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Pulmonary diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Leah Lande, Abraham Sanders, Dana Zappetti
While there has been no specific study that identifies the disease processes causing pleural effusion in pregnancy, likely up to 25% of pregnant patients have small, asymptomatic pleural effusions visible on ultrasound. When pleural effusions are symptomatic, they cause dyspnea, cough, and possibly chest pain—if significant, there may be room air hypoxia due to shunting through underlying atelectatic lung. Symptomatic effusions in early pregnancy are either due to ovarian hyperstimulation syndrome or the same processes that cause effusions in nonpregnant patients: infection, cardiomyopathy, and PE. Neither pre-eclampsia nor the HELLP syndrome is associated with pleural effusion. Thoracentesis with drainage is indicated for diagnosis and/or the relief of symptoms due to a significant amount of pleural fluid. The small bilateral effusions described above that are asymptomatic generally are self-limiting and do not require intervention (88).
Bacterial Pneumonia of Infants and Children
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
The most frequent complication of bacterial pneumonia is empyema/effusion.5-8 This occurs most often with staphylococcal pneumonia (60 to 80%) especially in young infants. Empyema/effusion is reported in up to 40% of patients with H. influenzae and approximately 20% of patients with pneumococcal pneumonia. Thoracentesis should always be performed if fluid is present in order to facilitate an etiologic diagnosis and to establish the character of the fluid.52 If a large amount of fluid is present, especially in the young infant, and if the fluid is producing respiratory compromise, tube thoracostomy is clearly indicated. Tube thoracostomy should be performed early if thick pus is obtained by thoracentesis or in the young infant with staphylococcal empyema. If the effusion is small and is serous in nature, especially if it is producing no respiratory compromise, repeated thoracenteses can be safely employed. Approximately 60 to 80% of patients with empyema/effusion will eventually require tube thoracostomy. When tube thoracostomy is required it should be discontinued as soon as drainage has substantially decreased. Patients with staphylococccal empyema require chest tube drainage for a median of 7 days whereas those with pneumococcal and H. influenzae empyema/effusion generally require only 3 to 4 days of drainage.
Chylothorax and other pleural effusions in neonates
Published in Prem Puri, Newborn Surgery, 2017
Miho Watanabe, Belinda Hsi Dickie, Richard G. Azizkhan
Initial thoracentesis is diagnostic and provides immediate relief of respiratory failure. If the size of the pleural effusion compromises respiration, and/or there is a high likelihood of ongoing fluid production and reaccumulation, a chest tube should be inserted for continuous drainage to keep the lungs fully expanded. Adequate drainage is necessary for sealing chyle leakage. If there is a need for repeating thoracentesis after the initial drainage, a thoracostomy tube is usually placed because of increased risk of producing pneumothorax and introducing infection. Prophylactic antibiotics are given when chest tubes are in place, since many of these neonates have an acquired immune deficiency caused by the acquired lymphocytopenia.
Primary Pleuropulmonary Synovial Sarcoma: Report of Two Cases and a Comprehensive Review of the Literature
Published in Cancer Investigation, 2022
Neda Khalili, Elham Askari, Nastaran Khalili, Aboulghasem Daneshvar-Kakhki, Makan Sadr, Sara Haseli, Mihan Pourabdollah Toutkaboni
A 29-year-old non-smoker woman complained of a 3-month history of severe dry cough, shortness of breath and pain in her left shoulder, which radiated to the upper arm. Her cough was aggravated by supine position. The patient did not report a history of therapeutic irradiation or exposure to chemicals. Physical examination of the respiratory system revealed dullness to percussion over the lower half of the left lung and decreased breath sounds on the left side. Examination of the heart, abdomen and other systems as well as routine hematological investigations were normal. Chest x-ray and CT scan showed a huge mass in the left hemithorax with ipsilateral pleural effusion (Figure 5). Thus, ultrasound-guided thoracentesis was performed for the patient. Pleural fluid analysis showed neutrophil dominant exudative effusion with normal ADA (24.2 IU/L). Pleural fluid cytology was negative for malignant cells.
Lung ultrasound-guided therapeutic thoracentesis in refractory congestive heart failure
Published in Acta Cardiologica, 2020
Aleksandar Lazarevic, Milan Dobric, Boris Goronja, Dijana Trninic, Svetozar Krivokuca, Jelena Jovanic, Eugenio Picano
The pleural cavity fluid is a dynamic variable since the parietal pleura continuously secretes small amounts of 20–30 mL of fluid daily, which is reabsorbed by the visceral pleura and lymphatic drainage [9]. The lymphatics have the capacity to reabsorb 20 times more fluid than is formed normally, and a pleural effusion develops when there is an excess pleural fluid formation or when there is decreased fluid removal from the lymphatics. In heart failure, the hemodynamic mechanism underlying pleural effusion is an increased right [10] or left atrial pressure [11,12]. Together with lung interstitium, pleural space acts as a sump for excess lung water [13]. The increased transudation exceeds the compensatory reserve of lymphatic drainage. When the amount of pleural effusion is moderate-to-severe, therapeutic thoracentesis improves ventilatory exchanges and corrects hypoxaemia at least partially, that may explain the immediate symptomatic relief [14]. In addition, therapeutic thoracentesis relieves the constrictive physiology of heart filling and low cardiac output which is frequently associated with massive pleural effusion [15,16]. Therapeutic thoracentesis therefore immediately improves symptoms and may restore a better lung function and myocardial performance, interrupting the vicious circle of increased pleural pressures, reduced lymphatic drainage, constrictive cardiac physiology, reduced lung ventilation and impaired tissue oxygenation leading to backward heart failure, increased pulmonary wedge and systemic venous pressures eventually worsening pleural effusion.
A challenging case of spontaneous bacterial empyema in a cirrhotic patient
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Saad Emhmed Ali, Olalekan Akanbi, Macy Godman, Mohanad Soliman, Wesam M. Frandah, Karim Benrajab
Abdominal ultrasound showed a small amount of ascites not amenable to paracentesis. Thoracentesis was performed, and 1100 ml of blood-tinged exudative fluid was removed. The fluid analysis was significant for RBC 16000, WBC 2643, with 70% neutrophils. Serum/pleural fluid albumin gradient >1.1 g/dL (Table 1). Fluid gram stain showed moderate polymorphonuclear white blood cells, and fluid culture was negative. Post-thoracentesis chest X-ray showed improvement in the right sided pleural effusion with no evidence of airspace disease (Figure 3). Based on the pleural fluid studies and absence of pneumonia on chest radiography, a diagnosis of spontaneous bacterial empyema was made, and the patient was treated with intravenous ceftriaxone 2 gram every 24 hours for seven days, following which he was discharged in a stable condition on ciprofloxacin prophylaxis with scheduled hepatology outpatient follow-up.