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1.
Cureus ; 15(6): e40232, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37435245

RESUMO

Spontaneous splenic rupture is an uncommon cause of acute-onset left-sided pleural effusion. It is often immediate with a high preponderance for recurrence, sometimes even requiring splenectomy. We report a case of spontaneous resolution of recurrent pleural effusion presenting a month after the initial atraumatic splenic rupture. Our patient was a 25-year-old male without significant medical history who was taking Emtricitabine/Tenofovir for pre-exposure prophylaxis. He presented to the pulmonology clinic for left-sided pleural effusion, diagnosed in the emergency department a day prior. He had a history of spontaneous grade III splenic injury one month before, where he was diagnosed with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) co-infection on polymerase chain reaction (PCR) testing and was managed conservatively. The patient underwent thoracentesis in the clinic, which showed exudative lymphocyte predominant pleural effusion and no malignant cells. The remainder of the infective workup was negative. He was readmitted two days later with worsening chest pain, and imaging revealed re-accumulation of pleural fluid. The patient declined thoracentesis, and a chest X-ray was repeated a week later, showing worsening pleural effusion. The patient insisted on continuing conservative management, and he was seen a week later with a repeat chest X-ray that showed near resolution of pleural effusion. Splenomegaly and splenic rupture can lead to pleural effusion due to posterior lymphatic obstruction, which can be recurrent. There are no current guidelines on management, and treatment options include watchful monitoring, splenectomy, or partial splenic embolization.

2.
Cureus ; 14(7): e26900, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35983398

RESUMO

In this case report, we describe a 50-year-old man who presented to our facility for a second opinion after a year-long history of recurrent and now persistent right-sided exudative pleural effusion. On review of previous records, negative findings were seen in microbiological studies, including acid-fast bacilli, cytology, flow cytometry, and pleural biopsy using video-assisted thoracoscopy. On transthoracic echocardiography performed during our evaluation, the expected respiratory variations across the mitral and tricuspid valves were not appreciated. This necessitated subsequent cardiac workup via magnetic resonance imaging, which showed a small pericardial fluid, thickened pericardium, and a septal bounce. The patient was surgically treated using a phrenic-to-phrenic pericardiectomy, following which his symptoms resolved completely. Pleural effusions occur in approximately 40-60% of patients with constrictive pericarditis, and despite the known association of pleural effusions with constrictive pericarditis, the diagnosis of constrictive pericarditis is not readily entertained in patients with undiagnosed pleural effusions.

3.
Open Respir Arch ; 4(4): 100201, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-37496966

RESUMO

Introduction: Occurrence of malignant pleural effusion (PE) is known to be associated with a poor prognosis, but the mortality of patients with non-malignant effusions has not been sufficiently studied. Our objective was to describe the clinical course and explore risk factors associated with all-cause mortality at 1, 5 and 10 years in patients who develop a PE. Methods: Retrospective observational study of patients undergoing diagnostic thoracentesis during the decade 2008-2017 in a pulmonology service. Demographic, biochemical, pathological and evolutionary variables were evaluated. The etiology of the effusions was determined using standardized criteria. Results: Pleural fluid samples from 358 patients with a mean age of 68.9 years (SD 15.1 years), 69.2% males, were analyzed. Malignant (29.4%), parapneumonic (19.8%) and secondary to heart failure (18.9%) effusions predominated. Patients with malignant and heart failure related PE had 1-year mortality rates of 60.0% and 30.8%, respectively, and 85% and 64.7% at 5 years. Male gender (hazard ratio [HR] 1.46; 95% CI: 1.03-2.07), positive cytology for malignancy (HR 1.66; 95% CI: 1.03-2.68) and effusion recurrence (HR 1.61; 95% CI: 1.17-2.21) were associated with a worse prognosis and 5-year mortality. Conclusions: Patients undergoing thoracentesis for effusion have a high short and long-term mortality. In our series of hospitalized patients with PE, the factors associated with higher mortality at 1 and 5 years were age, male sex, recurrence of PE, and coexistence of malignancy.

4.
Rev. cuba. med ; 59(4): e1577, oct.-dic. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144505

RESUMO

Introducción: El derrame pleural recidivante maligno se reproduce en breve tiempo y requiere el diagnóstico etiológico positivo de malignidad, la etiología más frecuente es el cáncer de pulmón. La pleurodesis química es el tratamiento de elección con la aplicación intrapleural de sustancias sinfisiantes. Objetivo: Describir la respuesta clínica y radiológica de los enfermos con derrame pleural recidivante maligno con el uso de bleomicina. Método: Estudio observacional comparativo en 30 pacientes con derrame pleural recidivante maligno divididos en dos grupos, en uno se aplicó la bleomicina intrapleural y al otro yodo povidona. Resultado: El 33,3 por ciento fueron del sexo masculino, 60 por ciento perteneció al grupo de edades de 60-69 años. El grupo tratado con bleomicina presentó una respuesta clínica favorable en los síntomas, p<0,005 después de la pleurodesis. En la evaluación de la respuesta radiológica, 66,6 por ciento pacientes tratados con la bleomicina tuvieron una resolución completa. Conclusiones: Se logró una buena respuesta clínica-radiológica con la pleurodesis química similar entre ambas modalidades de tratamiento. Se obtuvieron mejores resultados y menos reacciones adversas con la bleomicina intrapleural(AU)


Introduction: The malignant recurrent pleural effusion reproduces in short time and it requires a positive etiological diagnosis of malignancy, the most frequent etiology is lung cancer. Chemical pleurodesis is the treatment of choice with the intrapleural application of symphysiating substances. Objective: To describe the clinical and radiological response of patients with malignant recurrent pleural effusion with the use of bleomycin. Method: A comparative observational study in 30 patients with recurrent malignant pleural effusion was carried out. They were divided into two groups, one used intrapleural bleomycin and the other group used povidone iodine. Result: 33.3 percent were male, 60 percent belonged to the 60-69 age group. The group treated with bleomycin presented favorable clinical response in symptoms, p <0.005 after pleurodesis. At the evaluation of the radiological response, 66.6 percent patients treated with bleomycin had a complete resolution. Conclusions: Good clinical-radiological response was achieved with similar chemical pleurodesis between both treatment modalities. Better results and fewer adverse reactions were obtained with intrapleural bleomycin(AU)


Assuntos
Humanos , Masculino , Feminino , Bleomicina/uso terapêutico , Derrame Pleural Maligno/tratamento farmacológico , Neoplasias Pulmonares/etiologia , Estudo Observacional
5.
J Community Hosp Intern Med Perspect ; 10(6): 594-596, 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33194137

RESUMO

A 63-year-old male with a past medical history of stage 3 chronic kidney disease, type 2 diabetes mellitus, hypertension, and coronary artery disease presented with recurrent symptomatic pleural effusions, low back pain and unintentional weight loss. Labs revealed elevated serum calcium and parathyroid hormone-related peptide, but normal parathyroid hormone, vitamin D, and angiotensin-converting enzyme levels. Malignancy workup was revealing for salt-and-pepper appearance of the bone marrow on MRI of the lumbar spine consistent with multiple myeloma. CT of chest, abdomen, and pelvis was negative for neoplastic process but showed a pleural effusion and calcified granulomas in hilar lymph nodes. Bone marrow biopsy of the lumbar region was subsequently conducted and revealed granulomas confirming the diagnosis of sarcoidosis. Treatment of sarcoidosis resulted in complete resolution of his symptoms and pleural effusion. This case highlights the variable presentation of sarcoidosis and its ability to mimic malignancy. Prompt recognition and treatment is essential in avoiding unnecessary costs and harm to the patient.

6.
Surg Clin North Am ; 99(5): 921-939, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446918

RESUMO

This article reviews a few surgical palliative care procedures that can be performed by surgeons and interventional radiologists using image-guided techniques. Treatment of recurrent pleural effusions, gastrostomy feeding tube maintenance, percutaneous cholecystostomy, and transjugular intrahepatic portosystemic shunts (TIPS) with embolotherapy of bleeding stomal varices is discussed.


Assuntos
Cuidados Paliativos/métodos , Sistema Biliar/diagnóstico por imagem , Colecistostomia/métodos , Drenagem/métodos , Embolização Terapêutica/métodos , Nutrição Enteral/métodos , Varizes Esofágicas e Gástricas/terapia , Vesícula Biliar/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/terapia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Radiografia , Toracentese/métodos , Ultrassonografia
7.
Cureus ; 11(5): e4619, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31312546

RESUMO

Pleural effusions are frequently encountered in clinical practice. In the United States, malignancy is the third leading cause of pleural effusion after heart failure and pneumonia. The most common cause of malignant pleural effusion (MPE) is lung cancer, followed by breast cancer, lymphoma, and mesothelioma. Genitourinary cancers rarely metastasize to the pleura. Although several atypical patterns of thoracic metastasis from genitourinary cancers have been described in the literature, genitourinary cancers rarely give rise to MPEs. We describe a case where the workup of a unilateral pleural effusion led to the diagnosis of high-grade urothelial bladder carcinoma.

8.
AACN Adv Crit Care ; 29(4): 432-441, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30523014

RESUMO

Recurrent pleural effusion is a symptom of several end-stage diseases and is associated with limited life expectancy. Patients with this condition have disabling symptoms resulting in reduced quality of life and often receive inconsistent treatment due to delayed recognition of pleural effusion, repeat procedures, and lengthy hospitalizations. Placement of a tunneled pleural catheter allows the patient to manage his or her symptoms at home, yet this treatment remains underused because of provider misconceptions and unfamiliarity with the intervention. This article provides an overview of the indications for placement of a tunneled pleural catheter, possible complications, and management strategies, and introduces evidence-based clinical decision support tools to enhance provider knowledge. In addition, the article describes the implementation and evaluation of a performance improvement initiative on the use of tunneled pleural catheters in a multifaceted health care system.


Assuntos
Cateterismo/normas , Cuidados Críticos/normas , Drenagem/normas , Insuficiência Cardíaca/complicações , Derrame Pleural/terapia , Pleurodese/normas , Guias de Prática Clínica como Assunto , Cateterismo/métodos , Cuidados Críticos/métodos , Drenagem/métodos , Humanos , Derrame Pleural/etiologia , Pleurodese/métodos , Recidiva
9.
Ther Adv Respir Dis ; 11(9): 343-352, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28799457

RESUMO

BACKGROUND: Indwelling tunneled pleural catheters (TPCs) are increasingly being used to treat recurrent pleural effusions. There is also an increased interest in early pleurodesis in order to prevent infectious complications. We studied the time to removal and other outcomes for all the TPCs placed at our institution. METHODS: After institutional review board approval, records of patients who had had a TPC placed between July 2009 and June 2016 were reviewed; the catheters were placed in an endoscopy suite or during pleuroscopy with or without a sclerosant. The catheters were drained daily or less frequently and were removed after three drainages of less than 50 ml. RESULTS: During the study period 193 TPCs were placed. Of these 45 (23%) were placed for benign diseases. The commonest malignancy was lung cancer 70 (36%). Drainage 2-3 times a week without a sclerosant ( n = 100) lead to pleurodesis at 57 ± 78 days, while daily drainage after TPC + pleuroscopy + talc ( n = 41) achieved the same result in 14 ± 8 days ( p < 0.001). TPC + talc + daily protocol achieved pleurodesis in 19 ± 7 days, TPC + rapid protocol achieved the same result in 28 ± 19 days ( p = 0.013). The TPCs + sclerosant had an odds ratio of 6.01 (95% confidence interval: 2.1-17.2) of having a complication versus TPC without sclerosant. CONCLUSIONS: It is clear that TPCs when placed with a sclerosant had a significantly shorter dwell time; However, they were associated with higher odds of complications. One must be aware of these possibilities when offering what is essentially a palliative therapy.


Assuntos
Cateterismo/métodos , Derrame Pleural/terapia , Pleurodese/métodos , Soluções Esclerosantes/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateteres de Demora , Remoção de Dispositivo , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Lung India ; 32(6): 648-50, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26664182

RESUMO

Endomterisois is usually found in women of child-bearing age. A case is presented of massive right-sided pleural effusion caused by endometriosis. The final diagnosis was made by thoracoscopic pleural biopsy. Physicians should be aware of this potentially treatable cause of pleural effusion having excluded other possibilities such as malignancy and tuberculosis.

11.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-196798

RESUMO

Central nervous system(CNS) involvement by tuberculosis is uncommon in comparison to the involvement of other systems. Untreated tuberculous meningitis is characterized by progressive stupor and a fatal outcome within 4 to 8 weeks of the onset of symptoms. So rapid detection of Mycobacterium tuberculosis is of vital importance for these patients. In almost all patients with tuberculous meningitis, acid-fast bacteria are undetectable in the CSF. Culture techniques that permit the identification of the isolated mycobacterial species require several weeks. We report a case of tuberculous meningitis with intracranial tuberculoma in 8-year old male who experienced pleural effusion, repeatedly. CSF findings did not reveal diagnosis tuberculous meningitis. In MRI study, multiple intracranial tuberculomas were located at the cerebellum. Prolonged treatment with anti- tuberculous chemotherapy and high-dose corticosteroids led to complete recovery.


Assuntos
Criança , Humanos , Masculino , Corticosteroides , Bactérias , Cerebelo , Técnicas de Cultura , Diagnóstico , Tratamento Farmacológico , Evolução Fatal , Imageamento por Ressonância Magnética , Mycobacterium tuberculosis , Derrame Pleural , Estupor , Tuberculoma , Tuberculoma Intracraniano , Tuberculose , Tuberculose Meníngea
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