Pleural effusion

2018 ◽  
Author(s):  
Seamus Grundy
Keyword(s):  
Pleural Effusion ◽  
Drainage System ◽  
Clinical Problem ◽  
Lymphatic Drainage ◽  
Parietal Pleura ◽  
Local Inflammation ◽  
Fluid Removal ◽  
Fluid Production ◽  
Systemic Symptoms ◽  
Common Clinical Problem

Pleural effusion is a common clinical problem which can present both to primary and secondary care. The process by which fluid accumulates can be divided into transudative or exudative. Transudative effusions occur in the presence of normal pleura and are caused by increased oncotic or hydrostatic pressures. Exudative effusions are associated with abnormal pleura and are caused either by increased pleural fluid production due to local inflammation or infiltration or by decreased fluid removal which is caused by obstruction of the lymphatic drainage system. Patients may be entirely asymptomatic or they may present with breathlessness, particularly if the effusion is large. Other symptoms include a cough and systemic symptoms such as weight loss, anorexia, and fever. Chest pain is suggestive of inflammation/infiltration of the parietal pleura and points towards malignancy or empyema. This chapter describes the assessment and diagnosis of the patient with pleural effusion.

scholarly journals Malignant Pleural Effusion: Diagnosis and Management

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Lucía Ferreiro ◽  
Juan Suárez-Antelo ◽  
José Manuel Álvarez-Dobaño ◽  
María E. Toubes ◽  
Vanessa Riveiro ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Life Expectancy ◽  
Malignant Pleural Effusion ◽  
Clinical Problem ◽  
Indwelling Pleural Catheter ◽  
Thoracic Drainage ◽  
Pleural Catheter ◽  
Trapped Lung ◽  
Common Clinical Problem ◽  
Case Basis

Symptomatic malignant pleural effusion is a common clinical problem. This condition is associated with very high mortality, with life expectancy ranging from 3 to 12 months. Studies are contributing evidence on an increasing number of therapeutic options (therapeutic thoracentesis, thoracoscopic pleurodesis or thoracic drainage, indwelling pleural catheter, surgery, or a combination of these therapies). Despite the availability of therapies, the management of malignant pleural effusion is challenging and is mainly focused on the relief of symptoms. The therapy to be administered needs to be designed on a case-by-case basis considering patient’s preferences, life expectancy, tumour type, presence of a trapped lung, resources available, and experience of the treating team. At present, the management of malignant pleural effusion has evolved towards less invasive approaches based on ambulatory care. This approach spares the patient the discomfort caused by more invasive interventions and reduces the economic burden of the disease. A review was performed of the diagnosis and the different approaches to the management of malignant pleural effusion, with special emphasis on their indications, usefulness, cost-effectiveness, and complications. Further research is needed to shed light on the current matters of controversy and help establish a standardized, more effective management of this clinical problem.

Lymphatic Drainage System after Left Radical Neck Dissection

1994 ◽  
Vol 103 (1) ◽  
pp. 46-48 ◽  
Author(s):  
Gady Har-El ◽  
Frank E. Lucente
Keyword(s):  
Pleural Effusion ◽  
Neck Dissection ◽  
Thoracic Duct ◽  
Lymphatic Vessel ◽  
Lymphatic System ◽  
Radical Neck Dissection ◽  
Drainage System ◽  
Lymphatic Drainage ◽  
Venous System ◽  
Collateral System

The thoracic duct is the main lymphatic vessel that drains most of the body's lymph and all of the intestinal chyle into the venous system. The thoracic duct may be ligated during left radical neck dissection (RND) without any significant sequelae. The lymphatic system must, therefore, have collateral channels. The present study shows an increased incidence of pleural effusion after left RND when compared to right RND. We suggest that this represents the inability of the collateral system to immediately accommodate the increased volume of chyle.

Dietary Management of Neonatal Chylothorax

PEDIATRICS ◽  
1974 ◽  
Vol 53 (3) ◽  
pp. 400-403
Author(s):  
Juan J. Gershanik ◽  
Haldor T. Jonsson ◽  
Donald A. Riopel ◽  
Robert M. Packer
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Ductus Arteriosus ◽  
Caloric Intake ◽  
Lymphatic Drainage ◽  
Portal System ◽  
Marked Diminution ◽  
Fluid Production ◽  
A Chain

A neonate with transposition of the great arteries developed chylothorax following ligation of the patent ductus arteriosus. At first, multiple thoracenteses and chest drainage were employed without significant diminution of pleural fluid production. Administration of a formula containing medium chain triglycerides (MCT) was associated with a marked decrease of pleural fluid accumulation within a few days. Total lipid concentration of pleural fluid prior to the diet was 890 mg/100 ml and diminished to 40 mg/100 ml after eight days of administration of the diet. Cholesterol and cholesterol esters decreased from 101 mg/100 ml to 24 mg/100 ml and from 83 mg/100 ml to 9 mg/100 ml, respectively. Total triglyceride concentration fell from 111 mg/100 ml to 2 mg/100 ml. Only negligible amounts of fatty acids with a chain length lower than capric (C10:0) were recovered from the analyses of the samples. Thereafter, x-ray films revealed no pleural effusion and at the third-month follow-up visit the chest remained clear. The marked diminution in Volume of the pleural effusion in this case is thought to be associated with MCT feedings. MCT passes directly into the portal system, bypassing the lymphatic pathways and still provides adequate caloric intake. Thus, it seems ideal for the treatment of conditions which have a compromised lymphatic drainage. Both clinical data and biochemical findings in this case strongly suggest the use of MCT diet as an important adjunct of the management of neonatal chylothorax.

Malignant Pleural Effusion: Still a Long Way to Go

2019 ◽  
Vol 14 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Fausto Meriggi
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
English Language ◽  
Metastatic Cancer ◽  
Primary Tumour ◽  
Clinical Problem ◽  
Therapeutic Options ◽  
High Morbidity ◽  
Sclerosing Agents ◽  
Pubmed Database

Background:Malignant pleural effusion, which is a common clinical problem in patients with cancer, may be due to both primary thoracic tumours or to a metastatic spread in the chest and constitutes the first sign of disease in approximately 10% of patients. Almost all cancers can potentially produce a pleural effusion. The presence of malignant tumour cells in the pleural fluid is generally indicative of advanced disease and is associated with high morbidity and mortality with reduced therapeutic options. Dyspnoea during mild physical activity or at rest is generally the typical sign of restrictive respiratory failure. </P><P> Methods: This is a systematic review of all the main articles in the English language on the topic of malignant pleural effusion and reported by the Pubmed database from 1959 to 2018. I reviewed the literature and guidelines with the aims to focus on what is known and on future pathways to follow the diagnosis and treatment of malignant pleural effusions.Results:The main goal of palliation of a malignant pleural effusion is a quick improvement in dyspnoea, while thoracentesis under ultrasound guidance is the treatment of choice for patients with a limited life expectancy or who are not candidates for more invasive procedures such as drainage using an indwelling small pleural catheter, chemical pleurodesis with sclerosing agents, pleurectomy or pleuro-peritoneal shunt.Conclusion:Despite progress in therapeutic options, the prognosis remains severe, and the average survival is 4-9 months from the diagnosis of malignant pleural effusion. Moreover, mortality is higher for patients with malignant pleural effusion compared with those with metastatic cancer but no malignant pleural effusion. Therefore, the prognosis of these patients primarily depends on the underlying disease and the extension of a primary tumour. This review focuses on the most relevant updates in the management of malignant pleural effusion.

scholarly journals P046 Pointing the finger: an unusual presentation of dactylitis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Natalia Cernovschi - Feasey ◽  
Julekha Wajed
Keyword(s):  
Pleural Effusion ◽  
Soft Tissue ◽  
Middle Finger ◽  
Joint Involvement ◽  
Long Bones ◽  
History Of ◽  
Systemic Symptoms ◽  
The Right ◽  
Hands And Feet ◽  
Radiographic Changes

Abstract Background/Aims  Dactylitis is commonly associated with psoriatic arthritis, and regularly presents at Rheumatology clinics. We discuss a case where progressive systemic symptoms lead to the consideration of alternate diagnoses. Methods  A 46-year-old Nepalese woman presented to the Rheumatology department with a 3 month history of diffuse swelling of the right middle finger proximal interphalangeal joint, with the appearance of dactylitis. There was pain on movement, but no other joint involvement. Simultaneously she noticed blurred and decreased vision, which on review by the ophthalmologists, was diagnosed with bilateral uveitis. There was no history of psoriasis, inflammatory bowel disease, or other past medical history of note. There was no travel history in the past 12 months. A diagnosis of a presumed inflammatory arthritis was made. Results  Blood tests showed elevated c-reactive protein 55 (normal &lt;4 mg/l), erythrocyte sedimentation rate 138 (normal 0-22 mm/hr) and an iron deficiency anaemia. Rheumatoid factor and Anti-CCP antibody were negative. Hand radiographs were reported as normal. MRI of the third digit confirmed an enhancing soft tissue collection at the proximal phalanx of the right middle finger. She was referred for a biopsy of this lesion. Interestingly over the subsequent few months, she developed progressive breathlessness. Chest radiograph showed a left pleural effusion. Further tests showed negative serum ACE, Lyme and Toxoplasma screen. Quantiferon test was negative. Pleural aspirate showed a transudate with negative Acid-fast bacillus (AFB) test and culture. CT chest and abdomen showed a persistent pleural effusion, inflammatory changes in the small bowel and thickening of the peritoneum and omentum. In view of the systemic involvement, a peritoneal tissue biopsy was performed. This confirmed chronic granulomatous inflammation with positive AFB stain for mycobacterium tuberculosis. Our patient was started on quadruple anti- TB antibiotics for 6 months. Her systemic symptoms and dactylitis have improved, although there is on-going treatment for her ocular involvement. Conclusion  Approximately 10% of all cases of extrapulmonary TB have osteoarticular involvement. Dactylitis is a variant of tuberculous osteomyelitis affecting the long bones of the hands and feet. It occurs mainly in young children; however adults may be affected also. The first manifestation is usually painless swelling of the diaphysis of the affected bone followed by trophic changes in the skin. The radiographic changes are known as spina ventosa, because of the ballooned out appearance of the bone, although this was not seen in our case. Fibrous dysplasia, congenital syphilis, sarcoidosis and sickle cell anaemia may induce similar radiographic changes in the metaphysis of long bones of hands and feet, but do not cause soft tissue swelling or periosteal reaction. This case highlights the importance of testing for TB, especially in atypical cases of dactylitis, with other systemic features. Disclosure  N. Cernovschi - Feasey: None. J. Wajed: None.

Chronic pain following elective inguinal hernia repair—is it a common clinical problem?

2007 ◽  
Vol 32 (Suppl. 1) ◽  
pp. 174
Author(s):  
Z. M. Kirkor ◽  
T. N. Evans ◽  
H. Mathew ◽  
C. Swart ◽  
C. Morris ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Clinical Problem ◽  
Common Clinical Problem

scholarly journals The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xin You Li ◽  
Ming Tian ◽  
Ai Zhi Li ◽  
Chun Lei Han ◽  
Ke Zhong Li
Keyword(s):  
Laparoscopic Surgery ◽  
Shoulder Pain ◽  
Prospective Observational Study ◽  
Conditional Logistic Regression ◽  
Specific Treatment ◽  
Clinical Problem ◽  
Pain Visual Analogue Scale ◽  
Risk Patients ◽  
Treatment Plans ◽  
Common Clinical Problem

AbstractPostlaparoscopic shoulder pain (PLSP) is a common clinical problem that needs to be addressed by medical professionals who are currently perform laparoscopic surgeries. The purpose of this study was to determine the perioperative clinical factors and demographic characteristics associated with PLSP. A prospective observational study was performed with 442 inpatients undergoing laparoscopic surgery for infertility. The pain visual analogue scale was used as the measuring instrument. To identify the predictors of PLSP, we performed multivariate conditional logistic regression. PLSP was correlated with body mass index (BMI, odds ratio = 0.815). The incidence of shoulder pain and more severe shoulder pain in patients with a lower BMI was significantly higher than it was in patients with a higher BMI, and BMI was significantly negatively correlated with PLSP. Most of the patients (95%) began to experience shoulder pain on the first postoperative day, and it rarely occurred on the day of surgery. Patients with lower BMI presented a higher risk of reporting shoulder pain on the first postoperative day. We should identify high-risk patients in advance and make specific treatment plans according to the characteristics of their symptoms.

Preliminary study of the lymphatic drainage system of the nose and paranasal sinuses and its role in detection of sentinel metastatic nodes

2005 ◽  
Vol 125 (5) ◽  
pp. 566-570 ◽  
Author(s):  
J. M. Sánchez Fernández ◽  
F. Santaolalla ◽  
A. Sánchez Del Rey ◽  
A. Martínez-Ibargüen ◽  
A. González ◽  
...  
Keyword(s):  
Paranasal Sinuses ◽  
Drainage System ◽  
Lymphatic Drainage ◽  
Preliminary Study ◽  
Nose And Paranasal Sinuses

Homeopathic Treatment of Subclinical Hypothyroidism—A Series of 19 Cases

Homeopathy ◽  
2021 ◽  
Author(s):  
Luiz Carlos Esteves Grelle ◽  
Luiz Antonio Bastos Camacho
Keyword(s):  
Subclinical Hypothyroidism ◽  
Clinical Importance ◽  
Clinical Problem ◽  
Thyroid Stimulating Hormone ◽  
Exclusion Criteria ◽  
The Mean ◽  
Common Clinical Problem ◽  
Prompt Diagnosis ◽  
Serum Tsh ◽  
Tsh Levels

Abstract Background Subclinical hypothyroidism (SCH) is a common clinical problem. Controversy surrounds the definition, clinical importance, and need for prompt diagnosis and treatment of the mild form of SCH. Aim The aim of the study was to analyze the evolution of serum thyroid stimulating hormone (TSH) levels after a therapeutic homeopathic intervention in women older than 40 years with SCH. Methods This study is a retrospective series of 19 cases of SCH, with serum TSH levels between 5 and 10 mIU/L, treated exclusively with homeopathic medicines prescribed on an individualized basis. Results Nineteen patients were included according to the inclusion and exclusion criteria. Their mean age was 56 years, they were followed for a mean duration of 69 months, the mean number of serum TSH level measurements was 18, and the intervention was successful for 13 patients. Conclusion The homeopathic therapeutic intervention was successful in 68% of the patients, with serum TSH levels back within the normal range (0.5–5.0 mIU/L).

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