Study Objective: To determine the feasibility of rapid pleurodesis in patients with malignant pleural effusions in order to reduce hospital length of stay in patients with a limited life expectancy.
Design: Prospective case series.
Setting: Two university hospital programs.
Patients: Thirty-eight patients with symptomatic pleural effusions associated with malignancy.
Interventions: A 14F catheter was inserted percutaneously into the pleural space after radiographic confirmation of free fluid by lateral decubitus views. Following radiographic confirmation of complete fluid evacuation, a sclerosing agent (ie, talc slurry or bleomycin) was instilled into the pleural space. This was accomplished within 2 h of chest tube insertion, unless the tube was inserted in the evening or if the lung was trapped. After clamping the tube for 90 min, the pleural space was drained for 2 h, after which the chest tube was removed. The intervention was scored as "successful" if no radiographic evidence of fluid reaccumulation was noted at 4 weeks. A "partial successful" score indicated reaccumulation of fluid that did not produce symptoms and did not require repeat pleural drainage of any sort. All other outcomes were scored as "unsuccessful."
Measurements And Results: Forty chest tubes were inserted into 38 patients. Four procedures revealed the presence of a trapped lung and did not result in any attempt at pleurodesis. Five patients who received pleurodesis died in less than 1 month and therefore were not evaluable. Two patients had technical problems with the chest tube and were not evaluable. Of the remaining 29 procedures, drainage procedures with pleurodesis were performed in 27 patients, a complete response was seen in 14 patients (48%), a partial response was seen in 9 patients (31%), and 6 patients (21%) did not respond to pleurodesis. Chemical pleurodesis was completed as an outpatient procedure in only two patients. In one of these, the outcome was unsuccessful. In the remainder, insertion of the chest tube in the evening or additional medical problems necessitated hospital admission, but the entire procedure was completed within 24 h.
Conclusions: Chemical pleurodesis can be accomplished with good results in < 24 h in the majority of patients with malignant pleural effusions.
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http://dx.doi.org/10.1378/chest.123.6.1895 | DOI Listing |
Gastroenterol Clin North Am
March 2025
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India.
Pancreatic duct (PD) strictures, leaks, and disconnected ducts are important morphologic consequences of inflammatory disease of the pancreas, resulting in abdominal pain, pancreatic ascites, pancreatic pleural effusion, and external pancreatic fistula. Traditionally, these PD complications were treated surgically, but a better understanding of their pathophysiology, along with advancement in endoscopic interventions, has transformed the therapy from morbid surgical interventions to minimally invasive, safe, and effective endoscopic treatment. This review discusses the current diagnostic and management strategies for PD strictures, leaks, and disconnected pancreatic ducts.
View Article and Find Full Text PDFAm J Emerg Med
January 2025
Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada.
Rationale: Lung ultrasound, the most precise diagnostic tool for pleural effusions, is underutilized due to healthcare providers' limited proficiency. To address this, deep learning models can be trained to recognize pleural effusions. However, current models lack the ability to diagnose effusions in diverse clinical contexts, which presents significant challenges.
View Article and Find Full Text PDFHemorrhagic pleural effusion as the sole manifestation of pancreatitis is exceedingly rare and often presents diagnostic challenges due to its misleading symptoms. We report the case of an adult male with a large left-sided black pleural effusion secondary to chronic necrotizing pancreatitis. The patient presented with progressive shortness of breath and cough, with a history of alcohol use and a previous diagnosis of acute severe pancreatitis.
View Article and Find Full Text PDFBMJ Case Rep
January 2025
Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA.
A man in his 60s with advanced COPD and lung adenocarcinoma presented with sepsis and acute hypoxaemic respiratory failure. Imaging revealed bilateral pleural effusions, and he was found to have a polymicrobial empyema which included Despite appropriate treatment, he continued to deteriorate and ultimately died of sepsis. species, typically benign constituents of the oral microbiota, rarely can instigate pleuropulmonary infections, especially in immunocompromised individuals.
View Article and Find Full Text PDFIntroduction: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe hypersensitivity reaction rarely documented in patients with multiple myeloma (MM).
Methods: In our retrospective study of 108 newly diagnosed MM (NDMM) patients from January 2021 to October 2023, we identified four cases of DRESS. The clinical characteristics such as clinical manifestations, laboratory results, treatment and outcome were analyzed.
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