Intrapleural Alteplase in a Patient with Complicated Pleural Effusion

2003 ◽  
Vol 37 (3) ◽  
pp. 376-379 ◽  
Author(s):  
Charlotte A Walker ◽  
Mary Beth Shirk ◽  
Marva M Tschampel ◽  
James A Visconti
Keyword(s):  
Pleural Effusion ◽  
Chest Tube ◽  
Pleural Cavity ◽  
Surgical Intervention ◽  
Chest Tube Drainage ◽  
Tube Drainage ◽  
X Ray ◽  
Case Summary ◽  
Chest X Ray ◽  
Intrapleural Administration

OBJECTIVE: To report the intrapleural use of alteplase in a patient diagnosed with complicated pleural effusion (CPE). CASE SUMMARY: A 62-year-old white woman admitted with respiratory distress and hypotension developed a right-sided multi-loculated pleural effusion. Thoracentesis and chest tube drainage were not successful in resolving the effusion. In an attempt to increase the drainage of the pleural effusion, alteplase 16 mg was administered into the pleural cavity via the chest tube on 6 consecutive days. As a result, the volume drained from the patient's chest tube increased, there was improvement on the chest X-ray, and she did not require surgical intervention. DISCUSSION: While streptokinase and urokinase have been shown to be useful adjuncts to chest tube drainage in the treatment of complicated pleural effusion and empyema, there have been no reports on the use of intrapleural alteplase. This report demonstrates that intrapleural administration of alteplase is a useful adjunct to tube drainage in resolving CPE. CONCLUSIONS: This patient's CPE resolved when intrapleural alteplase was used as an adjunct to chest tube drainage and antibiotics. Controlled trials need to be conducted to investigate fully the efficacy, dosing, and safety of intrapleural alteplase in the treatment of patients with CPE and empyema.

scholarly journals Pleural Effusion in Children: How often do we suspect Tubercular origin?

1970 ◽  
Vol 30 (3) ◽  
pp. 132-134
Author(s):  
PN Shrestha ◽  
A Rayamajhi
Keyword(s):  
Pleural Effusion ◽  
Chest Tube ◽  
Clinical History ◽  
Chest Tube Drainage ◽  
Pleural Effusions ◽  
Tube Drainage ◽  
Nephritic Syndrome ◽  
Study Results ◽  
Detailed Clinical History ◽  
Chest X Ray

Introduction: Pleural effusion is a common problem in children; mostly due to common causes like pyogenic or tubercular infections. Different studies have showed that about 30%-60% of pleural effusion have resulted into formation of empyema. Method: This was an observational study done in children aged 3 months to 14 years with a diagnosis of pleural effusion admitted at Kanti Children’s Hospital, Maharajgunj from August 2009 to March 2010. The aim of the study was done to find out different modalities of treatment for the same and their outcome. A detailed clinical history and physical examination, was done in all children. Chest x-ray, laboratory reports and treatment were recorded and all patients followed up until death or discharge. Any change of management was also noted. Pleural effusion caused by nephritic syndrome or congestive cardiac failure were excluded from the study. Results: During the study period of eight months, 64 patients were admitted with the diagnosis of pleural effusion. Boys to girls ratio was 2:1. Right-sided pleural effusions were more common than left sided pleural effusions (53% vs. 37%). Most of patients improved with parental antibiotics along with chest tube drainage (62%). One in three patients (31%) received anti-tubercular drugs. Three patients (4.6%) were referred to surgeon for decortications and one patient (1.6%) died. Conclusion: Though chest tube drainage with parental antibiotics was the mainstay of treatment of pleural effusion, however one-third of patients also received anti-tubercular drugs. Key words: Pleural effusion; pyogenic; decortication; adenosine deaminase (ADA). DOI: 10.3126/jnps.v30i3.3914J Nep Paedtr Soc 2010;30(3):132-134Introduction: Pleural effusion is a common problem in children; mostly due to common causes like pyogenic or tubercular infections. Different studies have showed that about 30%-60% of pleural effusion have resulted into formation of empyema. Method: This was an observational study done in children aged 3 months to 14 years with a diagnosis of pleural effusion admitted at Kanti Children’s Hospital, Maharajgunj from August 2009 to March 2010. The aim of the study was done to find out different modalities of treatment for the same and their outcome. A detailed clinical history and physical examination, was done in all children. Chest x-ray, laboratory reports and treatment were recorded and all patients followed up until death or discharge. Any change of management was also noted. Pleural effusion caused by nephritic syndrome or congestive cardiac failure were excluded from the study. Results: During the study period of eight months, 64 patients were admitted with the diagnosis of pleural effusion. Boys to girls ratio was 2:1. Right-sided pleural effusions were more common than left sided pleural effusions (53% vs. 37%). Most of patients improved with parental antibiotics along with chest tube drainage (62%). One in three patients (31%) received anti-tubercular drugs. Three patients (4.6%) were referred to surgeon for decortications and one patient (1.6%) died. Conclusion: Though chest tube drainage with parental antibiotics was the mainstay of treatment of pleural effusion, however one-third of patients also received anti- tubercular drugs. Key words: Pleural effusion, pyogenic, decortication, adenosine deaminase (ADA). DOI: 10.3126/jnps.v30i3.3914J Nep Paedtr Soc 2010;30(3):132-134

scholarly journals Chest Tube Drainage Under Radiological Guidance for Pleural Effusion and Pneumothorax in a Tertiary Care University Teaching Hospital: Review of 51 Cases

2005 ◽  
Vol 12 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Luce Cantin ◽  
Carl Chartrand-Lefebvre ◽  
Luigi Lepanto ◽  
David Gianfelice ◽  
Antoine Rabbat ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Teaching Hospital ◽  
Chest Tube ◽  
Tertiary Care ◽  
Chest Tube Drainage ◽  
University Teaching ◽  
Tube Placement ◽  
Pigtail Catheter ◽  
First Line ◽  
Tube Drainage

BACKGROUND: Chest tube drainage under radiological guidance has been used with increasing frequency as a treatment option for pleural effusions and pneumothoraxes.OBJECTIVE: To evaluate the safety and usefulness of pleural drainage under radiological guidance for pleural effusion and pneumothorax in a tertiary care university teaching hospital.METHODS: A retrospective study of cases of chest tube placement under radiological guidance over a 12-month period in a university hospital.RESULTS: Fifty-one percutaneous pigtail catheter drainage cases were reviewed (30 patients). Forty-six (90%) chest tubes were inserted as a first-line treatment. The overall success rate of radiological drainage was 88%. Specific success rates were 92%, 85% and 91% for loculated pleural effusion, pneumothorax and empyema, respectively. The complications were few and minor.CONCLUSIONS: Pigtail catheter insertion under radiological guidance is a useful procedure for the treatment of sterile pleural effusion, empyema and pneumothorax. This technique can be used as a first-line procedure in the majority of cases.

Omitting Chest Tube Drainage after Subxiphoid Thoracoscopic Thymectomy

2019 ◽  
Vol 68 (05) ◽  
pp. 446-449 ◽  
Author(s):  
Hao Xu ◽  
Congying Guo ◽  
Yi Li ◽  
Lei Yang ◽  
Linyou Zhang
Keyword(s):  
Chest Tube ◽  
Operative Time ◽  
Pleural Cavity ◽  
Ultrasound Examination ◽  
Chest Tube Drainage ◽  
Chest Roentgenogram ◽  
Perioperative Outcomes ◽  
Chest Tubes ◽  
Chest Drainage ◽  
Tube Drainage

Background This study investigated the feasibility and safety of omitting chest tube drainage after subxiphoid thoracoscopic thymectomy. Methods From July 2018 through October 2018, 20 patients underwent subxiphoid thoracoscopic thymectomy without chest tube drainage. The clinical characteristics and perioperative outcomes of these patients are presented. Results All patients (10 males, 10 females; average age: 53.25 ± 12.50 years old) completed the operation. Chest tube drainage was omitted in a total of 20 patients. The operative time was 89.45 ± 49.80 minutes. No adverse events were observed. The bed-side ultrasound examination of the pleural cavity on the day of surgery showed a thimbleful of effusion and did not require thoracentesis. A postoperative chest roentgenogram on the next morning showed full expansion without pneumothorax in all patients. None of the patients required reintervention with chest drainage through the time of discharge. Conclusion The omission of chest tube drainage may be an alternative procedure for selected patients undergoing thoracoscopic thymectomy. The omission of chest tubes in thymectomy is safe, but further investigation is required.

scholarly journals Comparison of Single and Double Chest Tube Drainage Management in Patients Undergoing Thoracotomy

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A Elnori ◽  
H H Elsayed ◽  
A M Mostafa ◽  
M M M Kamal
Keyword(s):  
Chest Tube ◽  
Pleural Cavity ◽  
Chest Tube Drainage ◽  
Pleural Drainage ◽  
Inclusion Criteria ◽  
Chest Tubes ◽  
Single Tube ◽  
Tube Drainage ◽  
Specialized Hospital ◽  
Significant Difference

Abstract Background chest tube is the most commonly performed surgical procedure in thoracic surgery practice. It is defined as insertion of (chest tube) into the pleural cavity to drain air, blood, bile, pus, chyle or other fluids. Aim of the Work comparison of single and double chest tube drainage management in patients undergoing thoracotomy in the form of pain score, hospital stay, total drainage, residual collection after removal of chest tube and need for another chest tube at Cardiothoracic Academy Hospital and Ain Shams University Specialized Hospital (ASUSH). Patients and Methods this study was conducted on patients who undergone thoracotomy at the Cardiothoracic Academy Hospital and Ain Shams University Specialized Hospital throughout the last 6 months from March 2018 till August 2018. Data was collected retrospectively from 40 patients, 20 patients in each group. In the 20 patients in the ‘single-tube group', only one chest tube was inserted, and in the 20 patients in the ‘double-tube group', two chest tubes were inserted. Pre-, intra- and postoperative variables in both groups were compared. Results 40 patients met all inclusion criteria. The pre- and intraoperative characteristics of the patients were similar in both groups with no significant differences. The single-tube group was found to have a lesser amount of total pleural drainage than the double-tube group but there was no significant difference 202.50 cc vs 297.50 cc, respectively; (p > 0.05). Conclusion our results showed that the single chest tube drainage is more effective, reduces postoperative pain, hospitalization times and duration of drainage in patients who undergo thoracotomy.

Severe dengue with massive pleural effusion requiring urgent intercostal chest tube drainage: a case report

2012 ◽  
Vol 30 (2) ◽  
pp. 389.e1-389.e2 ◽  
Author(s):  
Afzal Azim ◽  
Jyoti N. Sahoo ◽  
Arvind K. Baronia ◽  
Mohan Gurjar ◽  
Ratendra K. Singh ◽  
...  
Keyword(s):  
Case Report ◽  
Pleural Effusion ◽  
Chest Tube ◽  
Chest Tube Drainage ◽  
Severe Dengue ◽  
Tube Drainage ◽  
Massive Pleural Effusion

scholarly journals PERSISTENT PLEURAL EFFUSION FOLLOWING CARDIAC SURGERY SUCCESSFULLY TREATED WITH CHEST TUBE DRAINAGE: A CASE REPORT

CHEST Journal ◽  
2020 ◽  
Vol 157 (6) ◽  
pp. A196
Author(s):  
F. Olmati ◽  
A. Iacovelli ◽  
C.D. Evangelista ◽  
D. Moschetta ◽  
P. Palange
Keyword(s):  
Cardiac Surgery ◽  
Case Report ◽  
Pleural Effusion ◽  
Chest Tube ◽  
Chest Tube Drainage ◽  
Tube Drainage

Intrapleural fibrinolytic therapy for complicated pleural effusions

1998 ◽  
Vol 18 (6) ◽  
pp. 73-80 ◽  
Author(s):  
BS Monroe ◽  
D Warner
Keyword(s):  
Clinical Experience ◽  
Chest Tube ◽  
Surgical Intervention ◽  
Fibrinolytic Therapy ◽  
Pleural Space ◽  
Pleural Effusions ◽  
Fibrinolytic Agents ◽  
Tube Drainage ◽  
Major Improvement ◽  
Intrapleural Administration

Intrapleural administration of fibrinolytic agents can be used to degrade the fibrin present in complicated pleural effusions, thus decreasing viscosity of the fluid and enhancing evacuation of the pleural space via chest tube drainage. Patients who may otherwise need surgical intervention could benefit from this treatment. As more knowledge is gained through clinical experience and research studies, patients' outcomes may show major improvement.

scholarly journals GAMBARAN FOTO TORAKS PADA EFUSI PLEURA DI BAGIAN/SMF RADIOLOGI FK UNSRAT RSUP PROF. DR. R.D. KANDOU MANADO PERIODE NOVEMBER 2014 – OKTOBER 2015

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Melinda G. Lantu ◽  
Elvie Loho ◽  
Ramli Hadji Ali
Keyword(s):  
Pleural Effusion ◽  
Medical Record ◽  
Developing Country ◽  
Pleural Cavity ◽  
Descriptive Study ◽  
Bilateral Pleural Effusion ◽  
X Ray ◽  
Left Pleural Effusion ◽  
Chest X Ray ◽  
Excessive Accumulation

Abstract: Pleural effusion is defined as excessive accumulation of fluid in the pleural cavity. This condition occurs worldwide and becomes a major problem in developing country including Indonesia. This was a retrospective descriptive study. Samples were the whole data of chest X-ray patients available in the medical record with a radiological diagnosis of pleural effusion. The results showed that there were 77 samples aged 45-59 years old. Males (65%) were more frequent than females (35%). Based on the location of effusion, 31 patients with right pleural effusion, 25 patients with left pleural effusion, and 21 patients with bilateral pleural effusion. Conclusion: Pleural effusion was mostly found among people aged above 20 years old. Chest X-ray was an important investigation t confirm the diagnosis of pleural effusion. Keywords: pleural effusion, chest x-ray Abstrak: Efusi pleura didefinisikan sebagai penimbunan cairan berlebihan dalam rongga pleura. Penyakit ini terdapat diseluruh dunia, bahkan menjadi problema utama di negara-negara yang sedang berkembang termasuk Indonesia. Jenis penelitian ini retrospekif deskriptif. Sampel penelitian ialah seluruh data rekam medik foto thoraks pada pasien dengan diagnosis radiologik efusi pleura. Hasil penelitian mendapatkan 77 sampel, terbanyak pada kelompok umur 45-59 tahun. Efusi pleura lebih banyak ditemukan pada laki-laki (65%) dibandingkan perempuan (35%). Berdasarkan lokasi efusi, 31 sampel dengan lokasi efusi pleura dekstra, 25 pasien dengan lokasi efusi pleura sinistra, dan 21 pasien dengan lokasi efusi pleura bilateral. Simpulan: Efusi pleura sering didapatkan pada pasien di atas 20 tahun. Pemeriksaan foto toraks merupakan salah satu pemeriksaan penunjang yang sering dilakukan untuk mendiagnosis efusi pleura.Kata kunci: efusi pleura, foto toraks

Sign in / Sign up

Export Citation Format

Share Document