Hydrothorax: Pleural Effusion Associated with Peritoneal Dialysis

2010 ◽  
Vol 30 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Susie Q. Lew
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Intervention ◽  
Thoracoscopic Surgery ◽  
Treatment Options ◽  
Medical Attention ◽  
Imaging Studies ◽  
Ultrafiltration Rate ◽  
Diagnostic Dilemma ◽  
Dialysis Adequacy ◽  
Video Assisted Thoracoscopic Surgery

Hydrothorax in a patient treated with peritoneal dialysis (PD) poses a diagnostic dilemma. Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of PD but generally does not threaten life. Shortness of breath causes the patient to seek medical attention. A sudden diminution in dialysis adequacy or poor ultrafiltration rate constitutes a unique marker for patients treated with PD compared to the general population. This article reviews the etiology for hydrothorax specifically in the PD population. Thoracentesis with chemical analysis of the fluid, imaging studies with and without contrast or markers, and video-assisted thoracoscopic surgery play important roles in the evaluation of hydrothorax. A conservative PD regimen, surgical intervention, and pleurodesis provide treatment options to those receiving PD.

scholarly journals Operative management of pediatric empyema: a single center review

2018 ◽  
Vol 21 (1) ◽  
pp. 10-13
Author(s):  
Aakriti Sharma ◽  
Ranjan Sapkota ◽  
Bibhusal Thapa ◽  
Prakash Sayami
Keyword(s):  
Thoracoscopic Surgery ◽  
Treatment Options ◽  
Operative Management ◽  
Successful Outcome ◽  
Open Approach ◽  
Empyema Thoracis ◽  
Transplant Center ◽  
Lung Expansion ◽  
Recorded Data ◽  
Video Assisted Thoracoscopic Surgery

Introduction: Empyema thoracis is an uncommon complication of childhood pneumonias but a common problem faced by a thoracic surgeon. Its management is still controversial, with a range of treatment options available and evolving gradually towards adoption of video-assisted thoracoscopic surgery (VATS) as the most commonly practiced one. Aim: The aim of this study was to review our experience in pediatric empyema thoracis. Methods: It was a retrospective review of the prospectively recorded data, spanning a period of 18 months in the Department of Cardio-Thoracic and Vascular Surgery in Manmohan Cardio-Thoracic Vascular and Transplant Center. Results: A total of 40 consecutive patients, 29 males and 11 females, aged 15 years or less were operated upon for a diagnosis of empyema thoracis made based on clinical, radiological and laboratory evidence. All of them were referred patients, mostly from pediatricians. VATS was undertaken in 36 of them, the remaining four treated by open approach. Deloculation sufficed in majority (26/40; 65%) of the patients which mostly (23/26; 90%) had either acute or subacute presentation. Decortication was required in 35% (14/40) of the patients. However, all of the patients but one had a successful outcome in terms of lung expansion, sterilization of the pleural cavity and absence of recurrence. There was no operative mortality. Conclusion: Surgical management of pediatric thoracic empyema is feasible and safe with favorable outcome. VATS is gradually becoming the more favored modality of operative management.  

Requirement of interventional treatment in a patient being conservatively managed for persistent pneumothorax over a prolonged period

2021 ◽  
Vol 14 (7) ◽  
pp. e243556
Author(s):  
Sophia Brenac
Keyword(s):  
Patient Involvement ◽  
Surgical Intervention ◽  
Thoracoscopic Surgery ◽  
Interventional Treatment ◽  
Decision Making Process ◽  
Good Recovery ◽  
Talc Pleurodesis ◽  
Cystic Changes ◽  
Video Assisted Thoracoscopic Surgery

An 85-year-old ex-smoker being managed conservatively over 2 years for a small right apical pneumothorax presented to the respiratory clinic with suddenly worsening shortness of breath and chest pain. A chest radiograph demonstrated sudden deterioration in the size of his pneumothorax. Previous CT scans had found emphysematous cystic changes within the lungs, and his new presentation warranted definitive surgical intervention with a right bullectomy and talc pleurodesis through a video-assisted thoracoscopic surgery procedure. The patient made a good recovery and was discharged from clinic a year later. This case demonstrates the importance of follow-up in patients with unresolved pneumothoraces due to the potential for sudden deterioration, and highlights the significance of respecting patient involvement and autonomy in the decision-making process.

scholarly journals Effectiveness of Local Hemostatic Agents in Epistaxis

2014 ◽  
Vol 5 (1) ◽  
pp. 1-5
Author(s):  
Tahir Hussain
Keyword(s):  
Surgical Intervention ◽  
Treatment Options ◽  
Tumor Resection ◽  
Medical Attention ◽  
Management Options ◽  
Hemostatic Agents ◽  
Surgical Measures ◽  
Epidemiological Profile ◽  
A Prospective Study ◽  
Head Neck

ABSTRACT Background Epistaxis is the commonest otorhinolaryngological emergency affecting up to 60% of the population in their lifetime with 6% requiring medical attention. Objective The aim of this study was to find out the epidemiological profile of epistaxis in our area and to find out the effectiveness of various available eight treatment options. Materials and methods This study was conducted to describe the etiological profile and treatment outcome of epistaxis. This was a prospective study of the cases of epistaxis from July 2012 to May 2013. Till date, the data regarding the management of epistaxis in our setting was not available. The purpose was to evaluate the clinical and management options for epistaxis in our settings. Results A total of 100 patients with epistaxis were studied. Males were affected twice more than the females (2.6:1). Their mean age was 48.63 years (4-82 years). The commonest cause of epistaxis was idiopathic (33%) followed by trauma (21%) and hypertension (18%). Nonsurgical measures, such as light packing with cotton gauze soaked with local hemostatic (hemocoagulase) and antiseptic/antibiotic (36%), silver nitrate cauterization 20 (16%) and anterior nasal packing (15%) and observation alone (11%) were the main intervention methods in 78% of cases. Surgical measures mainly intranasal tumor resection was carried out in 3% of cases. Conclusion The most common etiological factor for epistaxis is idiopathic. Most cases were successfully managed with conservative treatment alone and surgical intervention may not be necessary in most cases and should be the last resort. How to cite this article Hussain T. Effectiveness of Local Hemostatic Agents in Epistaxis. Int J Head Neck Surg 2014;5(1):1-5.

scholarly journals Thoracotomy versus VATS: is there an optimal approach to treating pneumothorax?

2013 ◽  
Vol 95 (1) ◽  
pp. 61-64 ◽  
Author(s):  
V Joshi ◽  
B Kirmani ◽  
J Zacharias
Keyword(s):  
Learning Curve ◽  
Recurrence Rate ◽  
Surgical Intervention ◽  
Thoracoscopic Surgery ◽  
Postoperative Bleeding ◽  
British Thoracic Society ◽  
Significant Difference ◽  
Optimal Approach ◽  
Video Assisted Thoracoscopic Surgery ◽  
Group 1

Introduction The 2010 British Thoracic Society guidelines recommend that a weighted decision be made by clinicians with regard to surgical intervention for pneumothorax as the video assisted thoracoscopic surgery (VATS) approach is better tolerated by patients but carries a higher rate of recurrence (5% vs 1%). Methods Overall, 163 patients underwent surgical intervention for pneumothorax at our institution and data were collected prospectively for almost 7 years. Of these, 86 patients underwent VATS under a single surgeon with extensive VATS experience to compensate for the associated learning curve while 79 patients underwent an open procedure. Results There was no statistically significant difference in the recurrence rate between the open and the VATS group (1% vs 3.5%, p=1.0). The VATS group was superior to the open group in terms of reduced postoperative bleeding (7.5% vs 0%, p=0.01), reduced number of intensive care unit admissions (16% vs 0%, p<0.01) and a reduced adjusted length of stay (3 vs 5.5 days, p<0.01). Conclusions A comparable recurrence rate is attainable with a VATS approach once the learning curve is surpassed and a reduction in morbidity is an additional merit.

scholarly journals Refractory pneumothorax and hemothorax associated with metastatic scalp angiosarcoma

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Masahide Isowa ◽  
Satona Tanaka ◽  
Ryo Nakanobo ◽  
Yoshito Yamada ◽  
Hiroshi Date
Keyword(s):  
Surgical Intervention ◽  
Thoracoscopic Surgery ◽  
Pathological Diagnosis ◽  
Parietal Pleura ◽  
Surgical Biopsy ◽  
Bullous Lesion ◽  
Life Threatening ◽  
History Of ◽  
Previously Treated ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background Pulmonary metastasis of scalp angiosarcoma (SA) is a rare, but life-threatening disease, challenging to diagnose and manage. We report two cases of pneumothorax and hemothorax with pathologically proven metastasis of SA in the parietal pleura, which was not predictable from images and difficult to manage. Patient A A 73-year-old man with SA underwent chemoradiotherapy and surgical resection for primary skin lesion, was sent to our department to treat right empyema, which was developed during chest tube drainage for pneumothorax. Computed tomography (CT) showed multiple bullous lesions. We performed repetitive video-assisted thoracoscopic surgery (VATS) for the debridement and hemostasis; however, hemothorax was uncontrollable. The repeated cytology of pleural effusion showed no malignancy. We eventually performed fenestration and metastatic SA was pathologically diagnosed by the biopsy of parietal pleura. The patient developed respiratory failure and uncontrolled anemia, which were fatal. Patient B A 71-year-old man with SA previously treated with chemoradiotherapy was referred to our department for left pneumothorax. CT showed multiple bullous lesions at apex without any changes at parietal pleura. VATS was performed and the apex bullous lesion with air leakage was resected. The parietal pleura showed several dark-red spots and the biopsy was undertaken. The pathological diagnosis was a metastasis of SA along with visceral pleura and parietal pleura. The patient then developed right pneumothorax and left hemopneumothorax. Bilateral pleurodesis was ineffective and the patient died due to deteriorating general condition. Conclusions In patients with a history of SA who develop pneumothorax and hemothorax, metastatic SA to visceral and parietal pleura should be always considered. Surgical biopsy, not cytology, is needed for pathological diagnosis. Lesions in the parietal pleura prior to hemothorax were thoracoscopically observed in one case. Surgeons must recognize that conventional surgical intervention or pleurodesis will have unsatisfactory results.

scholarly journals Effective Management of Peritoneal Dialysis-Associated Hydrothorax in a Child: A Case Report

2020 ◽  
Vol 10 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Cahyani Gita Ambarsari ◽  
Evita Karianni Bermanshah ◽  
Muhammad Arza Putra ◽  
Farhan Haidar Fazlur Rahman ◽  
Sudung Oloan Pardede
Keyword(s):  
Peritoneal Dialysis ◽  
Thoracoscopic Surgery ◽  
Underlying Mechanism ◽  
Long Term Follow Up ◽  
Stage Renal Disease ◽  
End Stage ◽  
Video Assisted Thoracoscopic Surgery

Peritoneal dialysis (PD) confers many advantages, including a better quality of life for children with end-stage renal disease; however, the procedure is associated with several complications, including pleuroperitoneal leaks. Here, we report an unusual case of hydrothorax caused by long-term PD in a child, which was further complicated by pneumonia. A 9-year-old boy who had received CAPD for 22 months presented with dyspnea, swelling, and increased body weight. Chest tube drainage yielded 500 mL of transudative fluid. Computed tomography peritoneography revealed increased outflow from the peritoneum to the pleural cavity. PD was suspended, and hemodialysis (HD) was initiated. Video-assisted thoracoscopic surgery was performed; however, because the patient had pneumonia during hospitalization, pleural adhesions with a septated appearance occurred. This resulted in difficulties identifying pleuroperitoneal fistula (PPF). Right pleural effusion resolved following pleurodesis using bleomycin. Regular HD was performed for 10 weeks, and PD was subsequently reinitiated. There was no recurrence of hydrothorax during long-term follow-up. We suspect that the underlying mechanism of hydrothorax in our patient was associated with a PPF that formed either due to a congenital diaphragmatic defect or an acquired defect, resulting in dialysate leakage. Our case demonstrates that a temporary switch from PD to HD, accompanied by pleurodesis, may help resolve hydrothorax that occurs as a complication of long-term PD.

scholarly journals Transdiaphragmatic Single-Port Video-Assisted Thoracoscopic Surgery; a Novel Approach for Pulmonary Metastasectomy through Laparotomy Incision – Case Series

2020 ◽  
Author(s):  
Riad Abdel Jalil ◽  
Mohamad K. Abou Chaar ◽  
Omar M. Shihadeh ◽  
Obada Al-Qudah ◽  
Azza Gharaibeh ◽  
...  
Keyword(s):  
Single Port ◽  
Thoracoscopic Surgery ◽  
Treatment Options ◽  
Tumor Resection ◽  
Germ Cell Tumors ◽  
Case Series ◽  
Pulmonary Metastasectomy ◽  
Abdominal Tumor ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background: Pulmonary metastasectomy was performed in the early twentieth century and ever since, it has evolved to be one of the main treatment options for certain metastatic malignancies. The advancement of minimally invasive procedures enabled new techniques to minimize morbidity and improve patient quality of care and overall outcome. Cases presentation: Herein we present three patients, aged 53, 48, and 27 years, known to have sigmoid, rectal, and non-seminomatous germ cell tumors respectively. All patients were diagnosed to have metastatic lung nodules and underwent laparotomy to excise abdominal tumors followed by trans-diaphragmatic single-port video-assisted thoracoscopic pulmonary metastasectomy. All patients achieved complete surgical tumor excision, and none had pulmonary related complications on follow-up.Conclusion: Our prescribed novel trans-diaphragmatic single-port video-assisted thoracoscopic surgery (VATS) technique for synchronous pulmonary metastasectomy and intra-abdominal tumor resection is safe and can achieve complete resection with negative margins.

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