Pleural Disease Archives - PulmCCM
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Pleural Disease Articles

Dec 262012
 
Pleural catheters equal to pleurodesis for dyspnea relief from malignant effusions (TIME2)

(image: Wikipedia) In the TIME2 randomized trial published in the June 13 2012 JAMA, indwelling pleural catheters and talc pleurodesis were equivalent at reducing dyspnea over the 6 weeks following the procedure among 106 patients with malignant pleural effusions. Most patients receiving pleural catheters required no hospital stays, and overall had fewer repeat procedures than those [… read more]

Should pleurodesis or PleurX drain be 1st-line Rx for malignant pleural effusion?

 Interventional Pulmonology, Lung Cancer, Pleural Disease, Review Articles  Comments Off on Should pleurodesis or PleurX drain be 1st-line Rx for malignant pleural effusion?
Jul 202012
 
Should pleurodesis or PleurX drain be 1st-line Rx for malignant pleural effusion?

(image: Wikipedia) There are an estimated 200,000 pleural effusions due to malignancy each year in the U.S. alone, and these represent an important cause of suffering and limitation in functional ability for people living with advanced cancer. Pleurodesis (using talc or other sclerosants) and placement of indwelling pleural catheters are both accepted, reasonable approaches to the [… read more]

Apr 222012
 
Should you check pleural manometry during thoracentesis?

(image: Cardinal Health) Should you routinely check pleural pressures with bedside manometry during thoracentesis? David Feller-Kopman of Johns Hopkins says, of course: it’s zero risk, zero cost, only seconds of extra time, and provides potentially useful clinical information. Specifically, one can identify people with “entrapped lung” and “trapped lung”: Identifying “Entrapped Lung” by Pleural Pressures [… read more]

Apr 212012
 
Pneumothorax in the ICU

Mechanisms of Pneumothorax in the Critically Ill Air can accumulate in the pleural space in three ways: Rupture of the visceral pleura allowing air to travel from alveoli to the pleural space (an “internal” pneumothorax, as from barotrauma from mechanical ventilation, or the rupture of a bulla or bleb); Entry of air from the atmosphere [… read more]

Mar 152012
 

Diaphragmatic dysfunction can result from nerve damage, primary muscle problems, or problems with the muscle’s interaction with the chest wall. The true incidence of diaphragmatic paralysis is unknown, since many patients are asymptomatic. Treatment for diaphragmatic dysfunction usually consists of watchful waiting, addressing underlying causes, with mechanical ventilation if respiratory failure develops. Causes of Diaphragmatic [… read more]

Deep sulcus sign in pneumothorax (Image, NEJM)

 Pleural Disease, Radiology & Imaging  Comments Off on Deep sulcus sign in pneumothorax (Image, NEJM)
Mar 072012
 

When someone with a pneumothorax lies supine — as in the 23-year old man described in this New England Journal mini-case from Saweera Sabbar and Eric James Nilles of Rashid Trauma Center in Dubai, UAE — air rises laterally and caudally, and creates displacement downward and medially of the hemidiaphragm, displaying as the “deep sulcus [… read more]

Feb 262012
 

I knew I smelled something fishy about this paper when I read and commented on it last year.  Now, Chest reports they’re giving this study a burial at sea, after the authors could not produce actual data supporting the trial. To help set the record straight: Chest published a retrospective study in March 2011, “Chest Tube [… read more]

Jan 202012
 

Richard Light and friends established that parapneumonic effusions (PPE) associated with community-acquired pneumonia very rarely progress if the effusion is freely layering and less than 1 cm in height on a lateral decubitus chest film. But who orders those anymore? Chest CT use has risen 20-fold since Light’s seminal 1980 paper. Often the CT has [… read more]

Cough leads to lung herniation through chest wall (Image, NEJM)

 Pleural Disease, Radiology & Imaging  Comments Off on Cough leads to lung herniation through chest wall (Image, NEJM)
Jan 192012
 

A 40-year old asthmatic woman coughed the corner of her right lower lobe right through her chest wall, needing a thoracotomy to repair it. She seemed to have recovered well at 3-month follow-up. Matthew O’Shea and Morgan Cleasby of Good Hope Hospital in Birmingham (United Kingdom) share their fascinating pictures in a New England Journal show-and-tell. [… read more]

Dec 262011
 

More than 65,000 people develop empyema each year, and 25% of them are in the hospital a month or longer. Past randomized trials and a meta-analysis showed streptokinase didn’t help, but case series suggested tissue plasminogen activator might. Rahman et al randomized 210 people to a 2 x 2 table: double-placebo, DNAse and t-PA, DNAse [… read more]

Oct 232011
 

Talc pleurodesis is 90-95% effective at prevention of recurrent primary spontaneous pneumothorax. However, there have been reports of ARDS occurring after talc pleurodesis, mostly in patients with malignant pleural effusions, raising concerns over its use. Bridevaux et al report results of talc pleurodesis on 418 patients with primary spontaneous pneumothorax (PSP) at nine centers in Europe and [… read more]

Oct 072011
 

Zhang et al pooled 20 studies that compared ultrasound, chest X-ray, or both against a reference standard (usually CT scan) for the diagnosis of pneumothorax. Chest X-ray had a pooled sensitivity of 52% and specificity 99% for diagnosis of pneumothorax. Ultrasound’s pooled sensitivity was 88% and specificity, 100%. Unsurprisingly, the accuracy of ultrasonography to diagnose [… read more]

Aug 102011
 

In the “why didn’t I think of that?” department: Menzies et al performed pleural fluid sampling on 62 patients with clinical pleural infection, and sent samples to the lab in both standard tubes and in blood culture bottles inoculated at the bedside. 20 standard samples were culture-positive; adding the positive inoculated samples identified an additional [… read more]

Pleural effusions more common in PAH than believed?

 Pleural Disease, Pulmonary Hypertension  Comments Off on Pleural effusions more common in PAH than believed?
Jul 152011
 

Lore has it that pure-right sided heart disease in pulmonary arterial hypertension doesn’t cause pleural effusions. Luo et al report here that it does, in 35 of 89 people (39%) with connective-tissue disease-related PAH. (29 of the 35 had no other discernible cause for the effusion.) CHEST 2011;140:42-47. Their group previously reported that people with [… read more]

Sirolimus improved chylous pleural effusions, lung function in LAM

 Diffuse Lung Disease & Interstitial Lung Disease, Pleural Disease  Comments Off on Sirolimus improved chylous pleural effusions, lung function in LAM
Jun 132011
 

Taveira-DaSilva reports an observational series of 19 women treated with sirolimus for lymphangioleiomyomatosis. Of 12 women with chylous pleural effusions, most had a large improvement or resolution in their effusions. Ann Intern Med 2011;154:797-805. In a randomized trial of 89 LAM patients published in NEJM March 2011, sirolimus reduced decline of lung function.

Outcomes after tunneled pleural catheters for malignant effusions

 Interventional Pulmonology, Lung Cancer, Pleural Disease, Review Articles  Comments Off on Outcomes after tunneled pleural catheters for malignant effusions
Apr 142011
 

In a retrospective review of 418 tunneled pleural catheters placed over 2 years, 91% of patients did not require any other drainage procedure. Spontaneous pleurodesis occurred in one-quarter, in whom the catheter was taken out at a median 44 days. More patients with catheters placed in the operating room achieved pleurodesis (36%). Complication rate overall [… read more]

Does CT-guided needle biopsy seed the pleura with cancer?

 Interventional Pulmonology, Lung Cancer, Pleural Disease  Comments Off on Does CT-guided needle biopsy seed the pleura with cancer?
Apr 092011
 

A retrospective look at 447 patients with stage I non-small cell lung cancer by Inoue et al suggests yes, but without affecting survival. When cancer recurred in those initially diagnosed by CT-guided needle biopsy, pleural dissemination was more likely (8 of 13 recurrences). However, 5-year disease free survival was 89% in the CT-biopsy group and [… read more]

Chest tubes for transudative effusions in vented patients? Show us the data!

 Critical Care, Interventional Pulmonology, Mechanical Ventilation, Pleural Disease  Comments Off on Chest tubes for transudative effusions in vented patients? Show us the data!
Mar 192011
 

THIS STUDY HAS BEEN RETRACTED. Kupfer et al looked retrospectively at 168 vented patients with transudative pleural effusions at Maimonides in Brooklyn. The half that got chest tubes (with an average of 1,200 mL drained) spent 3.8 days on the vent, vs 6.5 days for the group that got only thoracentesis, with no complications reported. [… read more]

The pleura and pleural diseases (Special Issue)

 Pleural Disease, Review Articles  Comments Off on The pleura and pleural diseases (Special Issue)
Mar 012011
 

Pleural imaging; CHF pleural effusions; hepatic hydrothorax; parapneumonic effusions and empyema; malignant pleural effusions and disease; chylothorax; thoracoscopy; the chest tube size debate; pneumothorax — did they miss anything? In 130 pages, probably not much. Sem Resp Crit Care Med Dec 2010.