Medicine › Pulmonary and Respiratory Medicine

Pleural and Pulmonary Diseases

Works Count: 63803

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Description

This cluster of papers focuses on the diagnosis and management of various pleural diseases, including pleural effusion, empyema, pneumothorax, and tuberculous pleural effusion. It covers topics such as thoracoscopy, pleurodesis, malignant pleural effusion, parapneumonic effusions, pleural catheter insertion, and thoracentesis.

Keywords

Pleural Effusion; Empyema; Pneumothorax; Thoracoscopy; Pleurodesis; Tuberculous Pleural Effusion; Malignant Pleural Effusion; Parapneumonic Effusions; Pleural Catheter; Thoracentesis

General Thoracic Surgery

1983-12-01

JOSEPH L. KOVARIK

This second edition consists of 18 sections with 75 chapters written by 79 contributors. Of these, 26 chapters are new, reflecting advances in thoracic surgery during the past ten years. … This second edition consists of 18 sections with 75 chapters written by 79 contributors. Of these, 26 chapters are new, reflecting advances in thoracic surgery during the past ten years. Diaphragmatic pacing, lung transplantation, and laser endoscopic procedures are examples of this expanding field. The text is arranged in a logical sequence of anatomy, physiology, diagnostic procedures, and preoperative evaluation. Following is more specific consideration of the surgical treatment of trauma and diseases of the chest wall, diaphragm, lungs, esophagus, and mediastinum. The section on anesthetic treatment of patients undergoing thoracic surgery includes discussion of postoperative care and ventilatory support. Considerable attention is devoted to the continuing study of the function and motor disturbances of the esophagus in the sections on physiology and the esophagus. Chapters dealing with radiation therapy, chemotherapy, and immunology discuss the optional or adjuvant therapies currently available. Technical aspects are well presented in the section on

The Pleura

1988-07-01

Steven A. Sahn

Carcinomatous involvement of the pleura

1977-11-01

Bart Chernow , Steven A. Sahn

Diagnosis of Diseases of the Chest.

1978-08-01

G Robert Fraser

Diagnosis of diseases of the chest , Diagnosis of diseases of the chest , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی Diagnosis of diseases of the chest , Diagnosis of diseases of the chest , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی

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Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974.

1979-12-01

L. Joseph Melton , Norman G. Hepper , K. P. Offord

Between 1950 and 1974, 318 cases of initial pneumothorax were diagnosed among the residents of Olmsted County, Minn. Seventy-five cases were due to trauma, and 102 were iatrogenic. One hundred … Between 1950 and 1974, 318 cases of initial pneumothorax were diagnosed among the residents of Olmsted County, Minn. Seventy-five cases were due to trauma, and 102 were iatrogenic. One hundred forty-one cases were spontaneous in onset, of which 77 were primary and 64 secondary to a specific underlying pulmonary disease. The age-adjusted incidence of primary spontaneous pneumothorax was 7.4/100,000/yr for males and 1.2/100,000/yr for females. For secondary spontaneous pneumothorax, the incidence was 6.3 and 2.0/100,000/yr for males and females, respectively. The ratio of male-to-female incidence was 6.2:1 for primary and 3.2:1 for secondary spontaneous pneumothorax. The differences between the incidence rates for primary and secondary pneumothorax by sex or in total were not significantly different.

The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients

1985-08-15

William W. Johnston

This study reports the cytopathologic diagnoses rendered on all malignant pleural effusions received and processed over a period of 14 years. Specimens of fluid from various body sites (25,464) were … This study reports the cytopathologic diagnoses rendered on all malignant pleural effusions received and processed over a period of 14 years. Specimens of fluid from various body sites (25,464) were examined. Of these, 5888 (23%) were specimens of pleural effusions. Five hundred eighty-four specimens (9.9% of total pleural fluid specimens) taken from 472 patients were diagnosed as containing cancer cells. Of the malignant pleural effusions, 75.7% were classified as carcinomatous in type. Adenocarcinomas comprised 47.4% of the 584 specimens. The groups of large cell undifferentiated carcinoma and lymphoma/leukemia approximated one another in being the second most common cancer groups (14.3% and 15.0%, respectively). For both males and females, the frequency of organ site or primary tumor type was lung (35.6%), lymphoma/leukemia (15.9%), breast (14.8%), female genital tract (8.1%), and gastrointestinal tract (5.9%). Among male patients, the order of frequency was lung (49.1%), lymphoma/leukemia (21.1%), gastrointestinal tract (7.0%), genitourinary tract (6.0%), and malignant melanoma (1.4%). In female patients, the order of frequency was breast (37.4%), female genital tract (usually ovary) (20.3%), lung (15.0%), lymphoma/leukemia (8.0%), and gastrointestinal tract (4.3%). In 48 patients (10.2%) the primary site of neoplasm was never determined. In 90.5% of patients a cytopathologic diagnosis conclusive for cancer was obtained on the first specimen of fluid. There were no false positive diagnoses.

Quantification of pleural effusions: sonography versus radiography.

1994-06-01

K. Eibenberger , W Dock , Markus Ammann +3 more

PURPOSE: To develop a practical method of estimating the volume of pleural effusions with sonography. MATERIALS AND METHODS: Fifty-one patients underwent sonography of the pleural space while supine. Sonographic results … PURPOSE: To develop a practical method of estimating the volume of pleural effusions with sonography. MATERIALS AND METHODS: Fifty-one patients underwent sonography of the pleural space while supine. Sonographic results and results of lateral decubitus radiography were compared with actual effusion volumes. The maximum thickness of the pleural fluid layer was measured with both modalities, while actual effusion volume was determined by means of complete drainage. RESULTS: Sonographic measurements correlated statistically significantly better with actual effusion volume (r = .80) than did radiographic measurements (r = .58) (P < or = .05). With sonographic measurement, an effusion width of 20 mm had a mean volume of 380 mL +/- 130 (standard deviation), while one of 40 mm had a mean volume of 1,000 mL +/- 330. Prediction error with sonographic measurement (mean, 224 mL) was statistically significantly less (P < or = .002) than that with radiographic measurement (mean, 465 mL). CONCLUSION: In quantification of pleural effusions, the sonographic measurement method presented is preferable to radiographic measurement.

Value of sonography in determining the nature of pleural effusion: analysis of 320 cases.

1992-07-01

Pan‐Chyr Yang , K T Luh , D B Chang +3 more

To assess the value of sonography in determining the nature of pleural effusions, we prospectively analyzed the sonographic findings in 320 patients with pleural effusion of various causes (224 with … To assess the value of sonography in determining the nature of pleural effusions, we prospectively analyzed the sonographic findings in 320 patients with pleural effusion of various causes (224 with exudates and 96 with transudates). The nature of the effusions was established on the basis of chemical, bacteriologic, and cytologic examination of pleural fluid; pleural biopsy; and clinical follow-up. All patients had high-frequency, real-time sonography performed by one of three sonographers who had no clinical information concerning the patients. The sonographer evaluated the images for internal echogenicity of the effusion, thickness of the pleura, and associated parenchymal lesions of the lung. The images were also printed out and interpreted a second time by the other two sonographers to reach a consensus. Our results showed that the two types of effusions could be distinguished on the basis of sonographic findings. Transudates were anechoic, whereas an anechoic effusion could be either a transudate or an exudate. Pleural effusions with complex septated, complex nonseptated, or homogeneously echogenic patterns were always exudates (p less than .01). Sonographic findings of thickened pleura and associated parenchymal lesions in the lung also were indicative of an exudate (p less than .01). Homogenous echogenic effusions were due to hemorrhagic effusion or empyema. Sonographic evidence of a pleural nodule was a specific finding in patients with a malignant effusion. We conclude that sonography is useful in determining the nature of pleural effusion.

Diagnosis and Treatment of Tuberculous Pleural Effusion in 2006

2007-03-01

Arun Gopi , Sethu M. Madhavan , Surendra K. Sharma +1 more

U.K. Controlled Trial of Intrapleural Streptokinase for Pleural Infection

2005-03-02

Nick Maskell , Christopher W.H. Davies , Andrew Nunn +7 more

Intrapleural fibrinolytic agents are used in the drainage of infected pleural-fluid collections. This use is based on small trials that did not have the statistical power to evaluate accurately important … Intrapleural fibrinolytic agents are used in the drainage of infected pleural-fluid collections. This use is based on small trials that did not have the statistical power to evaluate accurately important clinical outcomes, including safety. We conducted a trial to clarify the therapeutic role of intrapleural streptokinase.In this double-blind trial, 454 patients with pleural infection (defined by the presence of purulent pleural fluid or pleural fluid with a pH below 7.2 with signs of infection or by proven bacterial invasion of the pleural space) were randomly assigned to receive either intrapleural streptokinase (250,000 IU twice daily for three days) or placebo. Patients received antibiotics and underwent chest-tube drainage, surgery, and other treatment as part of routine care. The number of patients in the two groups who had died or needed surgical drainage at three months was compared (the primary end point); secondary end points were the rates of death and of surgery (analyzed separately), the radiographic outcome, and the length of the hospital stay.The groups were well matched at baseline. Among the 427 patients who received streptokinase or placebo, there was no significant difference between the groups in the proportion of patients who died or needed surgery (with streptokinase: 64 of 206 patients [31 percent]; with placebo: 60 of 221 [27 percent]; relative risk, 1.14 [95 percent confidence interval, 0.85 to 1.54; P=0.43), a result that excluded a clinically significant benefit of streptokinase. There was no benefit to streptokinase in terms of mortality, rate of surgery, radiographic outcomes, or length of the hospital stay. Serious adverse events (chest pain, fever, or allergy) were more common with streptokinase (7 percent, vs. 3 percent with placebo; relative risk, 2.49 [95 percent confidence interval, 0.98 to 6.36]; P=0.08).The intrapleural administration of streptokinase does not improve mortality, the rate of surgery, or the length of the hospital stay among patients with pleural infection.

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Effect of an Indwelling Pleural Catheter vs Chest Tube and Talc Pleurodesis for Relieving Dyspnea in Patients With Malignant Pleural Effusion

2012-05-20

Helen Davies , Eleanor Mishra , Brennan C Kahan +7 more

<h3>Context</h3>Malignant pleural effusion causes disabling dyspnea in patients with a short life expectancy. Palliation is achieved by fluid drainage, but the most effective first-line method has not been determined.<h3>Objective</h3>To determine … <h3>Context</h3>Malignant pleural effusion causes disabling dyspnea in patients with a short life expectancy. Palliation is achieved by fluid drainage, but the most effective first-line method has not been determined.<h3>Objective</h3>To determine whether indwelling pleural catheters (IPCs) are more effective than chest tube and talc slurry pleurodesis (talc) at relieving dyspnea.<h3>Design</h3>Unblinded randomized controlled trial (Second Therapeutic Intervention in Malignant Effusion Trial [TIME2]) comparing IPC and talc (1:1) for which 106 patients with malignant pleural effusion who had not previously undergone pleurodesis were recruited from 143 patients who were treated at 7 UK hospitals. Patients were screened from April 2007-February 2011 and were followed up for a year.<h3>Intervention</h3>Indwelling pleural catheters were inserted on an outpatient basis, followed by initial large volume drainage, education, and subsequent home drainage. The talc group were admitted for chest tube insertion and talc for slurry pleurodesis.<h3>Main Outcome Measure</h3>Patients completed daily 100-mm line visual analog scale (VAS) of dyspnea over 42 days after undergoing the intervention (0 mm represents no dyspnea and 100 mm represents maximum dyspnea; 10 mm represents minimum clinically significant difference). Mean difference was analyzed using a mixed-effects linear regression model adjusted for minimization variables.<h3>Results</h3>Dyspnea improved in both groups, with no significant difference in the first 42 days with a mean VAS dyspnea score of 24.7 in the IPC group (95% CI, 19.3-30.1 mm) and 24.4 mm (95% CI, 19.4-29.4 mm) in the talc group, with a difference of 0.16 mm (95% CI, −6.82 to 7.15; P = .96). There was a statistically significant improvement in dyspnea in the IPC group at 6 months, with a mean difference in VAS score between the IPC group and the talc group of −14.0 mm (95% CI, −25.2 to −2.8 mm; P = .01). Length of initial hospitalization was significantly shorter in the IPC group with a median of 0 days (interquartile range [IQR], 0-1 day) and 4 days (IQR, 2-6 days) for the talc group, with a difference of −3.5 days (95% CI, −4.8 to −1.5 days; P < .001). There was no significant difference in quality of life. Twelve patients (22%) in the talc group required further pleural procedures compared with 3 (6%) in the IPC group (odds ratio [OR], 0.21; 95% CI, 0.04-0.86; P = .03). Twenty-one of the 52 patients in the catheter group experienced adverse events vs 7 of 54 in the talc group (OR, 4.70; 95% CI, 1.75-12.60; P = .002).<h3>Conclusion</h3>Among patients with malignant pleural effusion and no previous pleurodesis, there was no significant difference between IPCs and talc pleurodesis at relieving patient-reported dyspnea.<h3>Trial Registration</h3>isrctn.org Identifier: ISRCTN87514420

Uniportal VATS wedge pulmonary resections

2004-01-28

Gaetano Rocco , Antonio E. Martin-Ucar , Eliseo Passera

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Bronchopleural Fistulas

2005-12-01

Manuel Lois , Marc Noppen

A Randomized Trial of Empyema Therapy

1997-06-01

Michael A. Wait , Sashi Sharma , Joyce Hohn +1 more

TRANSPORT OF AIR ALONG SHEATHS OF PULMONIC BLOOD VESSELS FROM ALVEOLI TO MEDIASTINUM

1939-11-01

Charles Macklin

EXPERIMENTAL INVESTIGATIONS Pulmonic Interstitial Emphysema. —That air, after it has broken from the pulmonic alveoli into the interstitial tissue of the lung, can travel along the sheaths of the pulmonary … EXPERIMENTAL INVESTIGATIONS Pulmonic Interstitial Emphysema. —That air, after it has broken from the pulmonic alveoli into the interstitial tissue of the lung, can travel along the sheaths of the pulmonary blood vessels, in artificial channels which it dissects for itself, to the root of the lung, and from there into the mediastinum, has been amply demonstrated in a series of experiments on cats and other animals.1The alveoli are made to leak by overinflating them, and so stretching and straining the walls. This is accomplished by passing a truncated catheter into a region of the lung (the lower lobe of the right lung is conveniently used) and blowing air into it, thus extending the alveolar walls and producing many small ruptures in their floors, which overlie the small branches of the pulmonary blood vessels. It is important to visualize clearly this locus of the leakage,2the area of

Murray and Nadel’s Textbook of Respiratory Medicine

2011-09-20

Vanessa Nomellini , Herbert Chen

Postoperative pain-related morbidity: Video-assisted thoracic surgery versus thoracotomy

1993-12-01

Rodney J. Landreneau , Stephen R. Hazelrigg , Michael J. Mack +7 more

Epidemiology of pneumothorax in England

2000-08-01

Dheeraj Gupta , Anna Hansell , Tom Nichols +3 more

<h3>BACKGROUND</h3> Little is known of the epidemiology of pneumothorax. Routinely available data on pneumothorax in England are described. <h3>METHODS</h3> Patients consulting in primary care with a diagnosis of pneumothorax in … <h3>BACKGROUND</h3> Little is known of the epidemiology of pneumothorax. Routinely available data on pneumothorax in England are described. <h3>METHODS</h3> Patients consulting in primary care with a diagnosis of pneumothorax in each year from 1991 to 1995 inclusive were identified from the General Practice Research Database (GPRD). Emergency hospital admissions for pneumothorax were identified for the years 1991–4 from the Hospital Episode Statistics (HES) data. Mortality data for England & Wales were obtained for 1950–97. Analyses of pneumothorax rates by age and sex were performed for all data sources. Seasonal and geographical analyses were carried out for the HES data. <h3>RESULTS</h3> The overall person consulting rate for pneumothorax (primary and secondary combined) in the GPRD was 24.0/100 000 each year for men and 9.8/100 000 each year for women. Hospital admissions for pneumothorax as a primary diagnosis occurred at an overall incidence of 16.7/100 000 per year and 5.8/100 000 per year for men and women, respectively. Mortality rates were 1.26/million per year for men and 0.62/million per year for women. The age distribution in both men and women showed a biphasic distribution for both GP consultations and hospital admissions. Deaths showed a single peak with highest rates in the elderly. There was an urban-rural trend observed for hospital admissions in the older age group (55+ years) with admission rates in the conurbations significantly higher than in the rural areas. Analysis for trends in mortality data for 1950–97 showed a striking increase in the death rate for pneumothorax in those aged 55+ years between 1960 and 1990, with a steep decline in the 1990s. Mortality in the younger age group (15–34 years) remained low and constant. <h3>CONCLUSION</h3> There is evidence of two epidemiologically distinct forms of spontaneous pneumothorax in England. The explanation for the rise and fall in mortality for secondary pneumothorax is obscure.

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A RESISTANT PNEUMOCOCCUS

1967-07-01

David Hansman , Monica M. Bullen

Surgical Stabilization of Internal Pneumatic Stabilization? A Prospective Randomized Study of Management of Severe Flail Chest Patients

2002-04-01

Hideharu Tanaka , Tetsuo Yukioka , Yoshihiro Yamaguti +4 more

Background We compared the clinical efficacy of surgical stabilization and internal pneumatic stabilization in severe flail chest patients who required prolonged ventilatory support. Methods Thirty-seven consecutive severe flail chest patients … Background We compared the clinical efficacy of surgical stabilization and internal pneumatic stabilization in severe flail chest patients who required prolonged ventilatory support. Methods Thirty-seven consecutive severe flail chest patients who required mechanical ventilation were enrolled in this study. All the patients received identical respiratory management, including end-tracheal intubation, mechanical ventilation, continuous epidural anesthesia, analgesia, bronchoscopic aspiration, postural drainage, and pulmonary hygiene. At 5 days after injury, surgical stabilization with Judet struts (S group, n = 18) or internal pneumatic stabilization (I group, n = 19) was randomly assigned. Most respiratory management was identical between the two groups except the surgical procedure. Statistical analysis using two-way analysis of variance and Tukey's test was used to compare the groups. Results Age, sex, Injury Severity Score, chest Abbreviated Injury Score, number of rib fractures, severity of lung contusion, and Pao2/Fio2 ratio at admission were all equivalent in the two groups. The S group showed a shorter ventilatory period (10.8 ± 3.4 days) than the I group (18.3 ± 7.4 days) (p < 0.05), shorter intensive care unit stay (S group, 16.5 ± 7.4 days; I group, 26.8 ± 13.2 days;p < 0.05), and lower incidence of pneumonia (S group, 24%; I group, 77%;p < 0.05). Percent forced vital capacity was higher in the S group at 1 month and thereafter (p < 0.05). The percentage of patients who had returned to full-time employment at 6 months was significantly higher in the S group (11 of 18) than in the I group (1 of 19). Conclusion This study proved that in severe flail chest patients, surgical stabilization using Judet struts has beneficial effects with respect to less ventilatory support, lower incidence of pneumonia, shorter trauma intensive care unit stay, and reduced medical cost than internal fixation. Moreover, surgical stabilization with Judet struts improved percent forced vital capacity from the early phase after surgical fixation. Also, patients with surgical stabilization could return to their previous employment quicker than those with internal pneumatic stabilization, even in those with the same severity of flail chest. We therefore concluded that surgical stabilization with Judet struts may be preferably applied to patients with severe flail chest who need ventilator support.

The Role of CT Pulmonary Angiography in the Investigation of Unilateral Pleural Effusions

2013-06-29

Clare Hooper , Isabel Laurence , John Harvey +4 more

The CT features of benign and malignant pleural diseases have been described. However, the accuracy of these features in the differential diagnosis of diffuse pleural disease has not been assessed … The CT features of benign and malignant pleural diseases have been described. However, the accuracy of these features in the differential diagnosis of diffuse pleural disease has not been assessed before. Without knowledge of clinical or pathologic data, we reviewed the CT findings in 74 consecutive patients with proved diffuse pleural disease (39 malignant and 35 benign). The patients included 53 men and 21 women 23-78 years old. Features that were helpful in distinguishing malignant from benign pleural disease were (1) circumferential pleural thickening, (2) nodular pleural thickening, (3) parietal pleural thickening greater than 1 cm, and (4) mediastinal pleural involvement. The specificities of these findings were 100%, 94%, 94%, and 88%, respectively. The sensitivities were 41%, 51%, 36%, and 56%, respectively. Twenty-eight of 39 malignant cases (sensitivity, 72%; specificity, 83%) were identified correctly by the presence of one or more of these criteria. Malignant mesothelioma (n = 11) could not be reliably differentiated from pleural metastases (n = 24). We conclude that CT is helpful in the differential diagnosis of diffuse pleural disease, particularly in differentiation of malignant from benign conditions.

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The "lung point": an ultrasound sign specific to pneumothorax

2000-10-01

David R. Lichtenstein , Gilbert Mezière , Philippe Biderman +1 more

Tuberculous Pleurisy

1998-10-12

Luís Valdés , David Álvarez , Esther San José +5 more

<h3>Objectives</h3> To determine the age at which tuberculous pleural effusions occur, the radiological and biochemical characteristics of the effusions, the sensitivities of the various diagnostic tests, and the utility of … <h3>Objectives</h3> To determine the age at which tuberculous pleural effusions occur, the radiological and biochemical characteristics of the effusions, the sensitivities of the various diagnostic tests, and the utility of combining clinical, radiological, and analytic data in diagnosis. <h3>Methods</h3> We studied the case histories of 254 patients in whom tuberculous pleural effusions were diagnosed with certainty between January 1, 1989, and June 30, 1997, in a Spanish university hospital in a region with a high incidence of tuberculosis. <h3>Results</h3> The mean (±SD) age of the patients was 34.1 ± 18.1 years, and 62.2% were younger than 35 years. The effusion was on the right side in 55.9% of patients, on the left side in 42.5% of patients, and on both sides in 1.6% of patients. In 81.5% of patients, less than two thirds of the hemithorax was affected. Associated pulmonary lesions were detected in 18.9% of patients, of whom 14.6% exhibited cavitation. In 93.3% of the effusions, more than 50% of leukocytes were lymphocytes, and almost all had the biologic characteristics of exudates (98.8% had high total protein contents, 94.9% had high cholesterol levels, and 82.3% had high lactate dehydrogenase levels). All but 1 effusion (99.6%) had an adenosine deaminase (ADA) concentration higher than 47 U/L, 96.8% (123/127) of the effusions had high ADA<sub>2</sub>levels, and 89% (73/82) of the effusions had high interferon gamma levels. Adenosine deaminase 2 contributed 72.2% ± 12.5% (mean ± SD) of total ADA activity. Total ADA activity was significantly correlated with ADA<sub>2</sub>(<i>r</i>=0.83) and with interferon gamma (<i>r</i>=0.30) levels. Definitive diagnosis was based on the observation of caseous granulomas in pleural biopsy tissue samples in 79.8% of patients, on the results of biopsy cultures in 11.7% of patients, and on pleural effusion cultures in the remaining 8.5% of patients. Results of the tuberculin skin test were positive in only 66.5% of patients. <h3>Conclusions</h3> In these patients, lymphocyte-rich exudative pleural effusions occurred, on average, at a young age, with no preference for either the right or the left side; normally affected no more than two thirds of the hemithorax; and were generally unaccompanied by pulmonary infiltrates. High ADA concentration was a highly sensitive diagnostic sign and was caused by a rise in ADA<sub>2</sub>concentration. The most sensitive criterion based on pleural biopsy was the observation of caseous granulomas, and culture of biopsy material further increased overall sensitivity. Negative skin test results were no guarantee of the effusion being nontuberculous. This, together with the low mean age of the patients and the low frequency of associated pulmonary lesions, suggests that tuberculous pleural effusion is a primary form of tuberculosis in this region.

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Pleural Effusions: The Diagnostic Separation of Transudates and Exudates

1972-10-01

Richard W. Light

In this prospective study of 150 pleural effusions, the utility of pleural-fluid cell counts, protein levels, and lactic dehydrogenase (LDH) levels for the separation of transudates from exudates was evaluated. … In this prospective study of 150 pleural effusions, the utility of pleural-fluid cell counts, protein levels, and lactic dehydrogenase (LDH) levels for the separation of transudates from exudates was evaluated. According to preset diagnostic criteria, 47 of the effusions were classified as transudates and 103 as exudates. Three characteristics were found, each of which was associated with over 70% of the exudates and, at most, one of the transudates: [1] a pleural fluid-to-serum protein ratio greater than 0.5; [2] a pleural fluid LDH greater than 200 IU; and [3] a pleural fluid-to-serum LDH ratio greater than 0.6. Moreover, all but one exudate had at least one of these three characteristics, whereas only one transudate had any of the three. The simultaneous use of both the pleural-fluid protein and LDH levels better differentiates transudates from exudates than does the use of either of these values individually.

Smoking and the Increased Risk of Contracting Spontaneous Pneumothorax

1987-12-01

László Bense , Gunnar Eklund , Lars-Gösta Wiman

Comparison of Needle Biopsy With Cytologic Analysis for the Evaluation of Pleural Effusion: Analysis of 414 Cases

1985-03-01

Udaya B. S. Prakash , Herbert M. Reiman

Medical and Surgical Treatment of Parapneumonic Effusions

2000-10-01

Gene Colice , Anne B. Curtis , Jean Deslauriers +6 more

Initial Diagnosis of Lung Cancer

2007-09-01

M. Patricia Rivera , Atul C. Mehta

BTS guidelines for the management of spontaneous pneumothorax

2003-05-01

Michael T. Henry , Thomas Arnold , J. Harvey

These guidelines have been replaced by BTS Pleural Disease Guideline 2010 Superseded By BTS Pleural Disease Guideline 2010: BTS Guidelines for the Management of Pleural Disease. Thorax 2003 May; 58(Suppl … These guidelines have been replaced by BTS Pleural Disease Guideline 2010 Superseded By BTS Pleural Disease Guideline 2010: BTS Guidelines for the Management of Pleural Disease. Thorax 2003 May; 58(Suppl 2): 1–59.

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Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score

2014-08-06

Amelia Clive , Brennan C Kahan , Clare Hooper +7 more

<h3>Background</h3> Malignant pleural effusion (MPE) causes debilitating breathlessness and predicting survival is challenging. This study aimed to obtain contemporary data on survival by underlying tumour type in patients with MPE, … <h3>Background</h3> Malignant pleural effusion (MPE) causes debilitating breathlessness and predicting survival is challenging. This study aimed to obtain contemporary data on survival by underlying tumour type in patients with MPE, identify prognostic indicators of overall survival and develop and validate a prognostic scoring system. <h3>Methods</h3> Three large international cohorts of patients with MPE were used to calculate survival by cell type (univariable Cox model). The prognostic value of 14 predefined variables was evaluated in the most complete data set (multivariable Cox model). A clinical prognostic scoring system was then developed and validated. <h3>Results</h3> Based on the results of the international data and the multivariable survival analysis, the LENT prognostic score (pleural fluid <b>l</b>actate dehydrogenase, Eastern Cooperative Oncology Group (<b>E</b>COG) performance score (PS), <b>n</b>eutrophil-to-lymphocyte ratio and <b>t</b>umour type) was developed and subsequently validated using an independent data set. Risk stratifying patients into low-risk, moderate-risk and high-risk groups gave median (IQR) survivals of 319 days (228–549; n=43), 130 days (47–467; n=129) and 44 days (22–77; n=31), respectively. Only 65% (20/31) of patients with a high-risk LENT score survived 1 month from diagnosis and just 3% (1/31) survived 6 months. Analysis of the area under the receiver operating curve revealed the LENT score to be superior at predicting survival compared with ECOG PS at 1 month (0.77 vs 0.66, p<0.01), 3 months (0.84 vs 0.75, p<0.01) and 6 months (0.85 vs 0.76, p<0.01). <h3>Conclusions</h3> The LENT scoring system is the first validated prognostic score in MPE, which predicts survival with significantly better accuracy than ECOG PS alone. This may aid clinical decision making in this diverse patient population.

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Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease

1995-01-01

Jonathan D. Cooper , Elbert P. Trulock , Anastasios N. Triantafillou +5 more

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Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010

2010-08-01

Helen Davies , R. J. O. Davies , C. W. H. Davies

Pleural infection is a frequent clinical problem with an approximate annual incidence of up to 80 000 cases in the UK and USA combined. The associated mortality and morbidity is … Pleural infection is a frequent clinical problem with an approximate annual incidence of up to 80 000 cases in the UK and USA combined. The associated mortality and morbidity is high; in the UK 20% of patients with empyema die and approximately 20% require surgery to recover within 12 months of their infection.1 2 Prompt evaluation and therapeutic intervention appears to reduce morbidity and mortality as well as healthcare costs.3 This article presents the results of a peer-reviewed systematic literature review combined with expert opinion of the preferred management of pleural infection in adults for clinicians in the UK. The clinical guidelines generated from this process are presented in figure 1. The guidelines are aimed predominantly at physicians involved in adult general and respiratory medicine and specifically do not cover in detail the complex areas of tuberculous empyema, paediatric empyema or the surgical management of post-pneumonectomy space infection. Figure 1 Flow diagram describing the management of pleural infection. This section provides background information for reference, interest and to set the management guidelines in context. ### Historical perspective The Egyptian physician Imhotep initially described pleural infection around 3000 BC, although Hippocrates has been more famously credited with its recognition in 500 BC. Until the 19th century open thoracic drainage was the recommended treatment for this disorder but carried an associated mortality of up to 70%.4 5 This high mortality was probably due to respiratory failure produced by the large open pneumothorax left by drainage.5 This was particularly true of Streptococcus pyogenes infections which produce streptokinase and large alocular effusions free of adhesions.5 Closed tube drainage was first described in 1876 but was not widely adopted until the influenza epidemic of 1917–19. An Empyema Commission subsequently produced recommendations that remain the basis for treatment today. They advocated adequate pus drainage with a closed …

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Management of malignant pleural effusions

2001-08-01

Veena B. Antony , R. Loddenkemper , P. Astoul +5 more

⇓Malignant pleural effusions are a common clinical problem in patients with neoplastic disease. In one post mortem series, malignant effusions were found in 15% of patients who died with malignancies … ⇓Malignant pleural effusions are a common clinical problem in patients with neoplastic disease. In one post mortem series, malignant effusions were found in 15% of patients who died with malignancies 1. Although there have been no epidemiological studies, the annual incidence of malignant pleural effusions in the United States is estimated to be >150,000 cases (table 1⇓) 2–17. Malignant pleural effusion is also one of the leading causes of exudative effusion; studies have demonstrated that 42–77% of exudative effusions are secondary to malignancy 18, 19. Fig. 1.— Malignant pleural effusions: sensitivity (%) of different biopsy methods (cytological and histological results combined). Presented is a prospective simultaneous comparison (n=208). Fig. 2.— Diagnostic sensitivity of cytology (□) and medical thoracoscopy (![Graphic][1]</img>) in malignant pleural effusions. n-numbers are as follows: lung cancer, 67; non-lung primary, 154; mesothelioma, 66; total, 287. Fig. 3.— View this table: Table 1— Incidence of malignant pleural effusions (MPEs) Nearly all neoplasms have been reported to involve the pleura. In most studies, however, lung carcinoma has been the most common neoplasm, accounting for approximately one-third of all malignant effusions. Breast carcinoma is the second most common. Lymphomas, including both Hodgkin's disease and non-Hodgkin's lymphoma, are also an important cause of malignant pleural effusions. Tumours less commonly associated with malignant pleural effusions include ovarian and gastrointestinal carcinomas. In 5–10% of malignant effusions, no primary tumour is identified 12, 13. The incidence of mesothelioma varies according to the geographical location. Post mortem studies suggest that most pleural metastases arise from tumour emboli to the visceral pleural surface, with secondary seeding to the parietal pleura 1, 20. Other possible mechanisms include direct tumour invasion (in lung cancers, chest wall neoplasms, and breast carcinoma), haematogenous spread to parietal pleura, and lymphatic involvement. A malignant tumour can cause a pleural effusion, both directly and indirectly. … [1]: F2/embed/inline-graphic-1.gif

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Intrapleural Use of Tissue Plasminogen Activator and DNase in Pleural Infection

2011-08-10

Najib M. Rahman , Nick Maskell , Alex West +7 more

More than 30% of patients with pleural infection either die or require surgery. Drainage of infected fluid is key to successful treatment, but intrapleural fibrinolytic therapy did not improve outcomes … More than 30% of patients with pleural infection either die or require surgery. Drainage of infected fluid is key to successful treatment, but intrapleural fibrinolytic therapy did not improve outcomes in an earlier, large, randomized trial.We conducted a blinded, 2-by-2 factorial trial in which 210 patients with pleural infection were randomly assigned to receive one of four study treatments for 3 days: double placebo, intrapleural tissue plasminogen activator (t-PA) and DNase, t-PA and placebo, or DNase and placebo. The primary outcome was the change in pleural opacity, measured as the percentage of the hemithorax occupied by effusion, on chest radiography on day 7 as compared with day 1. Secondary outcomes included referral for surgery, duration of hospital stay, and adverse events.The mean (±SD) change in pleural opacity was greater in the t-PA-DNase group than in the placebo group (-29.5±23.3% vs. -17.2±19.6%; difference, -7.9%; 95% confidence interval [CI], -13.4 to -2.4; P=0.005); the change observed with t-PA alone and with DNase alone (-17.2±24.3 and -14.7±16.4%, respectively) was not significantly different from that observed with placebo. The frequency of surgical referral at 3 months was lower in the t-PA-DNase group than in the placebo group (2 of 48 patients [4%] vs. 8 of 51 patients [16%]; odds ratio for surgical referral, 0.17; 95% CI, 0.03 to 0.87; P=0.03) but was greater in the DNase group (18 of 46 patients [39%]) than in the placebo group (odds ratio, 3.56; 95% CI, 1.30 to 9.75; P=0.01). Combined t-PA-DNase therapy was associated with a reduction in the hospital stay, as compared with placebo (difference, -6.7 days; 95% CI, -12.0 to -1.9; P=0.006); the hospital stay with either agent alone was not significantly different from that with placebo. The frequency of adverse events did not differ significantly among the groups.Intrapleural t-PA-DNase therapy improved fluid drainage in patients with pleural infection and reduced the frequency of surgical referral and the duration of the hospital stay. Treatment with DNase alone or t-PA alone was ineffective. (Funded by an unrestricted educational grant to the University of Oxford from Roche UK and by others; Current Controlled Trials number, ISRCTN57454527.).

A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions

1999-11-15

Joe B. Putnam , Richard W. Light , R. Michael Rodriguez +7 more

The purpose of this study was to compare the effectiveness and safety of a chronic indwelling pleural catheter with doxycycline pleurodesis via tube thoracostomy in the treatment of patients with … The purpose of this study was to compare the effectiveness and safety of a chronic indwelling pleural catheter with doxycycline pleurodesis via tube thoracostomy in the treatment of patients with recurrent symptomatic malignant pleural effusions (MPE).In this multi-institutional study conducted between March 1994 and February 1997, 144 patients (61 men and 83 women) were randomized in a 2:1 distribution to either an indwelling pleural catheter or doxycycline pleurodesis. Patients receiving the indwelling catheter drained their effusions via vacuum bottles every other day or as needed for relief of dyspnea.The median hospitalization time was 1.0 day for the catheter group and 6.5 days for the doxycycline group. The degree of symptomatic improvement in dyspnea and the quality of life was comparable in each group. Six of 28 patients who received doxycycline (21%) had a late recurrence of pleural effusion, whereas 12 of 91 patients who had an indwelling catheter (13%) had a late recurrence of their effusions or a blockage of their catheter after the initially successful treatment (P = 0.446). Of the 91 patients sent home with the pleural catheter, 42 (46%) achieved spontaneous pleurodesis at a median of 26.5 days.A chronic indwelling pleural catheter is an effective treatment for the management of patients with symptomatic, recurrent, malignant pleural effusions. When compared with doxycycline pleurodesis via tube thoracostomy, the pleural catheter requires a shorter hospitalization and can be placed and managed on an outpatient basis.

Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010

2010-08-01

Clare Hooper , Gary Lee , Nick Maskell

Pleural effusions are a common medical problem with more than 50 recognised causes including disease local to the pleura or underlying lung, systemic conditions, organ dysfunction and drugs.1 Pleural effusions … Pleural effusions are a common medical problem with more than 50 recognised causes including disease local to the pleura or underlying lung, systemic conditions, organ dysfunction and drugs.1 Pleural effusions occur as a result of increased fluid formation and/or reduced fluid resorption. The precise pathophysiology of fluid accumulation varies according to underlying aetiologies. As the differential diagnosis for a unilateral pleural effusion is wide, a systematic approach to investigation is necessary. The aim is to establish a diagnosis swiftly while minimising unnecessary invasive investigations and facilitating treatment, avoiding the need for repeated therapeutic aspirations when possible. Since the 2003 guideline, several clinically relevant studies have been published, allowing new recommendations regarding image guidance of pleural procedures with clear benefits to patient comfort and safety, optimum pleural fluid sampling and processing and the particular value of thoracoscopic pleural biopsies. This guideline also includes a review of recent evidence for the use of new biomarkers including N-terminal pro-brain natriuretic peptide (NT-proBNP), mesothelin and surrogate markers of tuberculous pleuritis. The history and physical examination of a patient with a pleural effusion may guide the clinician as to whether the effusion is a transudate or an exudate. This critical distinction narrows the differential diagnosis and directs further investigation. Clinical assessment alone is often capable of identifying transudative effusions. Therefore, in an appropriate clinical setting such as left ventricular failure with a confirmatory chest x-ray, such effusions do not need to be sampled unless there are atypical features or they fail to respond to treatment. Approximately 75% of patients with pulmonary embolism and …

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Diagnostic tools in tuberculous pleurisy: a direct comparative study: 1

2003-10-01

Andreas H. Diacon , B. W. Van de Wal , C Wyser +4 more

Thoracoscopy is the most accurate yet most expensive tool for establishing the diagnosis of tuberculous (TB) pleurisy. However, most high TB‐incidence regions have limited financial resources, lack the infrastructure needed … Thoracoscopy is the most accurate yet most expensive tool for establishing the diagnosis of tuberculous (TB) pleurisy. However, most high TB‐incidence regions have limited financial resources, lack the infrastructure needed for routine thoracoscopy and require an alternative, costeffective diagnostic approach for pleural effusions. Altogether, 51 patients with undiagnosed exudative pleural effusions were recruited for a prospective, direct comparison between bronchial wash, pleural fluid microbiology and biochemistry (adenosine deaminase (ADA) and cell count), closed needle biopsy, and medical thoracoscopy. The final diagnosis was TB in 42 patients (82%), malignancy in five (10%) and idiopathic in four patients (8%). Sensitivity of histology, culture and combined histology/culture was 66, 48 and 79%, respectively for closed needle biopsy and 100, 76 and 100%, respectively for thoracoscopy. Both were 100% specific. Pleural fluid ADA of ≥50 U·L<sup>−1</sup> was 95% sensitive and 89% specific. Combined ADA, lymphocyte/neutrophil ratio ≥0.75 plus closed needle biopsy reached 93% sensitivity and 100% specificity. A combination of pleural fluid adenosine deaminase, differential cell count and closed needle biopsy has a high diagnostic accuracy in undiagnosed exudative pleural effusions in areas with high incidences of tuberculosis and might substitute medical thoracoscopy at considerably lower expense in resourcepoor countries.

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Update on tuberculous pleural effusion

2010-03-22

Richard W. Light

The possibility of tuberculous pleuritis should be considered in every patient with an undiagnosed pleural effusion, for if this diagnosis is not made the patient will recover only to have … The possibility of tuberculous pleuritis should be considered in every patient with an undiagnosed pleural effusion, for if this diagnosis is not made the patient will recover only to have a high likelihood of subsequently developing pulmonary or extrapulmonary tuberculosis Between 3% and 25% of patients with tuberculosis will have tuberculous pleuritis. The incidence of pleural tuberculosis is higher in patients who are HIV positive. Tuberculous pleuritis usually presents as an acute illness with fever, cough and pleuritic chest pain. The pleural fluid is an exudate that usually has predominantly lymphocytes. Pleural fluid cultures are positive for Mycobacterium tuberculosis in less than 40% and smears are virtually always negative. The easiest way to establish the diagnosis of tuberculous pleuritis in a patient with a lymphocytic pleural effusion is to generally demonstrate a pleural fluid adenosine deaminase level above 40 U/L. Lymphocytic exudates not due to tuberculosis almost always have adenosine deaminase levels below 40 U/L. Elevated pleural fluid levels of gamma-interferon also are virtually diagnostic of tuberculous pleuritis in patients with lymphocytic exudates. In questionable cases the diagnosis can be established by demonstrating granulomas or organisms on tissue specimens obtained via needle biopsy of the pleura or thoracoscopy. The chemotherapy for tuberculous pleuritis is the same as that for pulmonary tuberculosis.

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CT in differential diagnosis of diffuse pleural disease.

1990-03-01

Ann N. Leung , Néstor L. Müller , Roberta R. Miller

CT in differential diagnosis of diffuse pleural disease.A N Leung, N L Müller and R R MillerAudio Available | Share CT in differential diagnosis of diffuse pleural disease.A N Leung, N L Müller and R R MillerAudio Available | Share

Parapneumonic Effusions and Empyema

2006-02-21

R.W. Light

Parapneumonic effusions occur in 20 to 40% of patients who are hospitalized with pneumonia. The mortality rate in patients with a parapneumonic effusion is higher than that in patients with … Parapneumonic effusions occur in 20 to 40% of patients who are hospitalized with pneumonia. The mortality rate in patients with a parapneumonic effusion is higher than that in patients with pneumonia without a parapneumonic effusion. Some of the excess mortality is due to mismanagement of the parapneumonic effusion. Characteristics of patients that indicate that an invasive procedure will be necessary for its resolution include the following: an effusion occupying more than 50% of the hemithorax or one that is loculated; a positive Gram stain or culture of the pleural fluid; and a purulent pleural fluid that has a pH below 7.20 or a glucose below 60, or has a lactic acid dehydrogenase level of more than three times the upper normal limit for serum. Patients with pneumonia and an effusion of more than minimal size should have a therapeutic thoracentesis. If the fluid cannot be removed with a therapeutic thoracentesis, a chest tube should be inserted and consideration be given to the intrapleural instillation of fibrinolytics. If the loculated effusion persists, the patient should be subjected to video-assisted thoracoscopic surgery, and if the lung cannot be expanded with this procedure, a full thoracotomy with decortication should be performed. The definitive procedure should be performed within 14 d.

Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010

2010-08-01

Andrew MacDuff , A G Arnold , J. Harvey

CLINICAL EVALUATION< Symptoms in PSP may be minimal or absent.In contrast, symptoms are greater in SSP, even if the pneumothorax is relatively small in size.(D) < The presence of breathlessness … CLINICAL EVALUATION< Symptoms in PSP may be minimal or absent.In contrast, symptoms are greater in SSP, even if the pneumothorax is relatively small in size.(D) < The presence of breathlessness influences the management strategy.(D) < Severe symptoms and signs of respiratory distress suggest the presence of tension pneumothorax.(D) The typical symptoms of chest pain and dyspnoea may be relatively minor or even absent, 23 so that

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Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010

2010-08-01

Tom Havelock , R Teoh , D. Laws +1 more

In hospital practice, pleural aspiration (thoracocentesis) and chest drain insertion may be required in many different clinical settings for a variety of indications. Doctors in most specialities will be exposed … In hospital practice, pleural aspiration (thoracocentesis) and chest drain insertion may be required in many different clinical settings for a variety of indications. Doctors in most specialities will be exposed to patients requiring pleural drainage and need to be aware of safe techniques. There have been many reports of the dangers of large-bore chest drains and it had been anticipated that, with the previous guidelines, better training and the advent of small-bore Seldinger technique chest drains, there would have been an improvement. Unfortunately the descriptions of serious complications continue, and in 2008 the National Patient Safety Agency (NPSA) issued a report making recommendations for safer practice.1 These updated guidelines take into consideration the recommendations from this report and describe the technique of pleural aspiration and Seldinger chest drain insertion and ultrasound guidance. Much of this guideline consists of descriptions of how to do these procedures but, where possible, advice is given when evidence is available. Before undertaking an invasive pleural procedure, all operators should be appropriately trained and have been initially supervised by an experienced trainer. Many of the complications described in the NPSA report were the result of inadequate training or supervision. A recent survey of UK NHS Trusts showed that the majority did not have a formal training policy for chest drain insertion in 2008.2 Studies of clinical practice have shown that there is a wide variation in the knowledge and skills of doctors inserting chest drains. In a published study3 where doctors were asked to indicate where they would insert a chest drain, 45% indicated they would insert the drain outside of the safety triangle, …

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Phase III Intergroup Study of Talc Poudrage vs Talc Slurry Sclerosis for Malignant Pleural Effusion

2005-03-01

Carolyn M. Dresler , Jemi Olak , James E. Herndon +7 more

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Usefulness of lactate dehydrogenase and its isoenzymes as indicators of lung damage or inflammation

1996-08-01

Marjolein Drent , NA Cobben , RF Henderson +2 more

This review describes the usefulness of monitoring the activity level of lactate dehydrogenase (LDH) and its isoenzyme pattern as indicators of pathological conditions in the lungs, such as cell damage … This review describes the usefulness of monitoring the activity level of lactate dehydrogenase (LDH) and its isoenzyme pattern as indicators of pathological conditions in the lungs, such as cell damage or inflammation. Cytoplasmatic cellular enzymes, like LDH, in the extracellular space, although of no further metabolic function in this space, are still of benefit because they serve as indicators suggestive of disturbances of the cellular integrity induced by pathological conditions. Since LDH is an enzyme present in essentially all major organ systems, serum LDH activity is abnormal in a large number of disorders. Although the increase in total serum LDH activity is rather nonspecific, it is proposed that measurement of LDH activity levels and its isoenzyme pattern in pleural effusion and, more recently, in bronchoalveolar lavage fluid may provide additional information about lung and pulmonary endothelial cell injury.

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Chemical Pleurodesis for Malignant Pleural Effusions

1994-01-01

Pamela Walker-Renard

Purpose: To provide information about available agents for chemical pleurodesis. Data Sources: A MEDLINE search (1966 to October 1992) was conducted using the terms malignant pleural effusion and pleurodesis. Study … Purpose: To provide information about available agents for chemical pleurodesis. Data Sources: A MEDLINE search (1966 to October 1992) was conducted using the terms malignant pleural effusion and pleurodesis. Study Selection: All articles containing references to patients with recurrent, symptomatic, malignant pleural effusions treated with chemical pleurodesis were selected and reviewed for pleurodesis regimen, number of patients treated, success rate (complete response), and adverse effects. The agents studied included doxycycline, minocycline, tetracycline, bleomycin, cisplatin, doxorubicin, etoposide, fluorouracil, interferon-β, mitomycin-c, Corynebacterium parvum, methylprednisolone, and talc. Data Extraction: Independent extraction by three observers. Results: Studies including a total of 1168 patients with malignant pleural effusions were reviewed for efficacy of the pleurodesis agent and studies including 1140 patients were reviewed for toxicity. Chemical pleurodesis produced a complete response in 752 (64%) of 1168 patients. The success rate of the pleurodesis agents varied from 0% with etoposide to 93% with talc. Corynebacterium parvum, the tetracyclines, and bleomycin had success rates of 76%, 67%, and 54%, respectively. The most commonly reported adverse effects were pain (265 of 1140, 23%) and fever (220 of 1140, 19%). Conclusions: Doxycycline and minocycline, with success rates of 72% and 86%, respectively, appear to be effective tetracycline-replacement agents in the few patients studied. Talc appears to be the most effective and least expensive agent; however, insufflation has the disadvantages of the expense of thoracoscopy and the usual need for general anesthesia. Bleomycin appears to be less effective than talc and the tetracyclines and is substantially more expensive.

BTS guidelines for the management of pleural infection in children

2005-01-29

Ian M. Balfour‐Lynn

<h3>Background</h3> The purpose of this study was to evaluate the incidence, timing and risk factors of corneal neovascularisation (NV) after deep anterior lamellar keratoplasty (DALK) for corneal ectasia. <h3>Methods</h3> This … <h3>Background</h3> The purpose of this study was to evaluate the incidence, timing and risk factors of corneal neovascularisation (NV) after deep anterior lamellar keratoplasty (DALK) for corneal ectasia. <h3>Methods</h3> This study included 616 eyes who underwent DALK between 2012 and 2020 in two tertiary referral centres. In one centre topical corticosteroids were discontinued after complete suture removal 1 year after surgery, whereas in the other they were discontinued 3–4 months after surgery. The presence and severity of corneal NV was ascertained based on slit lamp photographs. Potential risk factors for corneal NV were evaluated using the Cox proportional hazards model. <h3>Results</h3> The cumulative incidence of corneal NV was 8.7% at 1 year after surgery and 13.2% at 5 years. Mean time interval from surgery to development of corneal NV was 12.8±16.2 months, with 68.9% of cases occurring before complete suture removal. Early discontinuation of topical steroids, older age and ocular allergy were associated with an increased risk of developing corneal NV (respectively, HR=2.625, HR=1.019, HR=3.726, all p<0.05). <h3>Conclusions</h3> The risk of corneal NV is higher in the first year following DALK. Early discontinuation of topical steroids, ocular allergy and older age are significant predictors of corneal NV.

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Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010

2010-08-01

Mark Roberts , E Neville , Richard Berrisford +2 more

The discovery of malignant cells in pleural fluid and/or parietal pleura signifies disseminated or advanced disease and a reduced life expectancy in patients with cancer.1 Median survival following diagnosis ranges … The discovery of malignant cells in pleural fluid and/or parietal pleura signifies disseminated or advanced disease and a reduced life expectancy in patients with cancer.1 Median survival following diagnosis ranges from 3 to 12 months and is dependent on the stage and type of the underlying malignancy. The shortest survival time is observed in malignant effusions secondary to lung cancer and the longest in ovarian cancer, while malignant effusions due to an unknown primary have an intermediate survival time.2–6 Historically, studies showed that median survival times in effusions due to carcinoma of the breast are 5–6 months. However, more recent studies have suggested longer survival times of up to 15 months.7–10 A comparison of survival times in breast cancer effusions in published studies to 1994 calculated a median survival of 11 months.9 Currently, lung cancer is the most common metastatic tumour to the pleura in men and breast cancer in women.4 11 Together, both malignancies account for 50–65% of all malignant effusions (table 1). Lymphomas, tumours of the genitourinary tract and gastrointestinal tract account for a further 25%.2 12–14 Pleural effusions from an unknown primary are responsible for 7–15% of all malignant pleural effusions.3 13 14 Few studies have estimated the proportion of pleural effusions due to mesothelioma: studies from 1975, 1985 and 1987 identified mesothelioma in 1/271, 3/472 and 22/592 patients, respectively, but there are no more recent data to update this in light of the increasing incidence of mesothelioma.4 13 14 View this table: Table 1 Primary tumour site in patients with malignant pleural effusion Attempts have been made to predict survival based on the clinical characteristics of pleural fluid. None has shown a definite correlation: a recent systematic review of studies including 433 patients assessing the predictive value of pH concluded that low pH does not reliably predict …

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Pleural Effusion

2002-06-20

Richard W. Light

A 70-year-old man with an 80-pack-year history of smoking and a history of congestive heart failure presents with increasing shortness of breath. He also has aching chest pain on the … A 70-year-old man with an 80-pack-year history of smoking and a history of congestive heart failure presents with increasing shortness of breath. He also has aching chest pain on the right side that worsens with deep inspiration. He is afebrile. The chest radiograph reveals asymmetrical bilateral pleural effusions, with more fluid on the right. How should this patient be evaluated?

Management of Malignant Pleural Effusions

2000-11-01

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To Study Diagnostic Value of Thoracoscopy in Undiagnosed Cases of Exudative Pleural Effusion

2025-06-24

Veena Kumari , D.V. Pratapa Reddy , Raghumanda Sunil Kumar +3 more | Apollo Medicine

Background and Aims: Undiagnosed exudative pleural effusions were defined as pleural effusions in which an aetiological diagnosis could not be ascertained by initial pleural fluid analysis. Between 25% and 30% … Background and Aims: Undiagnosed exudative pleural effusions were defined as pleural effusions in which an aetiological diagnosis could not be ascertained by initial pleural fluid analysis. Between 25% and 30% of pleural effusions may remain undiagnosed despite a combination of pleural fluid analysis and closed pleural biopsy. Medical thoracoscopy may assist physicians in diagnosing such cases. Aims and Objectives: This study aims to study the diagnostic utility of medical thoracoscopy in undiagnosed pleural effusions. Materials and Methods: This is an observational prospective, hospital-based study conducted on 40 patients at the Government Hospital for Chest and Communicable Diseases, Department of Pulmonary Medicine, Andhra Medical College, Visakhapatnam, from January 2024 to December 2024. The study was carried out after obtaining institutional ethics clearance and informed written consent from the participants. Results: Thoracoscopy was performed in 40 patients, of whom 29 were male and 11 were female. The indication for thoracoscopy in all these patients was inconclusive initial pleural fluid analysis. Of the 40 cases, 17 were diagnosed as malignant and 23 as non-malignant. Of the 23 non-malignant cases, 15 were diagnosed as tuberculosis. Conclusion: Based on our results, we conclude that, given its high diagnostic yield and acceptable safety profile, rigid thoracoscopy should be considered in the evaluation of exudative pleural effusion when pleural fluid analysis is inconclusive.

Clinical significance and prognosis of non-expandable lungs in patients with unilateral pleural effusion.

2025-06-24

Aleš Rozman , Tara Velepec , Blaz Cestnik +1 more | Respiration

Non-expandable lung (NEL) is a clinical condition where the lung fails to fully expand after pleural effusion drainage, due to pleural disease or bronchial obstruction. Despite its relevant clinical implications, … Non-expandable lung (NEL) is a clinical condition where the lung fails to fully expand after pleural effusion drainage, due to pleural disease or bronchial obstruction. Despite its relevant clinical implications, NEL remains under-researched. This study aimed to evaluate the prevalence and clinical significance of NEL in patients with unilateral exudative pleural effusion and to assess its impact on prognosis, complications, and treatment options. A retrospective analysis of 518 medical thoracoscopy (MT) procedures performed in a University pulmonology center, from 2010 to 2020 was conducted. NEL was identified in 24.9% of benign pleural effusions (BPE) and 19.0% of malignant pleural effusions (MPE). In BPE, NEL was more common in older males and associated with mediastinal shift post-drainage. In MPE, NEL significantly increased diagnostic complications (19.2% vs. 3.2%, p = 0.0002) and reduced the likelihood of receiving specific oncological treatments (50.0% vs. 71.6%, p = 0.005). Survival analysis revealed poorer outcomes for NEL patients. In BPE, NEL was associated with a threefold higher mortality risk over three years (HR = 3.142, p = 0.0005). Similarly, MPE patients with NEL had a median survival of 8.5 months compared to 16 months for those with re-expandable lungs (HR = 1.695, p = 0.0008). These findings highlight NEL as a critical prognostic factor in exudative pleural effusions, warranting further research to improve diagnostic and therapeutic strategies tailored to this condition.

Successful simple chest closure without thoracoplasty after open-window thoracotomy for empyema: a report of two cases

2025-06-23

Yosuke Kiriyama , Shinji Otani , Takashi Ueki +7 more | Egyptian Journal of Bronchology

Abstract Background Thoracic wall reconstruction after open-window thoracotomy is invasive and challenging to perform in patients with comorbidities. We present two cases of empyema in which chest closure was achieved … Abstract Background Thoracic wall reconstruction after open-window thoracotomy is invasive and challenging to perform in patients with comorbidities. We present two cases of empyema in which chest closure was achieved with minimally invasive simple wound closure after open-window thoracotomy. Case presentation In these cases, two men who were 81 and 48 years old, respectively, were readmitted after video-assisted thoracoscopic right lower lung lobectomy to treat lung cancer because of a bronchial stump fistula. Simple wound closure was performed in both patients, and both were discharged without any complications. The first patient died 15 months later from left lung pneumonia. The second patient has had no recurrence of empyema and is currently undergoing chemotherapy as an outpatient for recurrent lung cancer at 24 months postoperatively. Conclusion Simple chest closure without concomitant thoracoplasty is an effective, minimally invasive procedure for treating fistula-free empyema.

Successful Assessment and Management of Chemothorax: A Case Report and Literature Review

2025-06-23

Hassan Edward Bakali , Batuhan Riza Ecer , Ravan Mammadov +1 more | Cureus

Air leaks management using polymeric hydrogel matrix after thoracoscopic lung segmentectomy: a single-center prospective randomized trial with a cost-effective analysis

2025-06-21

Samuele Nicotra , Giovanni Maria Comacchio , Marco Mammana +7 more | Updates in Surgery

18F-FDG PET and combined diffusion weighted MRI features in pleural infection: A case report

2025-06-21

Kyung-Ah Chun | Radiology Case Reports

Pleural Fluid Gas Analysis in Diagnosing and Differentiating Pulmonary Diseases

2025-06-20

İdris Kırhan , Aliye Gamze Çalış , Fatih Üzer +2 more | Harran Üniversitesi Tıp Fakültesi Dergisi

Background: This study aimed to evaluate pleural fluid gas parameters in patients with different underl-ying pulmonary diseases to assess their diagnostic implications. Materials and Methods: This study conducted at Akdeniz … Background: This study aimed to evaluate pleural fluid gas parameters in patients with different underl-ying pulmonary diseases to assess their diagnostic implications. Materials and Methods: This study conducted at Akdeniz University Pulmonology Department and Har-ran University Pulmonology Department. The retrospective study included 118 patients with pleural effusion confirmed via imaging between January 2018 and December 2024. Pleural fluid samples collec-ted by thoracentesis underwent gas analysis (pO₂, pCO₂, pH, HCO₃) and standard biochemical and cytolo-gical evaluations. Comparative analysis of gas characteristics was performed across diagnostic categories with a significance threshold of p &lt; 0.05. Results: In this study, 87 of 118 patients underwent arterial blood gas analysis, with a mean age of 66.4±14.2 years and 72.4% being male. Acidic, normal, and alkaline pleural fluid pH values were obser-ved in 25.3%, 26.4%, and 48.3% of patients, respectively. Most effusions were exudative (83.9%), and unilateral (81.6%), with malignancy (29.9%), pneumonia (35.6%), and heart failure (16.1%) being the leading causes. Among pneumonia cases, 45.1% had complicated effusions or empyema. Transudative effusions were associated with older age, higher pH, and lower LDH, pCO₂, and protein levels (p&lt;0.05). Compared to other causes, pneumonia-related effusions were more likely to be exudative, occur in males, and have higher protein levels. Malignant effusions showed significantly higher HCO₃ and protein levels (p&lt;0.05). Conclusions: Pleural fluid gas analysis may offer valuable diagnostic insights, particularly in differentia-ting infectious from non-infectious effusions.

Tension haemothorax

2025-06-20

Farah Alyetama | Radiopaedia.org

Target bronchus determination in giant emphysematous bullae: A case report

2025-06-20

Lecong Ouyang , Weidong Zhang , Z. Peter Wang | Medicine

Giant emphysematous bullae (GEB) in chronic obstructive pulmonary disease cause severe respiratory compromise. While surgical resection is standard, bronchoscopic volume reduction is crucial for surgically ineligible patients. Accurate target bronchus … Giant emphysematous bullae (GEB) in chronic obstructive pulmonary disease cause severe respiratory compromise. While surgical resection is standard, bronchoscopic volume reduction is crucial for surgically ineligible patients. Accurate target bronchus identification remains challenging with conventional imaging. A 67-year-old male with chronic obstructive pulmonary disease and right lung GEB presented with severe dyspnea (modified Medical Research Council score 4), hypercapnia (partial pressure of carbon dioxide: 45 mm Hg), and markedly limited exercise tolerance (6-minute walk distance: 62 m). He required home noninvasive ventilation and was deemed unfit for surgery due to critically impaired lung function (Forced expiratory volume in 1 second: 0.36 L, 12.2% predicted). Preoperative high-resolution computed tomography (CT) and 3D reconstruction localized the target bronchus to the right middle lobe. However, percutaneous aspiration and drug injection via drainage tube revealed misalignment, prompting reidentification of the target bronchus in the posterior segment of the right upper lobe. CT-guided percutaneous GEB volume reduction was performed, involving air extraction and intrabullous injection of erythromycin lactobionate. Subsequent selective bronchial occlusion of the posterior right upper lobe segment via bronchoscopic autologous blood and thrombin injection was conducted. Continuous negative-pressure drainage was maintained post-procedure. Follow-up CT at 6 months confirmed complete GEB closure. Dyspnea improved significantly (modified Medical Research Council score 3), exercise capacity increased (6-minute walk distance: 220 m), and ventilator use was discontinued. No complications or recurrence were observed during follow-up. Percutaneous aspiration and drug injection refine target bronchus identification when imaging yields ambiguous results, enhancing precision for subsequent bronchoscopic interventions. This strategy minimizes reliance on endobronchial valves, reducing costs and procedural complexity. Larger studies are needed to validate long-term efficacy, but this approach offers a promising minimally invasive alternative for high-risk patients.

Thoracotomy for Empyema Thoracis—Relevant as Ever in Children, as Timely Referral is Still a Concern: An Observational Study

2025-06-20

Neel Aggerwal , U Singh , S. Upreti +1 more | Pediatric Infectious Disease

Tuberculous pleuritis

2025-06-20

Farah Alyetama | Radiopaedia.org

Pleural Empyema in Spain (2016–2022): A Nationwide Study on Trends in Hospitalizations, Mortality, and Impact of Comorbidities

2025-06-20

Begoña Perez-de-Paz , M. Cotarelo , Lydia Rodriguez-Romero +5 more | Journal of Personalized Medicine

Background: Pleural empyema (PE) is a major cause of morbidity and mortality worldwide. This study aimed to analyze the epidemiological characteristics of patients hospitalized for PE in Spain between 2016 … Background: Pleural empyema (PE) is a major cause of morbidity and mortality worldwide. This study aimed to analyze the epidemiological characteristics of patients hospitalized for PE in Spain between 2016 and 2022. Methods: This retrospective observational study of PE cases was based on the hospital discharge records from the National Health System between 2016 and 2022. The variables analyzed were sex, age, comorbidities, discharge diagnoses and procedures, overall severity, whether empyema was a primary or secondary diagnosis, admission to the intensive care unit (ICU), length of stay (LOS), in-hospital mortality, and healthcare costs. Results: Between 2016 and 2022, 19864 PE cases were diagnosed in Spain, revealing an overall rate of 0.64 per 1000 hospitalizations, with the exception of a slight decline in 2021. The mean age of the patients with PE was 61 years, and 73.85% were men. Most patients had low comorbidities, with a median Charlson comorbidity index (CCI) of 1.7. Most cases (63%) involved secondary diagnoses (pneumonia, pneumococcal pneumonia, sepsis, COVID, or lung cancer). The in-hospital mortality rate was higher in the secondary diagnosis group than in the primary diagnosis group (13.4% vs. 6.2%, respectively, p < 0.001). The factors associated with increased mortality included older age (≥66 years), higher CCI scores, ICU admission, and shorter LOS (<10 days). Conversely, pleural drainage and pneumonia as secondary diagnoses were protective factors. Conclusions: PE is an increasingly common pathology in clinical practice, especially in older and frail patients. It is associated with high morbidity and mortality, and its prognosis worsens with age and comorbidities. Therefore, early and appropriate diagnosis and standardized management strategies are required to mitigate the mortality and healthcare costs.

The Evolution of the Indwelling Pleural Catheter

2025-06-20

Abdulla Baguneid , Thisarana Wijayaratne , Avinash Aujayeb +1 more | Pulmonary Therapy

An indwelling pleural catheter (IPC) is a valuable tool in the management of pleural effusions, allowing drainage strategies to be tailored to match patient-centred goals. Previously, IPCs were primarily utilised … An indwelling pleural catheter (IPC) is a valuable tool in the management of pleural effusions, allowing drainage strategies to be tailored to match patient-centred goals. Previously, IPCs were primarily utilised in malignant pleural effusion (MPE) in the presence of non-expandable lung (NEL) or after the failure of chemical pleurodesis. Several studies have compared IPC to intercostal chest drain (ICD) with talc pleurodesis (TP), as well as different drainage regimens, resulting in a transition of practice. Continued developments have led to novel adjuncts, such as digital drainage, which allow controlled flow rates. The emerging field of intrapleural therapy in MPE is gaining attention as a potential new treatment modality, possibly increasing the scope of IPCs further. This article will provide a narrative review of the role of IPCs and will be based on published evidence to date and highlight the importance of an individualised, patient-centred care approach.

Optimal timing of chest radiograph following chest tube removal in detecting recurrent pneumothorax: analysis of 163 patients with thoracic stab wounds at a major trauma centre in South Africa

2025-06-19

Victor Kong , Jonathan Ko , Cynthia Cheung +4 more | Annals of The Royal College of Surgeons of England

Routine chest radiograph (CXR) following chest tube removal is a common practice, yet the optimal timing of CXR in detecting recurrent pneumothorax (RPTX) remains unknown. This study reviewed the incidence … Routine chest radiograph (CXR) following chest tube removal is a common practice, yet the optimal timing of CXR in detecting recurrent pneumothorax (RPTX) remains unknown. This study reviewed the incidence of RPTX and its relationship to the timing of the detection of CXR. A prospective study was conducted over a 24-month period on patients with thoracic stab wounds who underwent CXR following chest tube removal at a major trauma centre in South Africa. One hundred and sixty-three patients were included (91% male, mean age: 25 years). Eleven patients (7%) had RPTX, one (9%) of whom required reinsertion of a chest tube. No patients were readmitted following discharge. The timing of the CXR was: <2h (11%), 2-4h (21%), 4-6h (28%), 6-8h (31%) and >8h (9%). Of the 11 RPTX, 55% were detected on CXR at <2h, 36% at 2-4h, 9% at 4-6h, 0% at 6-8h (0%) and 0% at >8h. All RPTX were detected within <6h of chest tube removal. There was no re-presentation of any patients following discharge. RPTX following chest tube removal is uncommon, and the need for reintervention is low. All patients with RPTX were detected on CXR obtained within 6h of removal. It would appear that routinely delaying CXR anytime beyond 6 hours is unnecessary.

Effective Treatment of Empyema With Fistula Using Saline Irrigation Through Tube Thoracostomy: A Case Report

2025-06-19

Ryokan Ikebe , Mizuho Namiki , Munekazu Takeda +2 more | Cureus

All that pops is not necessarily a pneumothorax!

2025-06-19

Amr Youssef , Elinor Bradley , Marcin Szostok +2 more | Thorax

Use of a novel ultrasound sign in the management of malignant pleural effusions: a prospective observational trial

2025-06-19

Pradeep Bajad , Naveen Dutt , Nishant Kumar Chauhan +5 more | Monaldi Archives for Chest Disease

The management of malignant pleural effusion (MPE) is influenced by the lung's ability to re-expand following fluid drainage. Lung entrapment can complicate this process and may be predicted using pleural … The management of malignant pleural effusion (MPE) is influenced by the lung's ability to re-expand following fluid drainage. Lung entrapment can complicate this process and may be predicted using pleural manometry. Recently, a novel lung ultrasound (LUS) marker-the sinusoidal sign-has emerged as a potential tool to differentiate between expandable and entrapped lung prior to thoracentesis. A prospective observational study was conducted to evaluate the role of pre-drainage LUS in identifying entrapped lung and compare its diagnostic accuracy with pleural manometry. A total of 30 patients with MPE were enrolled. Prior to thoracentesis, targeted ipsilateral LUS was performed at the level of the atelectatic lung. M-mode displacement <1 mm was considered indicative of an absent sinusoidal sign. Simultaneously, pleural manometry was conducted during thoracentesis to measure pressure changes and calculate pleural elastance. Lung expandability was determined based on pleural elastance and post-thoracentesis imaging findings (computed tomography thorax). A pleural elastance >13.6 cm H₂O/L was considered diagnostic of lung entrapment. A pleural elastance cut-off of 13.6 cm H₂O/L demonstrated 100% sensitivity, 93% specificity, a 100% positive predictive value, and 84.2% negative predictive value. The absence of the sinusoidal sign on LUS had a sensitivity of 78.6% and specificity of 100% in identifying entrapped lung. Both absent sinusoidal sign on pre-drainage LUS and elevated pleural elastance (>13.6 cm H₂O/L) during thoracentesis are reliable indicators of lung entrapment in MPE. LUS may serve as a useful, non-invasive bedside tool for early identification of non-expandable lung.

Endobronchial blocker and extracorporeal membrane oxygenation use for lung abscess complicated by a bronchopleural fistula in a pediatric patient: a case report and literature review

2025-06-19

Song Chen , Siwei Lu , Yuelin Sun +4 more | Frontiers in Pediatrics

Background A lung abscess is a thick-walled cavity containing purulent material that results from pulmonary infection. It is an uncommon condition that can occur at any age. Bronchopleural fistula (BPF) … Background A lung abscess is a thick-walled cavity containing purulent material that results from pulmonary infection. It is an uncommon condition that can occur at any age. Bronchopleural fistula (BPF) is a severe complication with a poor prognosis that may arise with the progression of the condition or as a result of treatment. Case presentation We describe a case of lung abscess complicated by a BPF and septic shock in a 7-year-old girl. A chest tube was inserted and venoarterial extracorporeal membrane oxygenation (ECMO) was emergently used. To selectively block the BPF, an endobronchial blocker was placed in the right intermediate bronchus under bronchoscopic guidance. This approach allowed the BPF to heal, enabled the recruitment of the other lung, and obstructed the purulent fluid. The patient recovered and was discharged after 70 days of treatment. Conclusions This case demonstrates that combined endobronchial blocker and ECMO can be an effective approach for patients with lung abscesses and BPFs (especially those aged &lt; 8 years) when the adjustment of conventional therapy is unsuccessful.

A Rare Case of Empyema in a 4-Year-Old Child: A Diagnostic and Management Challenge

2025-06-19

YARRAGUNTLA VENKATA MALLIKARJUNA CHARI | International Journal of Contemporary Medicine

IntroductionEmpyema thoracis, though a recognized complication of pneumonia, is relatively rare in very young children, especially in its loculated form. Delayed diagnosis or inadequate initial management may result in prolonged … IntroductionEmpyema thoracis, though a recognized complication of pneumonia, is relatively rare in very young children, especially in its loculated form. Delayed diagnosis or inadequate initial management may result in prolonged morbidity, poor nutrition, and complications. This case highlights the clinical complexity, diagnostic journey, and multidisciplinary management of a pediatric empyema in a 4-year-old female, underscoring the need for early referral, imaging, and prompt intervention. It contributes to pediatric literature by reinforcing the value of high clinical suspicion and the role of CT in evaluating non-resolving pneumonia.Patient Concerns and Clinical FindingsA 4-year-old girl initially presented with:⦁ Fever for 2 weeks⦁ Cough, vomiting, and reduced appetite⦁ Temporary relief with oral antibiotics at a local hospital, but fever recurred⦁ Subsequently managed with IV antibiotics at another facility before referral for further evaluationExamination Findings:⦁ Moderately built and nourished⦁ No cyanosis, icterus, clubbing, lymphadenopathy, or edema⦁ Tachypnea and reduced breath sounds on the left side⦁ No facial dysmorphism or structural abnormalities noted⦁ No neurological or systemic deficits Investigations:⦁ Complete Blood Count:⦁ Anemia (Low Hb, PCV, MCV, MCHC)⦁ CT Chest:⦁ Loculated empyema on the left side⦁ Pleural Fluid Cytology:⦁ Predominantly lymphocytes, neutrophils, mesothelial cells⦁ No malignant cells⦁ Routine Biochemical Workup:⦁ Elevated inflammatory markers Final Diagnosis:⦁ Left-sided loculated empyema thoracis in a 4-year-old child⦁ Secondary to unresolved pneumonia Management:⦁ Continued IV antibiotics⦁ Supportive management including IV fluids, antipyretics, and nutritional supplementation⦁ Monitoring via imaging and lab parameters⦁ Surgical consultation for possible intercostal drainage or decortication if conservative treatment fails Outcome:⦁ Gradual clinical improvement⦁ Reduction in fever and respiratory distress⦁ Ongoing follow-up for nutritional recovery and lung function monitoring Conclusion & Key Takeaways:⦁ Empyema in children, though uncommon, should be suspected in cases of persistent fever and respiratory symptoms not responding to antibiotics⦁ CT chest is crucial for diagnosing loculated pleural collections⦁ Early intervention, proper antibiotic therapy, and nutritional support are key to improving outcomes⦁ Reinforces the need for thorough evaluation in children with unresolved pneumonia to prevent complications such as chronic empyema or lung damage

Evaluation of Changes in Pleural Pressure, Spirometry and Their Effects on Dyspnoea and the Six-Minute Walk Test (6-MWT) Following Thoracentesis for Symptomatic Pleural Effusion

2025-06-18

Jineesh Joseph , Somenath Kundu , Prasanth Prasad +1 more | Cureus

Idiopathic lymphocytic–eosinophilic pleural effusion with clinical response to corticosteroids: a case report

2025-06-17

Justin Jin Hao Jang , Chia Meng Teoh , Pyng Lee | Singapore Medical Journal

Study of Clinical Profile and Diagnostic Approach in Patients with Pleural Effusion

2025-06-17

Hari S. Raman , C Senthil | International Journal of Science and Research (IJSR)

Spektrum Pneumologie – wissenswert, kompakt, anregend

2025-06-17

| Kompass Pneumologie

ASO Visual Abstract: Reconstruction of the Chest Wall in Primary and Secondary Tumors—A Systematic Review and Meta-analysis Comparing Rigid Versus Flexible Materials

2025-06-15

Rachid Eduardo Noleto da Nóbrega Oliveira , Paula Duarte D’Ambrosio , Iñaki Salvador-Corres +2 more | Annals of Surgical Oncology

A Rare Case of Polymicrobial Empyema Associated With COVID-19 Infection Complicated by a Bronchopleural Fistula

2025-06-14

Dhiraj R Regmi , Sandeep Kshetri , Laxman Wagle +1 more | Cureus

Right Sided Empyema with Necrotising Pneumonia: A Case Report

2025-06-12

Gounak Sankar Mal , B Haldar , S. Ashraf +1 more | International Journal of Medical and Pharmaceutical Case Reports

Aim: Empyema is a rare complication of pneumonia resulting from the accumulation of pusin the pleural space as a result of impairment of host defense and bacterial virulence. About zero.6% … Aim: Empyema is a rare complication of pneumonia resulting from the accumulation of pusin the pleural space as a result of impairment of host defense and bacterial virulence. About zero.6% of children laid low with pneumonia progress to empyema as in line with research. Case Presentation: Here we discussed a case of right sided empyema with necrotizing pneumonia in a one year old female pediatric patient. Discussion and Conclusion: Our patient case underscores the critical importance of early recognition and aggressive management of empyema and necrotizing pneumonia in children. Clinicians should maintain a high index of suspicion for these complication -compromised respiratory function, fever and bluish skin discoloration. Advanced imaging and microbiological testing are crucial in guiding diagnosis and treatment.

Comparison of conventional culture and automated blood culture system for microbiologic diagnosis of pleural infection

2025-06-12

Young Ho Lee , Min Seo Kang , Jinyoung Yang +7 more | Microbiology Spectrum

ABSTRACT Microbiological diagnosis of pleural infection is often hindered by the low sensitivity of conventional culture. The automated blood culture system (ABCS) has been shown to improve diagnostic sensitivity for … ABSTRACT Microbiological diagnosis of pleural infection is often hindered by the low sensitivity of conventional culture. The automated blood culture system (ABCS) has been shown to improve diagnostic sensitivity for the culture of non-blood specimens. This study examined the additional diagnostic benefit of ABCS against conventional bacterial culture in patients who underwent thoracentesis or percutaneous drainage. Non-duplicate patients whose pleural fluid samples were tested using both conventional culture and ABCS (BACT/ALERT 3D and VIRTUO, bioMerieux) from 2001 through 2021 were included. Cases were excluded if only contaminants such as coagulase-negative staphylococci, Corynebacterium species, and Bacillus species were identified. Data on culture results, demographics, and laboratory tests were collected. Of the 9,020 patients, 632 patients had positive results in ABCS after excluding those considered contaminants ( n = 180) or those positive only in conventional culture ( n = 5). Conventional culture was positive in 302 (47.8%) patients, whereas 330 (52.2%) patients had isolates only from ABCS. Patients with positive results from ABCS alone had lower pleural fluid lactate dehydrogenase and serum C-reactive protein (CRP) and higher pleural fluid glucose and protein. Among organisms isolated from ABCS alone, viridans group streptococci , Staphylococcus aureus, and Klebsiella spp. were the most common organisms identified. Higher pleural fluid glucose and blood white blood cells and lower CRP were significant factors associated with exclusive ABCS positivity. More than half of the patients whose pleural fluid cultures were positive using ABCS had a negative result on conventional culture. Our results suggest that ABCS might enhance the microbiologic diagnosis of pleural infection. IMPORTANCE This study demonstrated that an automated blood culture system (ABCS) has superior sensitivity in pleural infections compared with conventional culture. By comparing both methods in over 9,000 patients, researchers found that ABCS detected bacteria in approximately twice as many cases as conventional culture, especially in patients with a high probability of pleural infection. The findings suggest that ABCS can be a valuable tool in improving the accuracy of diagnosing pleural infections, which could lead to better treatment decisions and patient outcomes.

The importance of biomarkers in the diagnosis and monitoring of complicated course of acute pleural empyema

2025-06-12

V. V. Boyko , V. V. Tkachenko , А.Л. Сочнєва +6 more | The Ukrainian Journal of Clinical Surgery

Objective. To determine the value of biomarkers in the diagnosis and monitoring of complicated course of acute pleural empyema. Materials and Methods. We analyzed the results of treatment of 426 … Objective. To determine the value of biomarkers in the diagnosis and monitoring of complicated course of acute pleural empyema. Materials and Methods. We analyzed the results of treatment of 426 patients with acute pleural empyema for the period 2008–2022. This study included patients (n = 64) with clinical and laboratory signs of systemic inflammatory response syndrome and clinically proven infection that complicated the course of pleural empyema – sepsis (group 1), and patients (n = 63) with acute pleural empyema without signs of a systemic infectious process – without established sepsis (group 2). Results. The results of the study allowed us to form an idea of the importance of biomarkers in the diagnosis and monitoring of the complicated course of acute pleural empyema in different periods of complex treatment. Conclusions. The use of additional biomarkers reflecting specific pathological processes may become an important tool for making clinical decisions regarding the management of patients with sepsis.

Treatment outcomes in pediatric empyema: a retrospective observational study from a tertiary center in Dubai, United Arab Emirates

2025-06-12

Mohammed Al Blooshi , Munir Ahmad , Fadi Al Shamali +6 more | Pediatric Surgery International

Failure rate and complications of small-bore, wire-guided chest drains in adult patients presenting with traumatic and nontraumatic pleural diseases: A systematic review

2025-06-11

Zubaidah Alomar , Zainab Tawfek , Yousif Alomar +5 more | Qatar medical journal

Background: Pleural diseases are common and often require drainage, with the growing use of small-bore chest drains (SBCDs) instead of larger tubes. This review aimed to examine the failure rate … Background: Pleural diseases are common and often require drainage, with the growing use of small-bore chest drains (SBCDs) instead of larger tubes. This review aimed to examine the failure rate and complications associated with SBCD use in different pleural pathologies. Methods: A literature search (PubMed, SCOPUS, and Google Scholar) was performed on the complications associated with SBCDs to treat pleural diseases. This review analyzed patient demographics, indications, outcomes, failure rate, and complications associated with the use of SBCDs. The systematic review was conducted using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Results: Thirty studies were included in this review with 4,973 patients. The indications for insertions of SBCDs were pleural effusion at 48.4%, pneumothorax at 30.1%, empyema or parapneumonic effusion at 11.4%, hemothorax at 6.5%, and other indications at 3.6%. The overall failure rate to achieve satisfactory drainage was 19.4%. Significant complications included iatrogenic pneumothorax at 11.9%, major hemorrhage at 1.0%, local bleeding at 0.7%, infection at 1.2%, and iatrogenic organ injury at 0.9%. Other insertional complications included tube dislodgement at 5.9%, tube blockage at 5.4%, tube kinking at 3.7%, misplacement at 3.3%, and subcutaneous hematoma at 0.5%. Most of the data published revolves around hemodynamically stable patients with SBCD insertions and is, thus, deficient regarding hemodynamically unstable patients. Conclusion: Despite carrying notable failure rates and complications, small-bore catheters remain an acceptable option for managing selected pleural diseases.

Recommendations From the Medical Education Editor

2025-06-10

Mark Lavercombe | Respirology

Pneumothorax

2025-06-09

| Cambridge University Press eBooks

A case of complicated parapneumonic pleural effusion caused by paragonimus infection in a child was successfully treated by intrapleural injection of urokinase: a case report and literature review

2025-06-05

Yongyong Shi , Li Yan , Yu Hu | Frontiers in Pediatrics

Objective The clinical data of a child with complex parapneumonic effusion (PPE) caused by pneumofluke infection were analyzed, and the diagnosis and treatment of the disease were discussed through literature … Objective The clinical data of a child with complex parapneumonic effusion (PPE) caused by pneumofluke infection were analyzed, and the diagnosis and treatment of the disease were discussed through literature review. The effectiveness and safety of urokinase in the treatment of complex PPE and empyema caused by multiple pathogens were emphasized. Methods A 3-year-old male child with pneumofluke infection was admitted to the pediatric department of Mianyang Central Hospital. Chest CT and chest ultrasound showed a right pleural effusion with dense septum formation. The condition was relieved after treatment with praziquantel for anti-infection, thoracic catheter drainage, and urokinase injection into pleural cavity. Through systematic literature search of Pubmed, Embase, CNKI, Wanfang and VIP Chinese databases, no cases of urokinase treatment of pleural effusion caused by pneumofluke infection were found. Results A total of 150 ml thick yellow turbidous fluid was drained out of the pleural cavity, and the patient's symptoms and signs were significantly relieved. Reexamination of the chest CT showed that the right pleural effusion was significantly reduced and the right lung was significantly reexpanded. There were no complications such as bronchopleural fistula, pneumothorax, abnormal coagulation function, bleeding and fever during treatment. Conclusion Thoracic catheter drainage combined with injection of urokinase is an effective and safe method for the treatment of complex PPE and empyema caused by pneumofluke infection in children. At the same time, the literature review showed that urokinase injection into pleural cavity was effective in the treatment of complex PPE and empyema caused by infection, trauma, tumor and other causes, and no obvious side effects occurred.

“Vetus Sed Utilis”: Open Window Thoracostomy after Lung Surgery

2025-06-05

Antonio Mazzella , Claudia Bardoni , Luca Bertolaccini +4 more | The Thoracic and Cardiovascular Surgeon

Abstract Open window thoracostomy (OWT) is an ancient surgical intervention, born for managing chronic thoracic infectious diseases. Our goal is to report our 25-year experience in the management of these … Abstract Open window thoracostomy (OWT) is an ancient surgical intervention, born for managing chronic thoracic infectious diseases. Our goal is to report our 25-year experience in the management of these patients, focusing on its feasibility and usefulness in our modern era. We retrospectively reviewed our database (1999–2024), reporting all clinical preoperative, intraoperative, and postoperative data of patients undergoing OWT for treating chronic empyema, linked to broncho-pleural fistula after lung resection, or not. Data were collected on the type of original surgical intervention, perioperative and postoperative management, 30- and 90-day mortality, overall survival, and following reintervention to close OWT. Sixty-six OWTs were performed to treat acute and chronic septic complications due to original lung intervention for cancer. OWT was performed for treating a late broncho-pleural fistula after pneumonectomy (56 cases; 85%) or after lobectomy (8 cases; 12%) or pleural chronic empyema (2 cases; 3%). Thirty- and 90-day mortality after OWT following pneumonectomy was 3% (2 patients) and 6% (4 patients), respectively. No 30- and 90-day death was observed in the other patients. In 15 out of 66 patients (22.7%), OWT was closed by muscle, skin, or omentum flaps. No statistical differences were observed comparing the survival of the patients undergoing or not undergoing OWT closure, after pneumonectomy (p = 0.59). OWT is a safe, feasible, and sometimes mandatory technique for the management of chronic infectious issues linked to broncho-pleural fistula (BPF) after lung surgery. It is well tolerated by guaranteeing an appropriate quality of life.

Successful Autologous Blood Patch Pleurodesis in a Case of a Refractory Primary Spontaneous Pneumothorax

2025-06-04

Shahnawaz Hashmi , Saquib Siddiqui , Lwin Paing +1 more | Cureus