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a) Chest X-ray post-thoracentesis demonstrating hydropneumothorax (air and fluid in the pleural cavity). b) Computed tomography of the chest, coronal view. c) Computed tomography of the chest, axial view.
Source publication
Over 50 systemic conditions may affect the pleura and, thus, unilateral pleural effusions may present for a variety of reasons. Investigating the cause is essential to providing appropriate management. Various pleural interventions are available in current practice, but have varying diagnostic sensitivity. It is, therefore, vital to consider the in...
Contexts in source publication
Context 1
... CXR following therapeutic thoracocentesis revealed a hydropneumothorax (Fig 2a), raising the possibility of a non-expandable lung (NEL). Pleural fluid analysis suggested an exudative effusion (protein of 40 g/L and LDH of 620 IU). ...
Context 2
... revealed a lymphocytic effusion with no malignant cells seen. Computed tomography of the chest (Fig 2b and 2c) demonstrated a parietal pleural rind predominantly encasing the right lower lobe, likely causing the NEL. ...
Context 3
... CXR following therapeutic thoracocentesis revealed a hydropneumothorax (Fig 2a), raising the possibility of a non-expandable lung (NEL). Pleural fluid analysis suggested an exudative effusion (protein of 40 g/L and LDH of 620 IU). ...
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Citations
... While specific guidelines are lacking, it is advisable to ensure at least 10 mm of fluid depth for thoracic ultrasound to mitigate complications associated with thoracentesis [11]. For most scenarios, unilateral pleural effusions should be sampled to evaluate for an exudate [24]. Bilateral pleural effusions linked to congestive heart failure or other hypervolemic conditions generally do not necessitate sampling. ...
Thoracentesis is a fundamental procedure in interventional pulmonology, providing both diagnostic and therapeutic value. This review article offers a comprehensive analysis of thoracentesis, delving into pleural anatomy, procedural techniques, indications, and recent advancements. The article details the evolution of thoracentesis, including the crucial role of ultrasound guidance and emerging approaches that enhance precision and minimize complications. It addresses the wide range of indications for thoracentesis in diverse clinical scenarios, from the diagnosis of pleural effusions to therapeutic drainage of pleural collections. Furthermore, this review explores the management of coagulopathy and anticoagulation pertaining to thoracentesis. It will also provide strategies for preventing and managing complications, ensuring that thoracentesis remains a well-tolerated procedure with minimal risks. This article concludes by examining future directions in thoracentesis, including potential innovations and trends that will shape the landscape of interventional pulmonary medicine. This review serves as an essential resource for pulmonologists, interventional radiologists, and healthcare professionals, offering a comprehensive update on thoracentesis.
... Careful patient selection is required prior to LAT: a detailed history regarding the disease process including previous occupational exposure (e.g., asbestos) and previous malignant disease is important. A baseline functional assessment is useful to assess suitability to proceed with the procedure as well as potential treatment, and therefore, a World Health Organisation Performance Status of 2 or above is recommended [27,28]. The patient's medical comorbidities may provide important information regarding the patient's risk factors for the procedure, including drug intolerances and allergies. ...
... Aspirin does not need to be stopped. Formal anticoagulation should be withheld for 24 h for therapeutic low molecular weight heparin, 5 days for warfarin and normally 48 h for direct oral anticoagulants (although dagibatran might need to be stopped 4 days before a procedure if the patient's creatinine clearance is less than 50 millilitres per minute)) and platelet counts should be greater than 50,000 per microlitre of blood and the international normalised ratio should be less than 1.5 [4,[27][28][29]. Of note, it is our opinion that whilst platelet count is an established level in the BTS guidance [28,29], platelet activity is also important, and advice from haematology might be obtained prior to a procedure in a thrombocytopenic patient. ...
... Potential major complications occur in 1.8% cases, including empyema, bleeding, post-operative pneumothorax, bronchopleural fistula, pneumonia and port site tumour growth [4,23]. The overall risk of death is 0.1% [4,27,28]. However, this mortality was from earlier case series and was associated with talc-induced respiratory failure due to acute respiratory distress syndrome (ARDS)-non-graded talc was in use at the time. ...
The incidence of pleural disease is increasing, and interventions are crucial in this subspecialist area of respiratory medicine. One of the cornerstones of pleural effusion investigation and management is medical, which is also known as local anaesthetic thoracoscopy. This allows fluid drainage, biopsy for diagnosis and preventative measures for further fluid potential build-up. This article summarises the evidence around this procedure through a narrative review of the available evidence.
... Editor -When pleural effusion occurs as a manifestation of pulmonary embolism, this occurrence should generate an opportunity to implement the ultrasonographic pathway for the workup of suspected pulmonary embolism. 1 The first step in that pathway is to perform thoracic ultrasound (TUS) to ascertain whether or not the pleural effusion is attributable to pulmonary infarction. On ultrasonography, the majority of pulmonary infarcts are wedge shaped, but some may either be round or polygonal. ...
The main purpose of this narrative review is to educate general practitioners about a crucial pleural procedure, namely local anesthetic thoracoscopy (LAT), and to provide established respiratory physicians with an expert opinion-based summary of the literature. This narrative review focuses on the indications, technical aspects and complications of LAT, highlighting its safety and high degree of diagnostic sensitivity for patients who present with an unexplained pleural effusion and have a high pre-test probability of cancer.
