French pigtail catheter for controlling malignant pleural effusions. DESIGN: A prospective study in which patients were followed until their death. SETTING: A university-affiliated tertiary-care teaching hospital. PATIENTS: Medical oncology patients admitted with symptomatic malignant pleural effusions were considered for iodized talc pleurodesis. MAIN OUTCOME MEASURES: The control of pleural effusion. Treatment failure was defined as any reaccumulation of fluid in the pleural space. RESULTS: Fifteen patients were treated for a total of 17 instillations. The median follow-up on all patients until death was 6 months (range 1–20). The most frequent adverse effect in the study group was pleuritic chest pain (60%). The probability of control of effusion, as determined by the method of Kaplan–Meier, was 81% (SEM 9.7%). The cost of preparing 5 g of iodized talc was $4.32 (US). CONCLUSIONS: Iodized talc slurry instilled through a small-bore pigtail catheter is a safe, economical, and effective treatment for malignant pleural effusion.

scholarly journals Investigation of Pleural Effusions

2011 ◽  
Vol 10 (4) ◽  
pp. 216-220
Author(s):  
Luaie Idris ◽  
◽  
Nilushi Ranaweera ◽  
Diane Laws ◽  
◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Organ Dysfunction ◽  
Medical Condition ◽  
Pleural Space ◽  
Pleural Effusions ◽  
Common Medical Condition

Pleural effusion is a common medical condition which often presents on the AMU. There are more than 50 recognised causes of pleural effusion which include diseases local to the pleura or underlying lung, systemic conditions, organ dysfunction and drugs.1 The normal pleural space contains approximately 1mL of fluid. The balance between hydrostatic and oncotic pressures in the visceral and parietal pleural vessels maintains this environment; any disorder affecting this balance will result in a pleural effusion.

scholarly journals P-OGC91 Significance of the number, size and type of drains used for intercostal drainage after oesophagectomy for cancer

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Jennifer Wheat ◽  
Alan Askari ◽  
Asanish Kalyanasundaram ◽  
Mouhamad Ismail ◽  
John Bennett ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Neoadjuvant Therapy ◽  
Enhanced Recovery ◽  
Pleural Space ◽  
Secondary Outcome ◽  
Pleural Effusions ◽  
Chyle Leak ◽  
Thoracoabdominal Approach ◽  
Minimum Number ◽  
Recovery Protocols

Abstract Background Pleural space drainage with intercostal drains (ICD) is performed after oesophagectomy to allow the lung to reinflate, remove excess fluid post-operatively, and signal chyle or enteric content.  Enhanced recovery protocols encourage the use of the minimum number of drains for the shortest duration to facilitate rapid recovery after surgery. There is wide variability in the type, number and size of drains inserted at operation. This study sought to identify the most effective drain pattern insertion, using the need for respiratory reintervention as the primary end point and secondary outcome of the presence of pleural effusions. Methods All patients undergoing oesophagectomy for cancer in one unit were included between November 2014 and December 2020. The operation performed, drain sizes, sides and type were recorded. Respiratory reintervention was defined as replacement of an ICD, bronchoscopy, pleural aspiration or reintubation. The primary and secondary end points, and potential confounders such as age, histology, pre-operative stage of disease, neoadjuvant therapy, pre-existing lung disease, and anastomotic or chyle leak were recorded. Results The study period encompassed 258 patients who underwent oesophagectomy for cancer. Median age 69 (range 32-82), 211 male, 226 ACA:32 SCC, 224 neoadjuvant therapy, 212 right-sided thoracic operations, 46 left thoracoabdominal approach. Post-operative respiratory reinterventions occurred in 47 patients (18.2%). At least one post-operative pleural effusion was present in 52 patients (20.2%): 9 bilateral; 26 contralateral; 17 ipsilateral to the side of thoracic surgery. 67% of effusions were contralateral to the operated side. The use of two or three ICDs (HR 371683269, p < 1), one or two operative side ICDs (HR 0, p < 1), Blake’s drains in place of rigid ICDs (HR 0.938 [0.422-2.085], p < 0.875), and size 24F compared to 28F drains (HR 0, p < 0.999) are not significantly associated with post-operative respiratory reinterventions. Similarly, the presence of post-operative pleural effusions is not significantly associated with the use of two or three ICDs (HR 240242843, p < 1), one or two operative side ICDs (HR 0, p < 1), Blake’s drains in place of rigid ICDs (HR 1.505 [0.665-3.405], p < 0.327), and size 24F compared to 28F drains (HR 1.055 [0.109-10.2], p < 0.963). Conclusions This study supports the use of contralateral pleural space drainage as two thirds of effusions were contralateral to the operated side. It shows no correlation between the size of drains, number of drains or use of Blakes drains and the likelihood of requiring a post-operative respiratory intervention or development of post-operative pleural effusion. Therefore the ERAS principles of the fewest number of drains for the shortest duration should be adopted.

Management of pleural effusion and haemothorax

2016 ◽  
Author(s):  
Davide Chiumello ◽  
Silvia Coppola
Keyword(s):  
Pleural Effusion ◽  
Symptomatic Relief ◽  
Underlying Disease ◽  
Pleural Space ◽  
Bacterial Invasion ◽  
Pleural Effusions ◽  
Management Options ◽  
External Drainage ◽  
Malignant Effusions ◽  
Pleural Catheter

The main goal of management of pleural effusion is to provide symptomatic relief removing fluid from the pleural space. The options depend on type, stage, and underlying disease. The first diagnostic instrument is the chest radiography, while ultrasound can be very useful to guide thoracentesis. Pleural effusion can be a transudate or an exudate. Generally, a transudate is uncomplicated effusion treated by medical therapy, while an exudative effusion is considered complicated effusion and should be managed by drainage. Refractory non-malignant effusions can be transudative (congestive heart failure, cirrhosis, nephrosis) or exudative (pancreatitis, connective tissue disease, endocrine dysfunction), and the management options include repeated therapeutic thoracentesis, in-dwelling pleural catheter for intermittent external drainage, pleuroperitoneal shunts for internal drainage, or surgical pleurectomy. Parapneumonic pleural effusions can be classified as complicated when there is persistent bacterial invasion of the pleural space, uncomplicated and empyema with specific indications for pleural fluid drainage. Malignancy is the most common cause of exudative pleural effusions in patients aged >60 years and the decision to treat depends upon the presence of symptoms and the underlying tumour type. Options include in-dwelling pleural catheter drainage, pleurodesis, pleurectomy, and pleuroperitoneal shunt. Haemothorax needs to be differentiated from a haemorrhagic pleural effusion and, when suspected, the essential management is intercostal drainage. It achieves two objectives to drain the pleural space allowing expansion of the lung and to allow assessment of rates of blood loss to evaluate the need for emergency or urgent thoracotomy.

scholarly journals Integration of voltammetric analysis, protein electrophoresis and pH measurement for diagnosis of pleural effusions: a non-conventional diagnostic approach

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Maria Elena Pipita ◽  
Marco Santonico ◽  
Giorgio Pennazza ◽  
Alessandro Zompanti ◽  
Sara Fazzina ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diagnostic Techniques ◽  
Protein Electrophoresis ◽  
Ph Measurement ◽  
Diagnostic Approach ◽  
Great Promise ◽  
Pleural Effusions ◽  
Voltammetric Analysis ◽  
Post Surgery

Abstract Pleural effusion is very common, but an etiologic diagnosis is often difficult. We used three unconventional diagnostic techniques (voltammetric analysis, protein electrophoresis and pH measurement) performed on pleural effusion to do a preliminary distinction between a neoplastic and a non-neoplastic origin. Pleural fluid samples were collected through thoracentesis, thoracoscopy, or post-surgery pleural drainage of 116 patients admitted to acute care wards. Samples were analyzed with the three unconventional techniques: voltammetric analysis using the BIONOTE system, capillary electrophoresis and pH measurement using a potentiometric method. The BIONOTE system is an innovative system that performs a cyclic voltammetric analysis of a biological liquid sample. The final output of the electrochemical analysis is an electrical pattern that represents a fingerprint of the analyzed sample and each sample has a different fingerprint. Data from the three unconventional diagnostic techniques were analyzed using partial least squares discriminant analysis to discriminate neoplastic from non-neoplastic effusions; we also evaluated sensitivity, specificity and percentage of correct classification. The mean age was 68 years (SD: 12); 78 (67.24%) participants were men. Results obtained from all the unconventional techniques employed showed that neoplastic and non-neoplastic pleural effusions were correctly classified in 80.2% of cases, with a sensitivity of 77% and specificity of 83%. The combined use of voltammetric analysis, protein electrophoresis and pH measurement of pleural fluid can easily and quickly distinguish a neoplastic from a non-neoplastic pleural effusion with reliable accuracy and represents an innovative diagnostic approach. In fact, this protocol can be executed in just few minutes directly in the patient's bed and it holds great promise to improve the prognosis and therapeutic chances.

Pleural effusion

2007 ◽  
pp. 145-152
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Chest Radiograph ◽  
Pleural Space ◽  
Parietal Pleura ◽  
Clinical Approach ◽  
Clinical Scenario ◽  
Pleural Effusions ◽  
Wide Range

Introduction 146 Causes 146 Clinical approach 147 Pleural fluid 149 Management 151 Pleural effusions are a common clinical scenario with a wide range of causes. They are defined as an accumulation of fluid between the visceral and parietal pleura. There is normally around 20 ml of fluid present in the pleural space. Around 400 ml needs to be present before clinically apparent, whilst >200 ml is visible on the PA chest radiograph....

Pleural Effusion: Diagnosis and Management

2009 ◽  
Vol 19 (8) ◽  
pp. 242-247 ◽  
Author(s):  
Z Ahmad ◽  
R Krishnadas ◽  
P Froeschle
Keyword(s):  
Pleural Effusion ◽  
Hospital Admission ◽  
Perioperative Care ◽  
Pulmonary Infection ◽  
Lymphatic Drainage ◽  
Colloid Osmotic Pressure ◽  
Pleural Space ◽  
Common Finding ◽  
Diagnosis And Management ◽  
Pulmonary Capillaries

Pleural effusion is defined as an accumulation of fluid in the pleural space in excess of 15 to 20mls. The aetiology for the development of a pleural effusion includes changes in hydrostatic or colloid-osmotic pressure of pleural and pulmonary capillaries, changes in pleural vascular permeability and impaired lymphatic drainage. About 5% to 12% of patients referred for emergency medical treatment are diagnosed with a pleural effusion, making it a common finding on hospital admission. The excess of pleural fluid may be triggered by pleuro-pulmonary infection, malignancy, or conditions of cardiac, renal or hepatic origin. Subsequent management is guided mainly by aetiology and to a lesser degree by symptoms. This paper provides a review of pathophysiology, diagnosis and management of the condition and addresses specific issues regarding the perioperative care of these patients.

scholarly journals Novel pleural-bladder pump in malignant pleural effusions: from animal model to man

Thorax ◽  
2020 ◽  
Vol 75 (5) ◽  
pp. 432-434 ◽  
Author(s):  
Philippe Astoul ◽  
Sophie Laroumagne ◽  
Jeroen Capel ◽  
Nicholas A Maskell
Keyword(s):  
Quality Of Life ◽  
Animal Model ◽  
Pleural Effusion ◽  
Management Strategy ◽  
Malignant Pleural Effusion ◽  
Pleural Space ◽  
Optimal Management ◽  
Pleural Effusions ◽  
Pump System

Malignant pleural effusion is common and causes disabling symptoms such as breathlessness. Treatments are palliative and centred around improving symptoms and quality of life but an optimal management strategy is yet to be universally agreed. A novel pump system, allowing fluid to be moved from the pleural space to the urinary bladder, may have a role for the management of recurrent malignant pleural effusion. We hereby describe the first animal study using this device and the results of the first application in patients.

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