scholarly journals Pigtail Catheter Use for Draining Pleural Effusions of Various Etiologies

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Adel Salah Bediwy ◽  
Hesham Galal Amer
Keyword(s):  
Pleural Effusion ◽  
Success Rate ◽  
Pleural Fluid ◽  
Tube Thoracostomy ◽  
Chest Drain ◽  
Parapneumonic Effusion ◽  
Pigtail Catheter ◽  
Efficacy And Safety ◽  
Malignant Effusion ◽  
Pleural Effusions

Background. Use of small-bore pigtail catheter is a less invasive way for draining pleural effusions than chest tube thoracostomy. Methods. Prospectively, we evaluated efficacy and safety of pigtail catheter (8.5–14 French) insertion in 51 cases of pleural effusion of various etiologies. Malignant effusion cases had pleurodesis done through the catheter. Results. Duration of drainage of pleural fluid was 3–14 days. Complications included pain (23 patients), pneumothorax (10 patients), catheter blockage (two patients), and infection (one patient). Overall success rate was 82.35% (85.71% for transudative, 83.33% for tuberculous, 81.81% for malignant, and 80% for parapneumonic effusion). Nine cases had procedure failure, five due to loculated effusions, and four due to rapid reaccumulation of fluid after catheter removal. Only two empyema cases (out of six) had a successful procedure. Conclusion. Pigtail catheter insertion is an effective and safe method of draining pleural fluid. We encourage its use for all cases of pleural effusion requiring chest drain except for empyema and other loculated effusions that yielded low success rate.

scholarly journals The Differential Diagnostic Values of Cytokine Levels in Pleural Effusions

2005 ◽  
Vol 2005 (1) ◽  
pp. 2-8 ◽  
Author(s):  
Saadet Akarsu ◽  
A. Nese Citak Kurt ◽  
Yasar Dogan ◽  
Erdal Yilmaz ◽  
Ahmet Godekmerdan ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Parapneumonic Effusion ◽  
Pleural Effusions ◽  
Tuberculous Pleural Effusion ◽  
Cytokine Levels ◽  
Diagnostic Values

The aim is to examine whether the changes in pleural fluid interleukin (IL)-1β, IL-2, IL-6, and IL-8 levels were significant in differential diagnosis of childhood pleural effusions. IL-1β, IL-2, IL-6, and IL-8 levels in pleural fluids of all 36 patients were measured. The levels of IL-1β, IL-2, IL-6, and IL-8 in pleural fluids were statistically significantly higher in the transudate group compared with those of the exudate group. The levels of IL-1β, IL-6, and IL-8 were also found to be statistically significantly higher in the empyema group compared with both the parapneumonic and the tuberculous pleural effusion groups. The levels of IL-2 and IL-6 were detected to be statistically significantly higher in the tuberculous pleural effusion group in comparison with those of the parapneumonic effusion group. The results showed that pleural fluids IL-1β, IL-2, IL-6, and IL-8 could be used in pleural fluids exudate and transudate distinction.

scholarly journals Medical Chest Drain Insertion – Considerations for a Pleural Service

2020 ◽  
Author(s):  
Ying-Tung Liu ◽  
Zi Wei Goh ◽  
Lutz Beckert
Keyword(s):  
Success Rate ◽  
Pleural Fluid ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Fibrinolytic Therapy ◽  
Chest Drain ◽  
Pleural Effusions ◽  
Talc Pleurodesis ◽  
Malignant Pleural Effusions ◽  
The Right

Abstract Aim: To review local chest drain insertions, the indications, use of fibrinolytics, and the success rate of talc pleurodesis in a tertiary hospital in New Zealand. Methods: This is an observational study of all patients requiring chest drain insertion in the respiratory unit in Christchurch Hospital from January 2015 to December 2016. We analysed patient characteristics, type of drain inserted, and the nature of pleural fluid. We report the success of fibrinolytic therapy for empyema and pleurodesis for malignant pleural effusions. Results: A total of 486 chest drains were inserted for 333 patients, with a median age of 69 years. The majority of patients were male (60%) and 259 drains (53.3%) were inserted on the right. The main indications for chest drain insertion were malignant pleural effusions (50.5%), non-malignant pleural fluid (33.6%) and pneumothorax (17.7%). Most drains inserted were of small caliber; they were 12 French (Fr) (62.4%), central venous catheters to drain the pleural space (14.2%), and indwelling pleural catheters (10.9%). Talc slurry pleurodesis for malignant pleural effusions was used in 40 cases with a success rate of 75%. In the 41 cases of empyema and complicated parapneumonic effusions (CPE), 29 organisms were cultured. The majority of organisms identified were Streptococcus and Staphylococcus species. Fibrinolytics were used in 26 cases (52%) of empyema and CPE. Of the 22 patients who required surgical intervention, only two had prior fibrinolytic therapy for empyema / CPE. Conclusion: Small bore catheters were used in Christchurch in keeping with international guidelines. The success rate of talc slurry pleurodesis and fibrinolytic therapy was in keeping with international experience.

scholarly journals Potential diagnostic value of pleural fluid cytokines levels for tuberculous pleural effusion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Neda Dalil Roofchayee ◽  
Majid Marjani ◽  
Neda K. Dezfuli ◽  
Payam Tabarsi ◽  
Afshin Moniri ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Diagnostic Value ◽  
Parapneumonic Effusion ◽  
Pleural Effusions ◽  
Tuberculous Pleural Effusion ◽  
New Biomarkers ◽  
High Level

AbstractPatients with tuberculous pleural effusion (TPE) or malignant pleural effusions (MPE) frequently have similar pleural fluid profiles. New biomarkers for the differential diagnosis of TPE are required. We determined whether cytokine profiles in the PE of patients could aid the differential diagnosis of TPE. 30 patients with TPE, 30 patients with MPE, 14 patients with empyema (EMP) and 14 patients with parapneumonic effusion (PPE) were enrolled between Dec 2018 and 2019. The levels of interleukin (IL)-6, IL-18, IL-27, CXCL8, CCL-1 and IP-10 were determined in PE by ELISA along with measurements of adenosine deaminase (ADA). The best predictors of TPE were combined ADA.IL-27 [optimal cut-off value = 42.68 (103 U ng/l2), sensitivity 100%, specificity 98.28%], ADA [cut off value 27.5 (IU/l), sensitivity 90%, specificity 96.5%] and IL-27 [cut-off value = 2363 (pg/ml), sensitivity 96.7%, specificity 98.3%, p ≤ 0.0001]. A high level of IL-6 [cut-off value = 3260 (pg/ml), sensitivity 100%, specificity 67.2%], CXCL8 [cut-off value = 144.5 (pg/ml), sensitivity 93.3%, specificity 58.6%], CCL1 [cut-off value = 54 (pg/ml), sensitivity 100%, specificity 70.7%] and IP-10 [cut-off value = 891.9 (pg/ml), sensitivity 83.3%, specificity 48.3%] were also predictive of TPE. High ADA.IL-27, ADA and IL-27 levels differentiate between TPE and non-TPE with improved specificity and diagnostic accuracy and may be useful clinically.

scholarly journals Percutaneous Ultrasound-guided Pigtail Catheter for Pleural Effusions: Efficacy and Safety

2021 ◽  
Vol 35 (2) ◽  
pp. e248-e248
Author(s):  
B. Jayakrishnan ◽  
Masoud Kashoob ◽  
Rashid Al-Sukaiti ◽  
Saif Al-Mubaihsi ◽  
Anupam Kakaria ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Success Rate ◽  
Catheter Insertion ◽  
University Hospital ◽  
Pigtail Catheter ◽  
Success Rates ◽  
Pleural Effusions ◽  
Ultrasound Guided ◽  
Sultan Qaboos University ◽  
Significant Difference

Objectives: Small-bore pigtail catheters are now being used more frequently for draining pleural effusions. This study aimed to measure the efficacy, safety, and tolerability of these devices in different clinical conditions. Methods: We retrospectively collected data from 141 patients with pleural effusions of various etiologies who underwent ultrasound-guided pigtail catheter insertion at Sultan Qaboos University Hospital, Muscat, Oman. Results: The majority 109 (77.3%) of patients had exudates. The mean age was 50.0±18.6 years in patients with exudates and 67.3±15.5 in patients with transudates (p < 0.001). There was no significant difference (p = 0.232) in the median drainage duration between exudates (6.0 days) and transudates (4.5 days). The incidence of pain requiring regular analgesics, pneumothorax, and blockage were 36.2% (n = 51), 2.8% (n = 4), and 0.7% (n = 1), respectively. The overall success rate of pleural effusion drainage was 90.1%. Among the 109 cases of exudative pleural effusion, 89.0% were successful compared to a 93.8% success rate among patients with transudative effusion (p = 0.737). Short-term success rates were high in all causes of effusions: lung cancer (100%), metastasis (90.0%), pleural infections (83.3%), cardiac failure (94.7%), renal disease (85.7%), and liver disease (100%). Conclusions: Ultrasound-guided pigtail catheter insertion is an effective, comfortable, and safe method of draining pleural fluid. It should be considered as the first intervention if drainage of a pleural effusion is clinically indicated.

scholarly journals Profile of exudative pleural effusion in the region of Bhuj people

2018 ◽  
Vol 5 (4) ◽  
pp. 1057
Author(s):  
Vishal K. Desai ◽  
Rashmi S. Arora
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Demographic Data ◽  
Initial Step ◽  
Clinical History ◽  
Categorical Variables ◽  
Malignant Effusion ◽  
Pleural Effusions ◽  
Malignant Effusions ◽  
Exudative Pleural Effusion

Background: Exudative pleural effusions are a common diagnostic problem in clinical practice, as the list of causes is quite exhaustive, although sometimes they can be inferred from the clinical picture. In the West the most common cause is Para pneumonic effusions followed by malignancy, while in India it is tubercular effusion followed by malignant effusion. Despite the availability of various tests, there is a need for defining the best diagnostic and cost-effective approach to quickly diagnose and treat exudative pleural effusions. The objectives are to conduct a clinical and etiological study of exudative pleural effusion, to evaluate biochemical profile, cytological profile and radiological profiles of exudative pleural effusion.Methods: Prospective study of 100 patients with exudative pleural effusions. The demographic data was expressed as mean±standard deviation. Comparison between groups was done by Chi-Square test and Fischer exact test for categorical variables and Kruskar-Wallis and Mann-Whitney tests for continuous variables.Results: There were 67 males and 33 females. The mean age was 41.6±15.74. The majority were tubercular in origin (67%),13%,8%,3%and 6% were malignant effusions, Synpneumonic effusion, pancreatic effusions and empyema respectively. Diagnosis was not established in 3% of effusions. Massive effusions were seen in 53.8% of malignant effusions and 33.3% of empyemas. Most effusions had a total cell count between 1000 to 5000 cells /mm3.Lymphocyte predominant effusions were seen in 84.6% and 89.6% of malignant and tubercular effusions. 61.5% of malignant effusions had a positive cytology. Tubercular effusion had a pleural fluid ADA more than 40 IU/L. 92.3% of malignant effusion had pleural fluid ADA less than 30IU.Conclusions: Pleural effusion is a commonly encountered in medical practice and in our country, the commonest cause is tuberculosis, as is evidenced from the present study. The initial step in evaluating case of pleural effusion is to establish the cause of pleural effusion which is done by a detailed history, clinical examination and investigations like a chest radiology and pleural fluid analysis. Even in the advanced diagnostic approaches, still detailed clinical history and examination of the patient of the patient is important to make a clinical diagnosis. All suspected cases of pleural effusion should undergo Sonography of the thorax along with routine chest x-ray. Fluid cytology should be done to confirm tuberculosis or to rule out malignancy, which guides the physician for further evaluation of the patient if required.

scholarly journals Moxifloxacin Pharmacokinetics and Pleural Fluid Penetration in Patients with Pleural Effusion

2013 ◽  
Vol 58 (3) ◽  
pp. 1315-1319 ◽  
Author(s):  
Kalliopi Chatzika ◽  
Katerina Manika ◽  
Paschalina Kontou ◽  
Georgia Pitsiou ◽  
Despina Papakosta ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
High Performance ◽  
Drug Exposure ◽  
Volume Of Distribution ◽  
Pharmacokinetic Parameters ◽  
Time Interval ◽  
Parapneumonic Effusion ◽  
Malignant Effusion ◽  
Time Curve

ABSTRACTThe aim of this study was to evaluate the pharmacokinetics and penetration of moxifloxacin (MXF) in patients with various types of pleural effusion. Twelve patients with empyema/parapneumonic effusion (PPE) and 12 patients with malignant pleural effusion were enrolled in the study. A single-dose pharmacokinetic study was performed after intravenous administration of 400 mg MXF. Serial plasma (PL) and pleural fluid (PF) samples were collected during a 24-h time interval after drug administration. The MXF concentration in PL and PF was determined by high-performance liquid chromatography, and main pharmacokinetic parameters were estimated. Penetration of MXF in PF was determined by the ratio of the area under the concentration-time curve from time zero to 24 h (AUC24) in PF (AUC24PF) to the AUC24in PL. No statistically significant differences in the pharmacokinetics in PL were observed between the two groups, despite the large interindividual variability in the volume of distribution, clearance, and elimination half-life. The maximum concentration in PF (CmaxPF) in patients with empyema/PPE was 2.23 ± 1.31 mg/liter, and it was detected 7.50 ± 2.39 h after the initiation of the infusion. In patients with malignant effusion, CmaxPFwas 2.96 ± 1.45 mg/liter, but it was observed significantly earlier, at 3.58 ± 1.38 h (P< 0.001). Both groups revealed similar values of AUC24PF(31.83 ± 23.52 versus 32.81 ± 12.66 mg · h/liter). Penetration of MXF into PF was similarly good in both patient groups (1.11 ± 0.74 versus 1.17 ± 0.39). Despite similar plasma pharmacokinetics, patients with empyema/parapneumonic effusion showed a significant delay in achievement of PF maximum MXF levels compared to those with malignant effusion. However, in both groups, the degree of MXF PF penetration and the on-site drug exposure, expressed by AUC24PF, did not differ according to the type of pleural effusion.

Diagnostic efficacy and suitability of trans-thoracic ultrasonography for pleural fluid detection – The future non-invasive gold-standard?

2020 ◽  
Vol 13 (4) ◽  
pp. 184-190
Author(s):  
Muhammad Irfan ◽  
Abdul Rasheed Qureshi ◽  
Zeeshan Ashraf ◽  
Muhammad Amjad Ramzan ◽  
Tehmina Naeem ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Gold Standard ◽  
Pleural Effusions ◽  
Diagnostic Efficacy ◽  
Chest Sonography ◽  
X Ray ◽  
Non Invasive ◽  
Fluid Detection

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available  and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard.   Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology  OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

scholarly journals The value of exfoliative cell cytology in the diagnosis of exudative pleural effusions

2018 ◽  
Vol 88 (3) ◽  
Author(s):  
Cuneyt Tetikkurt ◽  
Nail Yılmaz ◽  
Seza Tetikkurt ◽  
Şule Gundogdu ◽  
Rian Disci
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diagnostic Yield ◽  
Final Diagnosis ◽  
Exfoliative Cytology ◽  
Pleural Effusions ◽  
Cytologic Examination ◽  
Collagen Vascular Diseases ◽  
Female Ratio ◽  
Exudative Pleural Effusion

The sensitivity and specificity of exfoliative cell cytology for the diagnosis of exudative pleural effusions varies widely according to the etiologic causes. The aim of this study is to assess the diagnostic value of exfoliative cell cytology for the identification of exudative pleural effusions. This is a retrospective study of the patients with an exudative pleural effusion admitted at our clinic in the last twenty years. We have conducted the clinical, the cytological findings, and the diagnostic results of six hundred patients from hospital records.  Male to female ratio was 2.2:1 with a mean age of 42.8 years (range 18-78 years) among the patients. Samples were processed and evaluated according to the standard methods. Cytology results were reviewed and the patients were stratified according to the final diagnosis of their disease. Of the six hundred exudative effusions, 240 were malignant on exfoliative cytology pleural fluid alone. Adenocarcinoma was the most common type of malignancy. Tuberculosis was the second most frequent etiology for the exudative effusions followed by infection and collagen vascular diseases. Diagnostic accuracy of cytology showed a good correlation with the final diagnosis with an overall 70.1% sensitivity, 62.5% specificity, and a 95.9% positive predictive value for all exudative pleural effusions. Cytologic examination of the pleural fluid is a simple non-invasive procedure as the initial step for the diagnostic work up of patients with a pleural effusion.  Exfoliative cytology provides high a final diagnostic yield for the identification of an exudative pleural effusion etiology. Furthermore, cytologic analysis leads the clinician into the correct diagnostic pathway as the most informative laboratory tool even when it was not diagnostic by itself for equivocal cases.

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