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1.
Medicine (Baltimore) ; 99(15): e19778, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282740

RESUMO

RATIONALE: Therapeutic or diagnostic thoracentesis is widely used in different clinical settings. Cardiac injury, a rare complication, could lead to fatal consequences. We describe a case of cardiac tamponade complicating thoracentesis that was recognized and rescued in a timely manner. PATIENT CONCERNS: A 42-year-old woman underwent blind thoracentesis due to excessive left pleural effusion after left pneumonectomy surgery. She suddenly lost consciousness and was in a state of shock a few minutes after needle insertion and fluid drainage. DIAGNOSIS: Bedside transthoracic echocardiography revealed pericardial effusion at a depth of 20 mm, and cardiac tamponade complicating thoracentesis was diagnosed. INTERVENTIONS: After draining 250 mL of non-coagulated blood by pericardiocentesis under transthoracic echocardiography guidance, a tube was placed for continuous drainage over the subsequent 36 hours. OUTCOMES: The patient's hemodynamic condition was stabilized hours after pericardiocentesis. The patient was discharged in good condition a few days later. LESSONS: Imaging assessment and guidance in the process of thoracentesis was indispensable, especially in a patient with altered intra-thoracic anatomy. Cardiac damage, as a life-threatening complication, should be considered once hemodynamic instability occurs during the procedure.


Assuntos
Tamponamento Cardíaco/etiologia , Pneumonectomia/métodos , Toracentese/efeitos adversos , Adulto , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/cirurgia , Drenagem/efeitos adversos , Ecocardiografia/métodos , Feminino , Humanos , Pericardiocentese/instrumentação , Derrame Pleural/cirurgia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Resultado do Tratamento
2.
BMJ Case Rep ; 12(4)2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30967447

RESUMO

Left ventricular puncture during a thoracentesis is a rare and unusual complication that has yet to be reported. We report a case in which a 74-year-old woman with dilated ischaemic heart disease suffered from puncture of the left ventricle during a routine ultrasound-guided thoracentesis despite following the recommended protocol and procedures. She became haemodynamically unstable and underwent an emergent thoracotomy for removal of the catheter and repair of the left ventricular wall.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Ventrículos do Coração/lesões , Hipertrofia Ventricular Esquerda/cirurgia , Toracentese/efeitos adversos , Idoso , Drenagem , Feminino , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Complicações Pós-Operatórias , Punções , Ultrassonografia de Intervenção
3.
BMC Gastroenterol ; 19(1): 58, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30999880

RESUMO

BACKGROUND: Vitamin K deficiency results in serious coagulation dysfunction, but hemorrhagic shock is rare. Herein, we describe a case of vitamin K deficiency and abnormality in the path of the intercostal artery, the combination of which led to hemorrhagic shock. CASE PRESENTATION: An 83-year-old woman was hospitalized for suspected gallstones. She developed septic shock after 4 days of hospitalization. We considered cholecystitis or cholangitis and performed abdominal ultrasonography, which revealed gallbladder enlargement, biliary sludge, and hyperplasia of the bile duct wall. Antibiotic treatment with sulbactam/ampicillin (SBT/ABPC) was initiated on day four, and percutaneous transhepatic gallbladder drainage (PTGBD) was performed on day five. The treatment was successful, but the patient developed bilateral pleural effusion because of hypoalbuminemia. We performed drainage for bilateral pleural effusion on days 13 and 17. The patient developed hypotension on day 18; blood tests showed anemia and severe coagulation dysfunction but a normal platelet count. We suspected vitamin K deficiency-induced coagulation dysfunction because of previous antibiotic treatment and restricted diet, and it led to hemorrhagic shock. Massive right hemothorax was observed by computed tomography, and urgent interventional radiology was performed. We observed no injury to the intercostal artery truncus but confirmed an abnormality in the course of the intercostal artery; therefore, we inferred that the cause of hemothorax in this case was injury to a small vessel, not truncus because of the abnormality. Because of the likelihood of rebleeding, we performed coil embolization from the seventh to the ninth intercostal artery. Because we confirmed vitamin K deficiency-induced coagulation dysfunction, we referred to the concentration of protein induced by vitamin K absence/antagonist-II (PIVKA-II), and it was found to increase by 23,000. CONCLUSIONS: A combination of vitamin K deficiency and abnormality in the course of the intercostal artery led to hemorrhagic shock. When using certain antibiotics and restricting diet, it is important to measure coagulation function, even if the platelet count is normal. Further, when thoracentesis is performed, abnormalities in the course of the intercostal artery should be identified. Thoracentesis with ultrasound may prevent hemothorax.


Assuntos
Artérias/anormalidades , Costelas/irrigação sanguínea , Choque Hemorrágico/etiologia , Toracentese/efeitos adversos , Deficiência de Vitamina K/complicações , Idoso de 80 Anos ou mais , Ampicilina/efeitos adversos , Ampicilina/uso terapêutico , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Colecistite/terapia , Dieta com Restrição de Gorduras/efeitos adversos , Drenagem , Feminino , Cálculos Biliares/terapia , Humanos , Derrame Pleural/cirurgia , Sulbactam/efeitos adversos , Sulbactam/uso terapêutico , Deficiência de Vitamina K/etiologia
4.
Rev Mal Respir ; 36(4): 477-483, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31005424

RESUMO

Drainage of primary spontaneous pneumothorax (PSP) may be managed by different techniques and with different types of drain. It is mainly performed in the pneumology department or in the emergency department. The aim of the study was to evaluate the factors that influence the success of PSP drainage. This retrospective, monocentric study performed in University Hospital of Toulouse, included patients with a first episode of PSP requiring drainage. The primary outcome was the rate of success according to the techniques of drainage. Data on the size of the drain (>14F or<14F), the drainage technique (small bore catheter or chest tube drainage) and the drainage department (pneumology or emergency) were collected. One hundred and twenty-four patients had a drainage between 2014 and 2016: the late recurrence free success rate was 59% (n=73). Compared with emergency, drainage in pneumology increased the success rate threefold regardless of the drainage technique (P=0.0001) The success rate was similar whatever the technique used (Seldinger or classic technique) (P=0.31). Success and complications rates were similar whether the drain was large (>14F) or small (<14F) (respectively P=0.99 and P=0.58). In our study, the drainage of PSP in the pneumology department, with a small caliber inserted by the Seldinger technique, was associated with a significantly higher success rate.


Assuntos
Drenagem/métodos , Pneumotórax/diagnóstico , Pneumotórax/terapia , Adulto , Tubos Torácicos/efeitos adversos , Tubos Torácicos/estatística & dados numéricos , Drenagem/efeitos adversos , Drenagem/instrumentação , Desenho de Equipamento/efeitos adversos , Desenho de Equipamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pneumotórax/epidemiologia , Pneumotórax/patologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Toracentese/efeitos adversos , Toracentese/instrumentação , Toracentese/métodos , Resultado do Tratamento , Adulto Jovem
5.
BMC Med Imaging ; 19(1): 31, 2019 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-31029094

RESUMO

BACKGROUND: A pseudoaneurysm occurs as the result of a contained rupture of an arterial wall, yielding a perfused sac that communicates with the arterial lumen. Pseudoaneurysm of an intercostal artery is an extremely rare event but it carries with it a significant risk of rupture and subsequent hemothorax. It must be considered as a potential complication of thoracentesis. CASE PRESENTATION: Here, we report a rare case of an intercostal artery pseudoaneurysm following thoracentesis in an 82-year old male. The patient presented with respiratory distress 1 day after a therapeutic thoracentesis had been performed. Computed tomography (CT) with contrast revealed a left intercostal pseudoaneurysm with hemothorax and adjacent compressive atelectasis. Doppler ultrasound revealed bidirectional blood flow in the pseudoaneurysm sac. An intercostal arteriogram and thoracic aortogram aided in confirmation of the pseudoaneurysm and successful treatment with coil embolization. CONCLUSIONS: An intercostal pseudoaneurysm complication following thoracentesis is very rare but important to rule out as a possible cause of hemothorax after the procedure. Capturing this finding with the aid of multiple imaging modalities allowed for diagnostic certainty and rapid treatment with coil embolization, leading to a successful patient recovery.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Hemotórax/diagnóstico por imagem , Toracentese/efeitos adversos , Idoso de 80 Anos ou mais , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Angiografia , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/terapia , Aortografia , Meios de Contraste/administração & dosagem , Embolização Terapêutica , Hemotórax/etiologia , Hemotórax/terapia , Humanos , Masculino , Imagem Multimodal , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia Doppler
6.
J Bronchology Interv Pulmonol ; 26(3): 166-171, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30433893

RESUMO

BACKGROUND: Pleural effusions may be aspirated manually or via vacuum during thoracentesis. This study compares the safety, pain level, and time involved in these techniques. METHODS: We randomized 100 patients receiving ultrasound-guided unilateral thoracentesis in an academic medical center from December 2015 through September 2017 to either vacuum or manual drainage. Without using pleural manometry, the effusion was drained completely or until the development of refractory symptoms. Measurements included self-reported pain before and during the procedure (from 0 to 10), time for completion of drainage, and volume removed. Primary outcomes were rates of all-cause complications and of early termination of the procedure with secondary outcomes of change in pain score, drainage time, volume removed, and inverse rate of removal. RESULTS: Patient characteristics in the manual (n=49) and vacuum (n=51) groups were similar. Rate of all-cause complications was higher in the vacuum group (5 vs. 0; P=0.03): pneumothorax (n=3), surgically treated hemothorax with subsequent death (n=1) and reexpansion pulmonary edema causing respiratory failure (n=1), as was rate of early termination (8 vs. 1; P=0.018). The vacuum group exhibited greater pain during drainage (P<0.05), shorter drainage time (P<0.01), no association with volume removed (P>0.05), and lower inverse rate of removal (P≤0.01). CONCLUSION: Despite requiring less time, vacuum aspiration during thoracentesis was associated with higher rates of complication and of early termination of the procedure and greater pain. Although larger studies are needed, this pilot study suggests that manual aspiration provides greater safety and patient comfort.


Assuntos
Drenagem/efeitos adversos , Drenagem/métodos , Derrame Pleural/terapia , Toracentese/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemotórax/etiologia , Hemotórax/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Processual/etiologia , Projetos Piloto , Derrame Pleural/complicações , Derrame Pleural/diagnóstico , Pneumotórax/etiologia , Estudos Prospectivos , Edema Pulmonar/etiologia , Fatores de Tempo , Vácuo
8.
Clin Respir J ; 13(2): 73-81, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30578625

RESUMO

Thoracoscopy in the endoscopy suite, has a high diagnostic yield of undiagnosed pleural effusions with minimal and mild complications. Whereas relatively minimal invasive techniques, such as thoracentesis, image-guided pleural biopsy or blind pleural biopsy, can yield sufficient cell or tissue material to establish the diagnosis of the underlying condition, more definite invasive diagnostic and therapeutic procedure, such as thoracoscopy, may be required for accurate sampling and diagnosis, and further provide real-time treatment options in same procedure. If thoracoscopy is considered the gold standard for the diagnosis is a fact in case. The current review aims to provide informations on thoracoscopy indications in benign pleural diseases according to up to date publications.


Assuntos
Derrame Pleural/diagnóstico por imagem , Toracentese/métodos , Toracoscopia/métodos , Quilotórax/diagnóstico por imagem , Quilotórax/patologia , Análise Custo-Benefício , Humanos , Biópsia Guiada por Imagem/métodos , Pleura/patologia , Derrame Pleural/microbiologia , Derrame Pleural/parasitologia , Derrame Pleural/patologia , Sensibilidade e Especificidade , Toracentese/efeitos adversos , Toracoscopia/economia , Toracoscopia/normas , Tuberculose Pleural/diagnóstico por imagem , Tuberculose Pleural/patologia
9.
Respirology ; 24(1): 76-82, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29966171

RESUMO

BACKGROUND AND OBJECTIVE: The main purpose of treatment in patients with malignant pleural effusion (MPE) is symptom palliation. Currently, patients undergo repeat thoracenteses prior to receiving a definitive procedure as clinicians are not aware of the risk factors associated with fluid recurrence. The primary objective of this study was to identify risk factors associated with recurrent symptomatic MPE. METHODS: Retrospective multicentre cohort study of patients who underwent first thoracentesis was performed. The primary outcome was time to fluid recurrence requiring intervention in patients with evidence of metastatic disease. We used a cause-specific hazard model to identify risk factors associated with fluid recurrence. We also developed a predictive model, utilizing Fine-Gray subdistribution hazard model, and externally validated the model. RESULTS: A total of 988 patients with diagnosed metastatic disease were included. Cumulative incidence of recurrence was high with 30% of patients recurring by day 15. On multivariate analysis, size of the effusion on chest X-ray (up to the top of the cardiac silhouette (hazard ratio (HR): 1.84, 95% CI: 1.21-2.80, P = 0.004) and above the cardiac silhouette (HR: 2.22, 95% CI: 1.43-3.46, P = 0.0004)), larger amount of pleural fluid drained (HR: 1.06, 95% CI: 1.04-1.07, P < 0.0001) and higher pleural fluid LDH (HR: 1.008, 95% CI: 1.004-1.011, P < 0.0001) were associated with increased hazard of recurrence. Negative cytology (HR: 0.52, 95% CI: 0.43-0.64, P < 0.0001) was associated with decreased hazard of recurrence. The model had low prediction accuracy. CONCLUSION: Pleural effusion size, amount of pleural fluid drained, LDH and pleural fluid cytology were found to be risk factors for recurrence.


Assuntos
L-Lactato Desidrogenase/análise , Neoplasias , Derrame Pleural Maligno , Toracentese , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/complicações , Neoplasias/patologia , Cuidados Paliativos/métodos , Derrame Pleural Maligno/metabolismo , Derrame Pleural Maligno/patologia , Derrame Pleural Maligno/fisiopatologia , Derrame Pleural Maligno/terapia , Radiografia Torácica/métodos , Recidiva , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Toracentese/efeitos adversos , Toracentese/métodos
10.
Dtsch Med Wochenschr ; 143(16): 1186-1192, 2018 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30086565

RESUMO

Pleural effusions of unknown origin and parapneumonic effusions almost invariably require thoracentesis. Fluid analysis is fundamental and guides further diagnostic and therapeutic decisions. Thoracentesis yields high diagnostic value and is a generally safe procedure - given that some basic principles are considered.


Assuntos
Derrame Pleural/terapia , Toracentese/métodos , Contraindicações , Diagnóstico Diferencial , Humanos , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Fatores de Risco , Toracentese/efeitos adversos
11.
Eur Respir J ; 52(1)2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30054348

RESUMO

Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.


Assuntos
Drenagem/métodos , Cuidados Paliativos/métodos , Derrame Pleural Maligno/terapia , Pleurodese/métodos , Toracentese/métodos , Comitês Consultivos , Drenagem/efeitos adversos , Europa (Continente) , Humanos , Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/epidemiologia , Pleurodese/efeitos adversos , Recidiva , Retratamento , Fatores de Risco , Sociedades Médicas , Toracentese/efeitos adversos
12.
Respiration ; 96(4): 330-337, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29991046

RESUMO

BACKGROUND: Repeat thoracentesis for symptom control is offered to patients with refractory hepatic hydrothorax (HH) but the risk profile for this management strategy remains unclear. OBJECTIVES: This study aimed to compare complication frequency and nature during repeat thoracentesis in patients with and without HH. METHODS: Complication rates in patients undergoing repeat thoracentesis for symptom relief was compared between patients with HH and a control group (non-HH group) at a single center from 2010 to 2015. Records were reviewed for demographics, laboratory values, number of thoracentesis, and associated complications with each procedure. RESULTS: 82 patients with HH (274 thoracenteses) and 100 control patients (188 thoracenteses) were included. A complication was noted in 17/462 (0.03%) procedures in the entire cohort. There was a higher overall complication rate with repeat thoracentesis in the HH group (8 vs. 0%, p = 0.016, 95% CI = 1.5-14.6). In the HH group, the cumulative risk of complications increased with sequential thoracenteses; a complication occurring in the preceding intervention was the strongest predictor for subsequent complication (OR = 17.1, p = 0.0013) and more than 1 previous complication was associated with a 15-fold increased risk of a subsequent complication (p < 0.001). In multivariate analysis within the HH group, the Model for End-Stage Liver Disease (MELD) score was an independent predictor of hemothorax (OR = 1.19, 95% CI = 1.03-1.36, p = 0.012). CONCLUSIONS: Repeat thoracentesis is an overall low-risk procedure, although a higher complication rate is observed in HH compared with non-HH patients. The presence of a previous complication significantly increases the risk of future complications in the HH population.


Assuntos
Hidrotórax/cirurgia , Hipertensão Portal/complicações , Complicações Pós-Operatórias/epidemiologia , Reoperação/efeitos adversos , Toracentese/efeitos adversos , Idoso , Feminino , Humanos , Hidrotórax/etiologia , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Virginia/epidemiologia
13.
Ther Adv Respir Dis ; 12: 1753466618785098, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29952251

RESUMO

Malignant pleural effusion (MPE) affects more than 1 million people globally. There is a dearth of evidence on the therapeutic approach to MPE, and not surprisingly a high degree of variability in the management thereof. We aimed to provide practicing clinicians with an overview of the current evidence on the management of MPE, preferentially focusing on studies that report patient-related outcomes rather than pleurodesis alone, and to provide guidance on how to approach individual cases. A pleural intervention for MPE will perforce be palliative in nature. A therapeutic thoracentesis provides immediate relief for most. It can be repeated, especially in patients with a slow rate of recurrence and a short anticipated survival. Definitive interventions, individualized according the patient's wishes, performance status, prognosis and other considerations (including the ability of the lung to expand) should be offered to the remainder of patients. Chemical pleurodesis (achieved via intercostal drain or pleuroscopy) and indwelling pleural catheter (IPC) have equal impact on patient-based outcomes, although patients treated with IPC spend less time in hospital and have less need for repeat pleural drainage interventions. Talc slurry via IPC is an attractive recently validated option for patients who do not have a nonexpandable lung.


Assuntos
Drenagem/métodos , Cuidados Paliativos/métodos , Derrame Pleural Maligno/terapia , Pleurodese/métodos , Toracentese/métodos , Drenagem/efeitos adversos , Humanos , Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/epidemiologia , Pleurodese/efeitos adversos , Recidiva , Retratamento , Fatores de Risco , Toracentese/efeitos adversos , Resultado do Tratamento
17.
Am J Emerg Med ; 36(8): 1524.e1-1524.e4, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29703561

RESUMO

INTRODUCTION: A tension hydrothorax is defined as a massive pleural effusion presenting with hemodynamic abnormalities secondary to mediastinal compression. In these patients pleural volume increases intrathoracic pressure to the point of compromising diastolic filling and cardiac output simulating a cardiac tamponade physiology. This is an uncommon yet potentially fatal medical emergency that if left untreated may progress to cardiac arrest. Early detection and rapid intervention of these patients prevents cardiorespiratory collapse. CASE PRESENTATION: We present a two-case report of patients presenting with malignant tension hydrothoraxes decompressed with ultrasound-guided thoracentesis and tube thoracostomy in the ED. CONCLUSION: Although these life-saving decompressive interventions appear simple, not having proper training is an independent factor for chest tube and thoracentesis complications. Courses and simulation training can benefit physicians to minimize potential complications when managing emergency conditions such as tension hydrothoraxes which continue to be a medical challenge. Whether thoracentesis or thoracostomy is superior in managing this condition remains in debate and a clinical dilemma.


Assuntos
Tamponamento Cardíaco/etiologia , Hidrotórax/cirurgia , Derrame Pleural/fisiopatologia , Toracentese/efeitos adversos , Adulto , Tubos Torácicos/efeitos adversos , Descompressão Cirúrgica/efeitos adversos , Emergências , Feminino , Hemodinâmica , Humanos , Masculino , Toracostomia/efeitos adversos
18.
Curr Opin Pulm Med ; 24(4): 392-397, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29521656

RESUMO

PURPOSE OF REVIEW: Hepatic hydrothorax is a nonmalignant pleural effusion associated with portal hypertension that may cause increased morbidity or mortality in cirrhotic patients. For patients who are refractory to salt restriction and diuretics, thoracentesis and catheter drainage are necessary for symptomatic relief. This review aimed to identify the best drainage method in patients with hepatic hydrothorax. RECENT FINDINGS: Chest tube placement is discouraged in cases of hepatic hydrothorax due to high complication and mortality rates. Although the complication rate associated with smaller caliber catheter drainage appears lower than with chest tube drainage, patients treated with catheter drainage still had a higher 30-day mortality compared with patients treated by thoracentesis. Catheter drainage was an independent risk factor for 30-day mortality in cirrhotic patients with pleural effusion after adjusting for age, hepatic dysfunction, and other comorbidities. Treating the underlying disorder with liver transplantation can dramatically improve survival in these patients. SUMMARY: The recent evidence supports series thoracentesis as the first-line drainage method in cases of hepatic hydrothorax compared with catheter drainage. Further prospective, randomized, controlled trials are necessary to further evaluate the mortality and complication rates of catheter drainage compared with thoracentesis in cirrhotic patients.


Assuntos
Cateteres de Demora , Tubos Torácicos , Drenagem/métodos , Hidrotórax/cirurgia , Toracentese , Cateteres de Demora/efeitos adversos , Tubos Torácicos/efeitos adversos , Drenagem/efeitos adversos , Drenagem/mortalidade , Humanos , Hidrotórax/etiologia , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Transplante de Fígado , Derivação Portossistêmica Transjugular Intra-Hepática , Toracentese/efeitos adversos
19.
Monaldi Arch Chest Dis ; 88(1): 900, 2018 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-29557577

RESUMO

Reexpansion pulmonary edema (RPE) is an uncommon complication of thoracentesis or chest drainage. It occurs in the ipsilateral or contralateral lung. Causes, pathogenesis and therapy are not well understood especially for contralateral RPE. We describe a case of fatal contralateral RPE in a 59-years-old woman with right lung cancer underwent ultrasound-guided thoracentesis for massive pleural effusion and severe dyspnea. Pathogenesis of contralateral RPE is probably multifactorial and in this case is mostly due to the overperfusion of the healthy lung and consequent capillary damage. The right therapy for this condition is not known.


Assuntos
Dispneia/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Toracentese/efeitos adversos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Dispneia/etiologia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Pleural/cirurgia , Edema Pulmonar/tratamento farmacológico , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Toracentese/métodos , Ultrassonografia de Intervenção/instrumentação
20.
Respir Med ; 145: 230-236, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29402510

RESUMO

Although pleural manometry is a relatively simple medical procedure it is only occasionally used to follow pleural pressure (Ppl) changes during a therapeutic thoracentesis and pneumothorax drainage. As some studies showed that pleural pressure monitoring might be associated with significant advantages, pleural manometry has been increasingly evaluated in the last decade. The major clinical applications of pleural pressure measurements include: the prevention of complications associated with large volume thoracentesis, diagnosis and differentiation between various types of an unexpandable lung and a possible prediction of the efficacy of chest tube drainage in patients with spontaneous pneumothorax. It is well known that the therapeutic thoracentesis might be complicated by cough, chest discomfort, and rarely, by a life threatening condition called reexpansion pulmonary edema (RPE). The serious adverse events of thoracentesis are related to pleural pressure drop rather than to the volume of removed pleural effusion. The use of pleural manometry during pleural fluid withdrawal enables the evaluation of the relationship between withdrawn pleural fluid volume, pleural pressure changes and procedure related complications. Pleural pressure measurement is also an important tool to study the different mechanism of pneumothorax complicating the thoracentesis. Pleural manometry is critical for measurement of pleural elastance, diagnosis of an unexpandable lung and differentiation between trapped lung and lung entrapment. This usually has significant clinical implications in terms of further management of patients with pleural effusion. The paper is a comprehensive review presenting different aspects of pleural pressure measurement in clinical practice.


Assuntos
Manometria/métodos , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/fisiopatologia , Diagnóstico Diferencial , Elasticidade , Humanos , Pleura/fisiopatologia , Derrame Pleural , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Pressão , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Toracentese/efeitos adversos
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