Subject(s)
Esophageal Fistula , Esophageal Perforation , Mediastinal Diseases , Stents , Humans , Mediastinal Diseases/surgery , Mediastinal Diseases/therapy , Mediastinal Diseases/complications , Esophageal Fistula/surgery , Esophageal Fistula/etiology , Esophageal Fistula/therapy , Esophageal Perforation/surgery , Esophageal Perforation/etiology , Esophageal Perforation/therapy , Pleural Diseases/surgery , Pleural Diseases/therapy , Pleural Diseases/etiology , Male , Respiratory Tract Fistula/surgery , Respiratory Tract Fistula/etiology , Respiratory Tract Fistula/therapy , Negative-Pressure Wound Therapy/methods , Middle Aged , Esophageal Diseases , Rupture, SpontaneousABSTRACT
BACKGROUND: Management of complicated pleural infections (CPIs) had historically been surgical; however, following the publication of the second multicenter intrapleural sepsis trial (MIST-2), combination tissue plasminogen (tPA) and dornase (DNase) offers a less invasive and effective treatment. Our aim was to assess the quality of life (QOL) and functional ability of patients' recovery from a CPI managed with either intrapleural fibrinolytic therapy (IPFT) or surgery. METHODS: We identified 565 patients managed for a CPI between January 1, 2013 and March 31, 2018. There were 460 patients eligible for contact, attempted through 2 phone calls and one mailer. Two questionnaires were administered: the Short Form 36-Item Health Survey (SF-36) and a functional ability questionnaire. RESULTS: Contact was made in 35% (159/460) of patients, and 57% (90/159) completed the survey. Patients had lower QOL scores compared to average US citizens; those managed with surgery had higher scores in physical functioning (surgery: 80, IPFT: 70, P=0.040) but lower pain scores (surgery: 58, IPFT: 68, P=0.045). Of 52 patients who returned to work, 48% (25) reported an impact on their work effectiveness during recovery, similarly between management strategies (IPFT: 50%, 13/26 vs. surgery: 46%, 12/26; P=0.781). CONCLUSION: Patients with a CPI had a lower QOL compared with average US citizens. Surgically managed patients reported improved physical functioning but worse pain compared with patients managed with IPFT. Patients returned to work within 4 weeks of discharge, and nearly half reported their ability to work effectively was impacted by their recovery. With further research into recovery timelines, patients may be appropriately counselled for expectations.
Subject(s)
Quality of Life , Humans , Male , Female , Middle Aged , Aged , Recovery of Function , Surveys and Questionnaires , Tissue Plasminogen Activator/therapeutic use , Tissue Plasminogen Activator/administration & dosage , Thrombolytic Therapy/methods , Treatment Outcome , Return to Work/statistics & numerical data , Fibrinolytic Agents/therapeutic use , Fibrinolytic Agents/administration & dosage , Adult , Pleural Diseases/therapyABSTRACT
The field of pulmonology saw significant advances in 2023. The publications highlighted in this article address advances and changes in practice related to asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, pleural disorders, and sleep-disordered breathing. One article reviews data examining the efficacy of vaccination against respiratory syncytial virus, a respiratory viral illness that has had devastating effects globally. Four studies evaluate the role of various therapies in COPD, including dupilumab, ensifentrine, pulmonary rehabilitation programs, and lung volume reduction versus endobronchial valves. Another study explores the effect on vascular events of positive-pressure ventilation in patients with sleep-disordered breathing and recent stroke. The use of combination therapy with rituximab and mycophenolate mofetil on progression-free survival in patients with nonspecific interstitial pneumonia is the topic of another study. We also highlight an update of clinical recommendations for the evaluation of patients with pleural disorders and a systematic review analyzing the effectiveness of inhaled corticosteroids as a supplement to dual therapy for COPD.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Pulmonary Medicine , Humans , Pulmonary Disease, Chronic Obstructive/therapy , Lung Diseases, Interstitial/therapy , Asthma/drug therapy , Pleural Diseases/therapy , Sleep Apnea Syndromes/therapyABSTRACT
Connective tissue diseases (CTD) are heterogeneous, immune-mediated inflammatory disorders often presenting with multiorgan involvement. With the advent of high-resolution computed tomography, CTD-related pleuritis-pleural thickening and effusion-is now increasingly recognized early in the disease trajectory. The natural history of CTD-related pleural effusions varies from spontaneous resolution to progressive fibrothorax with ventilatory impairment. Treatment of the underlying CTD is necessary to manage the pleural disease. Depending on the degree of symptom burden and physiological insult, specific treatment of pleural disease can include monitoring, repeated aspirations, systemic anti-inflammatory medication, and surgical decortication.
Subject(s)
Connective Tissue Diseases , Pleural Diseases , Pleural Effusion , Tomography, X-Ray Computed , Humans , Connective Tissue Diseases/complications , Pleural Diseases/therapy , Pleural Effusion/etiology , Pleural Effusion/therapy , Pleurisy/etiology , Anti-Inflammatory Agents/therapeutic use , Disease ProgressionABSTRACT
Bronchopleural fistula (BPF), a sinus tract between the bronchial system and the pleural space, is associated with COVID-19 and can lead to pneumothorax, which increases the mortality rate. Due to the analytical status of COVID-19 patients, sealing the BPF necessitates the least minimal invasive treatment. Herein, we demonstrated a technique of sealing post-COVID-19 BPF with direct injection of cyanoacrylate glue under the guidance of a computed tomography scan. Following glue injection, the BPF was completely sealed in all four patients. In conclusion, in COVID-19 patients with small and distal BPF, percutaneous glue injection is recommended for BPF closure.
Subject(s)
Bronchial Fistula , COVID-19 , Pleural Diseases , Humans , Cyanoacrylates/pharmacology , Cyanoacrylates/therapeutic use , COVID-19/complications , Bronchial Fistula/therapy , Pleural Diseases/therapy , Tomography, X-Ray ComputedABSTRACT
Thoracic ultrasound (TU) has rapidly gained popularity over the past 10 years. This is in part because ultrasound equipment is available in many settings, more training programmes are educating trainees in this technique, and ultrasound can be done rapidly without exposure to radiation.The aim of this review is to present the most interesting and innovative aspects of the use of TU in the study of thoracic diseases.In pleural diseases, TU has been a real revolution. It helps to differentiate between different types of pleural effusions, guides the performance of pleural biopsies when necessary and is more cost-effective under these conditions, and assists in the decision to remove thoracic drainage after talc pleurodesis.With the advent of COVID19, the use of TU has increased for the study of lung involvement. Nowadays it helps in the diagnosis of pneumonias, tumours and interstitial diseases, and its use is becoming more and more widespread in the Pneumology ward.In recent years, TU guided biopsies have been shown to be highly cost-effective, with other advantages such as the absence of radiation and the possibility of being performed at bedside. The use of contrast in ultrasound to increase the cost-effectiveness of these biopsies is very promising.In the study of the mediastinum and peripheral pulmonary nodules, the introduction of echobronchoscopy has brought about a radical change. It is a fully established technique in the study of lung cancer patients. The introduction of elastography may help to further improve its cost-effectiveness.In critically-ill patients, diaphragmatic ultrasound helps in the assessment of withdrawal of mechanical ventilation, and is now an indispensable tool in the management of these patients. (AU)
Subject(s)
Humans , Pleural Diseases/complications , Pleural Diseases/diagnostic imaging , Pleural Diseases/therapy , Pleural Effusion, Malignant/etiology , Pleurodesis/methods , Thoracic Diseases/diagnostic imagingABSTRACT
Thoracic ultrasound (TU) has rapidly gained popularity over the past 10 years. This is in part because ultrasound equipment is available in many settings, more training programmes are educating trainees in this technique, and ultrasound can be done rapidly without exposure to radiation. The aim of this review is to present the most interesting and innovative aspects of the use of TU in the study of thoracic diseases. In pleural diseases, TU has been a real revolution. It helps to differentiate between different types of pleural effusions, guides the performance of pleural biopsies when necessary and is more cost-effective under these conditions, and assists in the decision to remove thoracic drainage after talc pleurodesis. With the advent of COVID19, the use of TU has increased for the study of lung involvement. Nowadays it helps in the diagnosis of pneumonias, tumours and interstitial diseases, and its use is becoming more and more widespread in the Pneumology ward. In recent years, TU guided biopsies have been shown to be highly cost-effective, with other advantages such as the absence of radiation and the possibility of being performed at bedside. The use of contrast in ultrasound to increase the cost-effectiveness of these biopsies is very promising. In the study of the mediastinum and peripheral pulmonary nodules, the introduction of echobronchoscopy has brought about a radical change. It is a fully established technique in the study of lung cancer patients. The introduction of elastography may help to further improve its cost-effectiveness. In critically-ill patients, diaphragmatic ultrasound helps in the assessment of withdrawal of mechanical ventilation, and is now an indispensable tool in the management of these patients. In neuromuscular patients, ultrasound is a good predictor of impaired lung function. Currently, in Neuromuscular Disease Units, TU is an indispensable tool. Ultrasound study of the intercostal musculature is also effective in the study of respiratory function, and is widely used in Respiratory Rehabilitation. In Intermediate Care Units, thoracic ultrasound is indispensable for patient management. In these units there are ultrasound protocols for the management of patients with acute dyspnoea that have proven to be very effective.
Subject(s)
Pleural Diseases , Pleural Effusion, Malignant , Thoracic Diseases , Humans , Pleural Effusion, Malignant/etiology , Pleurodesis/methods , Pleural Diseases/diagnostic imaging , Pleural Diseases/therapy , Pleural Diseases/complications , Thoracic Diseases/diagnostic imaging , PleuraABSTRACT
A 48-year-old man developed sudden-onset haematemesis and melena after decompensated posthepatitic cirrhosis. Endoscopic variceal injectional sclerotherapy was emergently performed. However, the patient developed esophago-pleural fistula, empyema, and liver failure. He thus received symptomatic treatments and nasojejunal feedings, which failed to restore the nutrition as the gastroesophageal reflux exacerbated the hydrothorax. Percutaneous endoscopic gastro-jejunal (PEG-J) was therefore carefully performed for enteral nutrition support. The patient had recovered from the fistula at a six-month follow-up, which allowed the resumption of an oral diet. Our literature review revealed that PEG-J is a feasible approach to treating esophago-pleural fistula, a rare but lethal complication of endoscopic sclerotherapy.
Subject(s)
Empyema , Esophageal and Gastric Varices , Fistula , Pleural Diseases , Male , Humans , Middle Aged , Sclerotherapy/adverse effects , Pleural Diseases/therapy , Fistula/complications , Fistula/therapy , Endoscopy/adverse effects , Empyema/complications , Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/therapy , Gastrointestinal Hemorrhage/complicationsABSTRACT
BACKGROUND: Pleural procedures are essential for the investigation and management of pleural disease and can be associated with significant morbidity and mortality. There is a lack of pleural procedure complication data in the Australian and New Zealand region. AIMS: To review pleural procedure practices at Wollongong Hospital with an emphasis on the assessment of complications, use of thoracic ultrasound (TUS), pathology results and comparison of findings with international data. METHODS: Retrospective analysis of medical records was performed on pleural procedures identified through respiratory specialist trainee logbooks at Wollongong Hospital from January 2018 to December 2021. Comparison of complication rates was made to the British Thoracic Society 2011 a national pleural audit. RESULTS: One hundred and twenty-one pleural procedures were identified. There were 71 chest drains, 49 thoracocentesis and one indwelling pleural catheter (IPC) insertion. Ninety-seven per cent of procedures were performed for pleural effusions and 3% for pneumothorax. This audit demonstrated a complication rate (excluding pain) of 16.9% for chest drains and 4.1% for thoracocentesis. This gave an overall complication event rate of 10.8% (excluding pain) for pleural procedures. There was no major bleeding, organ puncture, pleural space infection or death. Bedside TUS was used in 99% of procedures. CONCLUSION: Complication rates for pleural procedures performed by respiratory specialist trainees at Wollongong Hospital are comparable with international outcomes. This audit provides data for comparison on pleural procedure complication rates in Australia. Future studies are required to determine complication rates with IPCs.
Subject(s)
Pleural Diseases , Pleural Effusion, Malignant , Pleural Effusion , Humans , Retrospective Studies , Treatment Outcome , Australia/epidemiology , Pleural Effusion/diagnostic imaging , Pleural Effusion/epidemiology , Pleural Effusion/therapy , Pleural Diseases/epidemiology , Pleural Diseases/therapy , Hospitals, Teaching , Pain , Catheters, Indwelling/adverse effects , Pleural Effusion, Malignant/etiologySubject(s)
Bronchial Fistula , Mycobacterium abscessus , Humans , Mycobacterium abscessus/drug effects , Mycobacterium abscessus/isolation & purification , Bronchial Fistula/therapy , Bronchial Fistula/diagnostic imaging , Male , Mycobacterium Infections, Nontuberculous/drug therapy , Pleural Diseases/therapy , Middle Aged , Drugs, Chinese Herbal/therapeutic use , Medicine, Chinese TraditionalABSTRACT
Fungal pleural infections are infrequent and insidious, for which there are neither large clinical studies nor targeted guidelines to provide standardized treatment options. We reported 4 cases of fungal pleural infection and reviewed the cases of fungal pleural infections in previous studies to provide a basis for the diagnosis and treatment of fungal pleural infections. There were 2 females and 2 males with a mean age of 58.5 years in our data. The average time from onset to diagnosis was 30.25 days. Risk factors most frequently included pulmonary diseases (nâ =â 4) and malignancy (nâ =â 1). Two patients underwent pleural biopsy through a thoracoscope, and no pathogens were detected. Pleural fluid culture was positive in 2 out of 3 cases. The diagnoses were "possible" (nâ =â 1), "probable" (nâ =â 1), and "proven" (nâ =â 2). All patients received systemic antifungal therapy, and 3 received combined thoracic drainage. The outcomes were cured (nâ =â 1), improved (nâ =â 2) and lost to follow-up (nâ =â 1). We reviewed 12 cases of fungal pleural infection in previous studies. The diagnosis was confirmed via culture in 7 cases and via biopsy in 8 cases. The pathogen was Aspergillus in 7 cases. After a combination of systemic antifungal (nâ =â 12) and local treatment (nâ =â 11), 10 patients improved and 2 patients died. Diagnosis of fungal pleural infection should incorporate risk factors, clinical presentation and fungal evidence, with pleural fluid culture being an important and feasible mean of confirming the diagnosis; and treatment should be based on systemic antifungal therapy supplemented by topical therapy.
Subject(s)
Communicable Diseases , Mycoses , Pleural Diseases , Male , Female , Humans , Middle Aged , Antifungal Agents/therapeutic use , Mycoses/therapy , Mycoses/drug therapy , Pleura , Prognosis , Communicable Diseases/drug therapy , Pleural Diseases/diagnosis , Pleural Diseases/therapyABSTRACT
Tuberculous bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis, in which abnormal connections form between the bronchial tree and the pleural space. These abnormal connections allow air and secretions to pass from the lungs into the pleural space, causing a range of symptoms from benign cough to acute tension pneumothorax. The management of tuberculous BPF requires an individualized approach based on the patient's condition and response to treatment. Anti-tuberculosis therapy is essential for controlling the active tuberculosis infections. Intercostal drainage and suction are also commonly used to drain air and fluid from the pleural space, providing relief from the symptoms. For some patients, more invasive surgeries, such as decortication, thoracoplasty or pleuropneumonectomy are required to definitively close the fistula when medical management alone is insufficient. Herein, we describe a rare case of tuberculous BPF in a young adult female, who was treated with anti-tuberculosis medications and open thoracotomy.
Subject(s)
Bronchial Fistula , Pleural Diseases , Tuberculosis , Humans , Young Adult , Bronchial Fistula/etiology , Bronchial Fistula/therapy , Lung/surgery , Pleural Diseases/therapy , Pleural Diseases/etiology , Pneumonectomy/adverse effects , Tuberculosis/complications , Tuberculosis/therapy , Female , Antitubercular Agents/therapeutic useABSTRACT
Methods: We conducted a retrospective review of patients with pleural infection requiring intrapleural therapy at two tertiary referral centres. Results: We included 84 (62.2%) and 51 (37.8%) patients who received sequential and concurrent intrapleural therapy, respectively. Patient demographics and clinical characteristics, including age, RAPID score, and percentage of pleural opacity on radiographs before intrapleural therapy, were similar in both groups. Treatment failure rates (defined by either in-hospital mortality, surgical intervention, or 30-day readmission for pleural infection) were 9.5% and 5.9% with sequential and concurrent intrapleural therapy, respectively (p = 0.534). This translates to a treatment success rate of 90.5% and 94.1% for sequential and concurrent intrapleural therapy, respectively. There was no significant difference in the decrease in percentage of pleural effusion size on chest radiographs (15.1% [IQR 6-35.7] versus 26.6% [IQR 9.9-38.7], p = 0.143) between sequential and concurrent therapy, respectively. There were also no significant differences in the rate of pleural bleeding (4.8% versus 9.8%, p = 0.298) and chest pain (13.1% versus 9.8%, p = 0.566) between sequential and concurrent therapy, respectively. Conclusion: Our study adds to the growing literature on the safety and efficacy of concurrent intrapleural therapy in pleural infection.