1
|
Abstract
Various clinical trials have been published on the optimal clinical management of patients with pleural exudates, particularly those caused by malignant tumors, while little information is available on the diagnosis and treatment of pleural transudates. The etiology of pleural transudates is wide and heterogeneous, and they can be caused by rare diseases, sometimes constituting a diagnostic challenge. Analysis of the pleural fluid can be a useful procedure for establishing diagnosis. Treatment should target not only the underlying disease, but also management of the pleural effusion itself. In cases refractory to medical treatment, invasive procedures will be necessary, for example therapeutic thoracentesis, pleurodesis with talc, or insertion of an indwelling pleural catheter. Little evidence is currently available and no firm recommendations have been made to establish when to perform an invasive procedure, or to determine the safest, most efficient approach in each case. This article aims to describe the spectrum of diseases that cause pleural transudate, to review the diagnostic contribution of pleural fluid analysis, and to highlight the lack of evidence on the efficacy of invasive procedures in the management and control of pleural effusion in these patients.
Collapse
|
2
|
Sahn SA, Huggins JT, San Jose E, Alvarez-Dobano JM, Valdes L. The Art of Pleural Fluid Analysis. ACTA ACUST UNITED AC 2013. [DOI: 10.1097/cpm.0b013e318285ba37] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
3
|
Huang CL, Lin PC, Lee JY, Chang YT. Hydrothorax following delayed extravascular migration of a totally implantable venous access device in a child. J Pediatr Surg 2012; 47:e1-4. [PMID: 23084222 DOI: 10.1016/j.jpedsurg.2012.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 04/09/2012] [Accepted: 05/08/2012] [Indexed: 10/27/2022]
Abstract
Totally implantable venous access devices are widely used in pediatric oncology. The authors encountered a 10-year-old boy with implantation of the device at the age of 7 years owing to acute lymphoblastic leukemia. In the recent half-year, the device was not used except for regular heparin flushing. However, hydrothorax occurred when fluid therapy was required from the device during this admission. Thoracoscopic approach showed extravascular migration and intrapleural malposition of the catheter. Intrapleural migration of the extravascular portion of the catheter owing to irritation and pressure necrosis of the pleura and gradual shortening of intravascular portion of the catheter when the child grew up may be the pathogenesis of delayed extravascular migration of the catheter.
Collapse
Affiliation(s)
- Chein-Lin Huang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | | | |
Collapse
|
4
|
|
5
|
Boon JM, van Schoor AN, Abrahams PH, Meiring JH, Welch T. Central venous catheterization--an anatomical review of a clinical skill. Part 2. Internal jugular vein via the supraclavicular approach. Clin Anat 2008; 21:15-22. [PMID: 18058904 DOI: 10.1002/ca.20563] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The safe and successful performance of a central venous catheterization (CVC) requires a specific knowledge of anatomy in addition to a working knowledge. Misunderstanding the anatomy may result in failure or complications. This review aims to aid understanding of the anatomical framework, pitfalls, and complications of CVC of the internal jugular veins. CVC is common practice amongst surgeons, anesthesiologists, and emergency room physicians during the preparations for major surgical procedures such as open-heart surgery, as well as for intensive care monitoring and rapid restoration of blood volume. Associated with this technique are certain anatomical pitfalls and complications that can be successfully avoided if one possesses a thorough knowledge of the contraindications, regional anatomy, and rationale of the technique.
Collapse
Affiliation(s)
- J M Boon
- Department of Anatomy, University of Pretoria, Pretoria, South Africa
| | | | | | | | | |
Collapse
|
6
|
Boon JM, van Schoor AN, Abrahams PH, Meiring JH, Welch T, Shanahan D. Central venous catheterization -- an anatomical review of a clinical skill -- Part 1: subclavian vein via the infraclavicular approach. Clin Anat 2007; 20:602-11. [PMID: 17415720 DOI: 10.1002/ca.20486] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The safe and successful performance of a central venous catheterization (CVC) requires a specific knowledge of anatomy in addition to a working knowledge. Misunderstanding the anatomy may result in failure or complications. This review aims to aid understanding of the anatomical framework, pitfalls, and complications of CVC of the subclavian (SCV). CVC is common practice amongst surgeons, anesthesiologists, and emergency room physicians during the preparations for major surgical procedures such as open-heart surgery, as well as, for intensive care monitoring and rapid restoration of blood volume. Associated with this technique are certain anatomical pitfalls and complications that can be successfully avoided if one possesses a thorough knowledge of the contraindications, regional anatomy, and rationale of the technique.
Collapse
Affiliation(s)
- J M Boon
- Department of Anatomy, University of Pretoria, South Africa
| | | | | | | | | | | |
Collapse
|
7
|
Abstract
A review of 50 years of research on catheter tip placement indicates an overwhelming preference for the lower third of the superior vena cava as the appropriate tip location. Despite this evidence, there are still practitioners, physicians, and nurses who advocate tip placement within the axillo-subclavian-innominate vein (also referred to as the midclavicular). This article looks at the arguments presented by practitioners who support midclavicular tip placement. It also reviews some of the research from which the recommendations for superior vena cava placement are derived.
Collapse
Affiliation(s)
- Lynda S Cook
- CuraScript Infusion Pharmacy, Greensboro, NC 27455, USA.
| |
Collapse
|
8
|
Kwak HJ, Lim ES, Ban SY, Lee JY, Yoon JS, Kil HK, Kim KJ. Hydromediastinum following Internal Jugular Vein Catheterization - A case report -. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.52.3.335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hyun Joo Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eui Sung Lim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - So Young Ban
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Yeon Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Sun Yoon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Keum Kil
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Jun Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Links DJR, Crowe PJ. Horner's syndrome after placement of a peripherally inserted central catheter. JPEN J Parenter Enteral Nutr 2006; 30:451-2. [PMID: 16931616 DOI: 10.1177/0148607106030005451] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a delayed case of Horner's syndrome after the use of a peripherally inserted central line. Central vein thrombosis, a well-recognized complication of central venous access, led to temporary injury to the sympathetic tract in the neck. Presentation of Horner's syndrome with central venous access in place should be further investigated to rule out central vein thrombosis.
Collapse
|
10
|
Abstract
Most pleural effusions are caused by hydrostatic and oncotic pressure imbalance, inflammation or infection, or abnormalities in lymphatic drainage. A select number of effusions are caused by fluid of extravascular origin. Some of these effusions result from complications of treatment, whereas others are a ramification of the underlying disease. The incidence, pathogenesis, clinical presentation, chest radiographic manifestations, pleural fluid analysis, diagnosis, and management are discussed.
Collapse
Affiliation(s)
- Steven A Sahn
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 812-CSB, PO Box 250630, Charleston, SC 29425, USA.
| |
Collapse
|
11
|
Maruyama K, Koizumi T. Hydromediastinum associated with a peripherally inserted central venous catheter in a newborn infant. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:195-8. [PMID: 16615050 DOI: 10.1002/jcu.20194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We report a case of hydromediastinum in a newborn associated with a peripherally inserted central venous catheter. A 9-day-old male infant with total parenteral nutrition via a peripherally inserted central venous catheter had acute respiratory distress. A chest radiograph showed a widened mediastinal shadow and left pleural effusion, and sonography revealed fluid collection in the mediastinum and bilateral hydrothorax. Sonography is useful in the diagnosis of hydromediastinum when infants treated with peripherally inserted central venous catheters have acute respiratory distress.
Collapse
Affiliation(s)
- Kenichi Maruyama
- Department of Neonatology, Gunma Children's Medical Center, 779 Shimohakoda, Hokkitsu, Gunma, 377-8577, Japan
| | | |
Collapse
|
12
|
Botha R, van Schoor AN, Boon JM, Becker JHR, Meiring JH. Anatomical considerations of the anterior approach for central venous catheter placement. Clin Anat 2005; 19:101-5. [PMID: 16302239 DOI: 10.1002/ca.20240] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Central venous catheterization (CVC) entails the catheterization of the superior vena cava via either the subclavian or the internal jugular vein (IJV). This study looked at the frequency in which a needle was inserted into the IJV using the anterior CVC approach, which entails inserting the needle into the apex of Sedillot's triangle, formed by the sternal and clavicular heads of sternocleidomastoid (SCM). The ipsilateral distances from the apex of Sedillot's triangle to the superior aspect of the sternoclavicular joint and the diameter of the IJV were also measured. A needle was inserted into the apex of Sedillot's triangle in 36 adult cadavers with mean age of 62 +/- 19 years (mean +/- SD), mean height of 1.6 +/- 0.18 m, and a mean weight of 55 +/- 16 kg. Subsequent dissections of this area revealed the relation of the needle to the IJV. Results indicate that on the right, the needle was inserted into the IJV in 97.14% of the cases. On the left, the needle entered the IJV in 78.79% of the cases. From the sternoclavicular joint, the apex of Sedillot's triangle was found to be 40.87 +/- 1.62 mm and 38.73 +/- 6.34 mm on the right and left, respectively. The IJV diameter was 17.29 +/- 1.07 mm on the right and 15.30 +/- 0.25 mm on the left. We conclude that the anterior CVC approach is an anatomically accurate technique. It is furthermore important to realize that when performing any invasive procedure, a sound anatomical knowledge of the region is extremely important, as complications are often due to lack of understanding or misunderstanding of the relevant anatomy.
Collapse
Affiliation(s)
- R Botha
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | | | | | | | | |
Collapse
|
13
|
Ségura P, Speeg-Schatz C, Wagner JM, Kern O. [Claude Bernard-Horner syndrome and its opposite, Pourfour du Petit syndrome, in anesthesia and intensive care]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1998; 17:709-24. [PMID: 9750809 DOI: 10.1016/s0750-7658(98)80108-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse cases of Horner's syndrome (HS) and its opposite, Pourfour du Petit's syndrome (PPS), occurring in anaesthesia and intensive therapy with consideration of the data of current literature. DATA SOURCES For this paper we have reviewed the French, English and German literature published in anaesthesia and intensive care journals using Medline search and the current textbooks. STUDY SELECTION All observational studies on these syndromes, whether clinical cases or letters to the editor, form the basis for this article. DATA EXTRACTION The articles were analysed mainly with regard to diagnosis, therapy and prognosis of syndromes due to iatrogenic causes. DATA SYNTHESIS HS is caused by a paralysis of the ipsilateral sympathetic cervical chain and includes a ptosis of the upper eyelid, a slight elevation of the lower lid, a sinking of the eyeball, a constriction of the pupil, a narowing of the palpebral fissure, a nasal stuffiness associated with anhidrosis, and flushing of the affected side of the face. Regional anaesthesia (intra-oral anaesthesia, brachial plexus block, epidural anaesthesia whether by thoracic, lumbar or caudal approach, as well as interpleural analgesia) is the main anaesthetic cause for HS. HS due to the effect of a local anaesthetic is transient, it can precede a high spinal block and a cardiovascular collapse. HS from puncture of the internal jugular vein is most often permanent. When transient, HS regresses within 3 months after puncture. Other causes of HS include intraoperative posture, pleural drain, neck surgery, neck trauma. A mydriatic collyrium, such as phenylephrine, resolves ptosis for less than 1 hour and results in blurred vision from pupillary dilation. Major ptosis requires surgery. PPS is the reciprocal HS and is caused by a stimulation of the ipsilateral sympathetic cervical chain. PPS can precede HS. It carries a risk for conjunctivitis, keratitis and epiphora in case of major exophthalmia. PPS is often reported as an unilateral mydriasis. PPS has the same causes as HS. Myotic collyriums are relatively inefficient. Major lid retraction requires a tarsorraphy, pomades and nocturnal lid occlusion. A part of HS and most PPS occurring in anaesthesia and intensive care remain unrecognized or are recognized with delay, especially if they remain minor and transient or when they occur in unconscious patients, in horizontal posture.
Collapse
Affiliation(s)
- P Ségura
- Service d'anesthésie-réanimation chirurgicale, hôpital de Hautepierre, Strasbourg, France
| | | | | | | |
Collapse
|
14
|
Lee TS, Chen BJ. Hydromediastinum following insertion of a central venous pressure line via the right external jugular vein. J Clin Anesth 1993; 5:436-8. [PMID: 8217184 DOI: 10.1016/0952-8180(93)90112-r] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The insertion of a central venous pressure (CVP) catheter has been known to be associated with a variety of complications. Among these, isolated hydromediastinum is relatively rare. We recently encountered a patient who developed hydromediastinum due to extravascular penetration of a CVP line inserted via the right external jugular vein. The clinical manifestations and significance of this complication are discussed.
Collapse
Affiliation(s)
- T S Lee
- Department of Anesthesiology, Harbor-UCLA Medical Center, Torrance 90059
| | | |
Collapse
|
15
|
Duntley P, Siever J, Korwes ML, Harpel K, Heffner JE. Vascular erosion by central venous catheters. Clinical features and outcome. Chest 1992; 101:1633-8. [PMID: 1600785 DOI: 10.1378/chest.101.6.1633] [Citation(s) in RCA: 126] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We evaluated the clinical characteristics of eight patients who presented with vascular erosion from central venous catheters and reviewed the available literature. Patients typically presented with dyspnea or chest pain, unilateral or bilateral pleural effusions, and mediastinal widening one to seven days after catheter insertion. Pleural fluid appeared transudative with variable glucose concentrations (range, 174 to 588 mg/dl) that were always greater than concurrent serum values. Diagnosis was delayed 3.0 +/- 1.5 days (range, 0 to 11 days) after vascular erosion. One patient died and four patients received chest tubes. Seven of eight patients had left-sided line placement; six of these seven left-sided catheters abutted the superior vena cava wall within approximately 45 degrees of perpendicular. Results of a literature search confirm the hazards of delayed diagnosis and the importance of left-sided catheter placement as a risk factor for vascular erosion.
Collapse
Affiliation(s)
- P Duntley
- Department of Medicine, St. Joseph's Hospital and Medical Center, Phoenix 85001-2071
| | | | | | | | | |
Collapse
|
16
|
Gallagher PG, Benzing G. Iatrogenic Horner's syndrome. J Crit Care 1990. [DOI: 10.1016/0883-9441(90)90045-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|