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Sidhu C, Wright G, Peddle-McIntyre CJ, Tan AL, Lee YCG. Management of malignant pleural effusion and trapped lung: a survey of respiratory physicians and thoracic surgeons in Australasia. Intern Med J 2024; 54:1119-1125. [PMID: 38560767 DOI: 10.1111/imj.16366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Malignant pleural effusions (MPEs) are common, and a third of them have underlying trapped lung (TL). Management of MPE and TL is suspected to be heterogeneous. Understanding current practices in Australasia is important in guiding policies and future research. AIMS Electronic survey of Australia-New Zealand respiratory physicians, thoracic surgeons and their respective trainees to determine practice of MPE and TL management. RESULTS Of the 132 respondents, 56% were respiratory physicians, 23% were surgeons and 20% were trainees. Many respondents defined TL as >25% or any level of incomplete lung expansion; 75% would use large-volume thoracentesis to determine whether TL was present. For patients with TL, indwelling pleural catheters (IPCs) were the preferred treatment irrespective of prognosis. In those without TL, surgical pleurodesis was the most common choice if prognosis was >6 months, whereas IPC was the preferred option if survival was <3 months. Only 5% of respondents considered decortication having a definite role in TL, but 55% would consider it in select cases. Forty-nine per cent of surgeons would not perform decortication when the lung does not fully expand intra-operatively. Perceived advantages of IPCs were minimisation of hospital time, effusion re-intervention and usefulness irrespective of TL status. Perceived disadvantages of IPCs were lack of suitable drainage care, potentially indefinite duration of catheter-in-situ and catheter complications. CONCLUSION This survey highlights the lack of definition of TL and heterogeneity of MPE management in Australasia, especially for patients with expandable lungs. This survey also identified the main hurdles of IPC use that should be targeted.
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Affiliation(s)
- Calvin Sidhu
- School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Gavin Wright
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
- School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Carolyn J Peddle-McIntyre
- School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- Pleural Medicine Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Ai Ling Tan
- Pleural Medicine Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Yun Chor Gary Lee
- Pleural Medicine Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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Piggott LM, Hayes C, Greene J, Fitzgerald DB. Malignant pleural disease. Breathe (Sheff) 2023; 19:230145. [PMID: 38351947 PMCID: PMC10862126 DOI: 10.1183/20734735.0145-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
Malignant pleural disease represents a growing healthcare burden. Malignant pleural effusion affects approximately 1 million people globally per year, causes disabling breathlessness and indicates a shortened life expectancy. Timely diagnosis is imperative to relieve symptoms and optimise quality of life, and should give consideration to individual patient factors. This review aims to provide an overview of epidemiology, pathogenesis and suggested diagnostic pathways in malignant pleural disease, to outline management options for malignant pleural effusion and malignant pleural mesothelioma, highlighting the need for a holistic approach, and to discuss potential challenges including non-expandable lung and septated effusions.
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Affiliation(s)
- Laura M. Piggott
- Department of Respiratory Medicine, Tallaght University Hospital, Dublin, Ireland
- Department of Respiratory Medicine, St. James's Hospital, Dublin, Ireland
- These authors contributed equally
| | - Conor Hayes
- Department of Respiratory Medicine, Tallaght University Hospital, Dublin, Ireland
- Department of Respiratory Medicine, St. James's Hospital, Dublin, Ireland
- These authors contributed equally
| | - John Greene
- Department of Oncology, Tallaght University Hospital, Dublin, Ireland
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Qureshi M, Thapa B, Muruganandan S. A Narrative Review-Management of Malignant Pleural Effusion Related to Malignant Pleural Mesothelioma. Heart Lung Circ 2023; 32:587-595. [PMID: 36925448 DOI: 10.1016/j.hlc.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/29/2023] [Accepted: 02/08/2023] [Indexed: 03/17/2023]
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive, almost universally fatal cancer with limited therapeutic options. Despite efforts, a real breakthrough in treatment and outcomes has been elusive. Pleural effusion with significant breathlessness and pain is the most typical presentation of individuals with MPM. Although thoracentesis provides relief of breathlessness, most such pleural effusions recur rapidly, and a definitive procedure is often required to prevent a recurrence. Unfortunately, the optimal treatment modality for individuals with recurrent MPM-related effusion is unclear, and considerable variation exists in practice. In addition, non-expandable lung is common in pleural effusions due to MPM and makes effective palliation of symptoms more difficult. This review delves into the latest advances in the available management options (both surgical and non-surgical) for dealing with pleural effusion and non-expandable lung related to MPM. We discuss factors that determine the choice of definitive procedures that need to be tailored to the individual patient.
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Affiliation(s)
- Maryum Qureshi
- Department of Thoracic Surgery, Northern Hospital, Melbourne, Vic, Australia.
| | - Bibhusal Thapa
- Department of Thoracic Surgery, Northern Hospital, Melbourne, Vic, Australia
| | - Sanjeevan Muruganandan
- Department of Respiratory Medicine, Northern Hospital, Melbourne, Vic, Australia; School of Medicine, Health Sciences, Dentistry, University of Melbourne, Vic, Australia
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Pleural space management after lung transplant: Early and late outcomes of pleural decortication. J Heart Lung Transplant 2021; 40:623-630. [PMID: 33994081 DOI: 10.1016/j.healun.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 02/22/2021] [Accepted: 03/23/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Pleural complications after lung transplant may restrict allograft expansion, requiring decortication. However, its extent, indications, risk factors, and effect on allograft function and survival are unclear. METHODS From January 2006 to January 2017, 1,039 patients underwent primary lung transplant and 468 had pleural complications, 77 (16%) of whom underwent 84 surgical decortications for pleural space management. Multivariable time-related analysis was performed to identify risk factors for decortication. Mixed-effect longitudinal modeling was used to assess allograft function before and after decortication. RESULTS Cumulative number of decortications per 100 transplants was 1.8, 7.8, and 8.8 at 1 month, 1 year, and 3 years after transplant, respectively. Indications for the 84 decortications were complex effusion in 47 (56%), fibrothorax in 17 (20%), empyema in 11 (13%), and hemothorax in 9 (11%). Thoracoscopic operations were performed in 52 (62%) and full lung re-expansion was achieved in 76 (90%). Complications occurred after 30 (36%) decortications, with 15 pulmonary complications (18%), including 2 patients requiring extracorporeal support due to worsening function. Ten reinterventions occurred via thoracentesis (2), tube thoracostomy (1), and reoperation (7). In-hospital and 30-day mortality was 5.2% (n = 4/77). Forced expiratory volume in 1 second increased from 50% to 60% within the first year after decortication, followed by a slow decline to 55% at 5 years. Postdecortication survival was 87%, 68%, and 48% at 1, 3, and 5 years, respectively. CONCLUSIONS Despite high risk of reoperative surgery, decortication after lung transplant allows salvage of pleural space and graft function with a reasonable morbidity profile.
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Tunneled Pleural Catheters for Patients With Chronic Pleural Infection and Nonexpandable Lung. J Bronchology Interv Pulmonol 2019; 26:132-136. [PMID: 30908392 DOI: 10.1097/lbr.0000000000000553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic pleural infection is characterized by thickened pleura and nonexpandable lung often requiring definitive surgical intervention, such as decortication and/or pleural obliteration procedures. Such procedures are associated with significant morbidity and require proper patient selection for a successful outcome. We report a cohort of 11 patients with pleural space infection and a nonexpandable lung treated with tunneled pleural catheters (TPCs). Following placement, hospital discharge and TPC removal occurred after a median of 5 and 36 days, respectively. Three patients presented with residual loculated effusion that resolved with instillation of intrapleural fibrinolytic therapy. One patient eventually required open window thoracostomy for ongoing pleural infection due to poor medical compliance with TPC care and drainage instructions. TPCs represent an alternative option for drainage of an infected pleural space in nonsurgical candidates with a nonexpandable lung. Their use, as a compliment to traditional treatment, may facilitate prompt hospital discharge and ambulatory management in patients with limited life expectancy.
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Matthews C, Freeman C, Sharples LD, Fox-Rushby J, Tod A, Maskell NA, Edwards JG, Coonar AS, Sivasothy P, Hughes V, Rahman NM, Waller DA, Rintoul RC. MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial. BMJ Open Respir Res 2019; 6:e000368. [PMID: 30687504 PMCID: PMC6326291 DOI: 10.1136/bmjresp-2018-000368] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction One of the most debilitating symptoms of malignant pleural mesothelioma (MPM) is dyspnoea caused by pleural effusion. MPM can be complicated by the presence of tumour on the visceral pleura preventing the lung from re-expanding, known as trapped lung (TL). There is currently no consensus on the best way to manage TL. One approach is insertion of an indwelling pleural catheter (IPC) under local anaesthesia. Another is video-assisted thoracoscopic partial pleurectomy/decortication (VAT-PD). Performed under general anaesthesia, VAT-PD permits surgical removal of the rind of tumour from the visceral pleura thereby allowing the lung to fully re-expand. Methods and analysis MesoTRAP is a feasibility study that includes a pilot multicentre, randomised controlled clinical trial comparing VAT-PD with IPC in patients with TL and pleural effusion due to MPM. The primary objective is to measure the SD of visual analogue scale scores for dyspnoea following randomisation and examine the patterns of change over time in each treatment group. Secondary objectives include documenting survival and adverse events, estimating the incidence and prevalence of TL in patients with MPM, examining completion of alternative forms of data capture for economic evaluation and determining the ability to randomise 38 patients in 18 months. Ethics and dissemination This study was approved by the East of England-Cambridge Central Research Ethics Committee and the Health Research Authority (reference number 16/EE/0370). We aim to publish the outputs of this work in international peer-reviewed journals compliant with an Open Access policy. Trial registration NCT03412357.
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Affiliation(s)
- Claire Matthews
- Papworth Trials Unit Collaboration, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Carol Freeman
- Papworth Trials Unit Collaboration, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Linda D Sharples
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia Fox-Rushby
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Angela Tod
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | | | - John G Edwards
- Department of Thoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Aman S Coonar
- Department of Thoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Victoria Hughes
- Papworth Trials Unit Collaboration, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Najib M Rahman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David A Waller
- Department of Thoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Robert Campbell Rintoul
- Papworth Trials Unit Collaboration, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Department of Oncology, University of Cambridge, Cambridge, UK
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Dalphy A, Burkett A. Pleural cerebrospinal fluid shunting causing trapped lung: A respiratory physician's approach to management and prevention. Respir Med Case Rep 2018; 25:303-305. [PMID: 30370216 PMCID: PMC6199769 DOI: 10.1016/j.rmcr.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/24/2022] Open
Abstract
Cerebrospinal fluid (CSF) shunting into the pleural space can cause complications such as long-standing pleural effusions and trapped lung. These complications can be difficult to manage due to the propensity of effusions to recur, and the irreversible nature of trapped lung. This report describes the case of a woman with a pleural CSF shunt who developed chronic pleural effusions and trapped lung over two years, following a 24-year period without any respiratory shunt complications. Management options for this patient included thoracentesis, lung decortication, insertion of an indwelling pleural catheter, and shunt revision. Advocating for pleural shunt revision when symptomatic or increasingly large pleural effusions occur may prevent the development of trapped lung.
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Affiliation(s)
- Alexander Dalphy
- School of Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, D02 YN77 Ireland,Corresponding author. 123 St Stephen's Green, Dublin, D02 YN77 Ireland.
| | - Andrew Burkett
- Division of Respiratory Medicine, Grand River Hospital, 835 King St W, Kitchener, Ontario, N2G 1G3, Canada
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Tian Y, Zheng W, Zha N, Wang Y, Huang S, Guo Z. Thoracoscopic decortication for the management of trapped lung caused by 14-year pneumothorax: A case report. Thorac Cancer 2018; 9:1074-1077. [PMID: 29802756 PMCID: PMC6068443 DOI: 10.1111/1759-7714.12770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 04/25/2018] [Indexed: 12/02/2022] Open
Abstract
Trapped lung is defined by the lung's inability to expand and fill the thoracic cavity because of a restricting “peel” caused by benign or malignant pleural disease. However, trapped lung secondary to pneumothorax is rarely reported. We present a case of trapped lung caused by a pneumothorax that occurred some 14 years before the patient presented to our hospital with a complaint of incapacitating dyspnea. Computed tomography (CT) scans revealed trapping of the right lung with abnormal thickening of the visceral pleura. In view of the patient's history of pneumothorax, we concluded that his dyspnea was attributable mainly to the trapping of his lung by the earlier pneumothorax. We therefore scheduled thoracoscopic decortication, which was successfully completed. The patient's recovery after the operation was uneventful, and seven weeks after surgery the right lung had re‐expanded well.
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Affiliation(s)
- Yan Tian
- Hyperbaric Oxygen Therapy Center, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Wenqi Zheng
- Laboratory of Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Nashunbayaer Zha
- Department of Thoracic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yufei Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Shaojun Huang
- Department of Thoracic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Zhanlin Guo
- Department of Thoracic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Abstract
Pleural metastasis is a common occurrence in up to 30% of patients with metastatic cancer. When lung entrapment and loculation of fluid occur, treatment is more difficult and we have named this condition "oncothorax." The malignant adhesions that entrap the lung in an oncothorax are not typically amenable to surgical decortication. The standard approach for managing these patients is to place an indwelling catheter. Other options may include pleurectomy and decortication, intrapleural hyperthermic chemoperfusion, and intrapleural photodynamic therapy. However, these procedures should be provided selectively depending on patient performance status, extent of metastatic disease, and level of experience.
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Affiliation(s)
- Roman Petrov
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Temple University Hospital, Fox Chase Cancer Center, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Charles Bakhos
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Temple University Hospital, Fox Chase Cancer Center, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Abbas E Abbas
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Temple University Hospital, Fox Chase Cancer Center, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA.
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Etiology of Malignant Pleural Effusion and Utilization of Diagnostic and Therapeutic Procedures: A Nationwide Analysis. J Bronchology Interv Pulmonol 2017; 24:e10-e12. [PMID: 27984393 DOI: 10.1097/lbr.0000000000000344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gorman J, Funk D, Srinathan S, Embil J, Girling L, Kowalski S. Perioperative implications of thoracic decortications: a retrospective cohort study. Can J Anaesth 2017; 64:845-853. [PMID: 28493038 PMCID: PMC5506207 DOI: 10.1007/s12630-017-0896-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/09/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose An increasing number of thoracic decortications have been performed in Manitoba, from five in 2007 to 45 in 2014. The primary objective of this study was to define the epidemiology of decortications in Manitoba. The secondary objective was to compare patients who underwent decortication due to primary infectious vs non-infectious etiology with respect to their perioperative outcomes. Methods Data for this cohort study were extracted from consecutive charts of all adult patients who underwent a decortication in Manitoba from 2007-2014 inclusive. Results One hundred ninety-two patients underwent a decortication. The most frequent disease processes resulting in a decortication were pneumonia (60%), trauma (13%), malignancy (8%), and procedural complications (5%). The number of decortications due to complications of pneumonia rose at the greatest rate, from three cases in 2007 to 29 cases in 2014. Performing a decortication for an infectious vs a non-infectious etiology was associated with a higher rate of the composite postoperative outcome of myocardial infarction, acute kidney injury, need of vasopressors for > 12 hr, and mechanical ventilation for > 48 hr (44.4% vs 24.2%, respectively; relative risk, 1.83; 95% confidence interval, 1.1 to 2.9; P = 0.01). Conclusion There has been a ninefold increase in decortications over an eight-year period. Potential causes include an increase in the incidence of pneumonia, increased organism virulence, host changes, and changes in practice patterns. Patients undergoing decortication for infectious causes had an increased risk for adverse perioperative outcomes. Anesthesiologists need to be aware of the high perioperative morbidity of these patients and the potential need for postoperative admission to an intensive care unit.
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Affiliation(s)
- Jay Gorman
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Duane Funk
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba, 2nd Floor Harry Medovy House, 671 William Avenue, Winnipeg, MB, Canada
| | | | - John Embil
- Internal Medicine, Section of Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Linda Girling
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba, 2nd Floor Harry Medovy House, 671 William Avenue, Winnipeg, MB, Canada
| | - Stephen Kowalski
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba, 2nd Floor Harry Medovy House, 671 William Avenue, Winnipeg, MB, Canada.
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The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg 2017; 153:e129-e146. [PMID: 28274565 DOI: 10.1016/j.jtcvs.2017.01.030] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/24/2016] [Accepted: 01/08/2017] [Indexed: 11/24/2022]
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13
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Trapped lung secondary to cardiomegaly in a 78 year-old male with congestive heart failure. Respir Med Case Rep 2016; 18:4-7. [PMID: 27054087 PMCID: PMC4802684 DOI: 10.1016/j.rmcr.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/03/2016] [Accepted: 03/06/2016] [Indexed: 12/04/2022] Open
Abstract
Although the etiologies of both trapped lung and cardiomegaly are well-established, co-presentation of the two conditions, and possible interactions between them, are much rarer. Here we describe the case of 78 year-old male found to have both cardiomegaly and trapped lung, with a cause of death of congestive heart failure and subsequent cardiac arrest. This case prompted consideration of possible interactions between the two conditions. Issues related to decision-making for imaging and clinical interventions are also discussed.
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Madani A, Ferri L, Seely A. Pleural Disorders. POCKET MANUAL OF GENERAL THORACIC SURGERY 2015. [PMCID: PMC7123486 DOI: 10.1007/978-3-319-17497-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This chapter provides an overview of both benign and malignant pleural disorders, starting with the relevant anatomy and physiology. The focus is on the management of pneumothoraces and pleural effusions—conditions that are commonly encountered on a general thoracic surgery service. The pleural cavity is lined by parietal and visceral pleura, which are smooth membranes that are continuous with one another at the hilum and pulmonary ligaments.
Parietal Pleura: innermost chest wall layer, divided into cervical, costal, mediastinal and diaphragmatic pleura.
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Affiliation(s)
| | | | - Andrew Seely
- The Ottawa Hospital – General Campus, University of Ottawa, Ottawa, Ontario Canada
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Okiror L, Coltart C, Bille A, Guile L, Pilling J, Harrison-Phipps K, Routledge T, Lang-Lazdunski L, Hemsley C, King J. Thoracotomy and decortication: impact of culture-positive empyema on the outcome of surgery. Eur J Cardiothorac Surg 2014; 46:901-6. [DOI: 10.1093/ejcts/ezu104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Molander V, Diakopoulou M, Orre L, Ferrara G. Chronic empyema: importance of preventing complications in the management of pleural effusions. BMJ Case Rep 2013; 2013:bcr-2013-200454. [PMID: 23946529 DOI: 10.1136/bcr-2013-200454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of chronic empyema in a 63-year-old man with a history of asbestos exposure and alcohol overconsumption. In 2009, he presented with dyspnoea, exudative pleurisy on the right side with no symptoms of infection or malignancy. In 2013, the patient presented with increased dyspnoea and a massive chronic empyema had evolved. Culture of the pleural fluid was positive for Escherichia coli and anaerobic bacteria, and he was treated with antibiotics, chest drainage as well as surgical evacuation. After surgery, as the lung failed to expand, growth of opportunistic bacteria and rising C reactive protein obliged long-time treatment with broad-spectrum antibiotics as well as chest drainage with daily saline flushes. The patient still suffers from fatigue, poor nutritional status and anaemia, and further treatment with chest drainage and antibiotics is planned. Advanced chronic empyema is a difficult condition with poor response to treatment, and diagnostic delay is the main cause of complications.
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Affiliation(s)
- Viktor Molander
- Lung Allergi Kliniken, Karolinska University Hospital, Stockholm, Sweden
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