China
Africa
Explore chapters and articles related to this topic
The Extra-Pleural and Pleural Spaces, including Plombages, Pleural Tumours and the Effects of Asbestos.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
The cause of pleural disease may be surmised in many patients by knowing the presence of metastases, heart failure, rib fractures, primary lung neoplasm, etc. However, aspiration of some fluid, which is now most conveniently carried out under ultra-sound control, is invaluable in many cases, and will immediately show if the fluid is 'clear', blood-stained, frank blood, pus, chyle, etc.
Empyema
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Joseph Sujka, Shawn D. St Peter
Despite being sequentially outlined, there is no certainty that each stage will progress to the next. More importantly, the stage of pleural disease may not relate to the degree of physiologic illness. The severity of illness is determined by the extent of underlying parenchymal disease and the extent of intravascular inflammatory response. Patients may be quite systemically ill early in the course of severe pneumonia but clinically stabilize later on in empyema development, which should be considered prior to intervention. Patients should always be viewed considering the layers of processes when treating empyema (Figure 17.1).
Pulmonary Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Charles S. Dela Cruz, Barbara Seaworth, Graham Bothamley
Adjunct corticosteroid use has not been shown to reduce all-cause mortality or result in higher sputum conversion in patients with pulmonary TB.120 However, the addition of corticosteroid therapy to anti-mycobacterial treatment has been considered for some HIV-infected patients who develop clinical manifestations suggestive of an immune reconstitution inflammatory syndrome (IRIS) after treatment with anti-TB and antiretroviral medications. Signs and symptoms include high fevers, new or worsening pulmonary and pleural disease, lymphadenopathy and/or CNS manifestations, These reactions are felt to develop due to the reconstitution of the immune response from the antiretroviral treatment.121 For patients with TB, IRIS is more commonly seen in patients with a CD4 cell count of less than 50 cell/mm3 early on during their antiretroviral treatment.
Optimal diagnostic strategies for pleural diseases and identifying high-risk patients
Published in Expert Review of Respiratory Medicine, 2023
D N Addala, P Denniston, A Sundaralingam, N M Rahman
Pleural diseases represent a wide range of conditions with significant impacts on patients and burden to healthcare systems. The most common presentation of pleural disease is with pleural effusion resulting in symptoms of breathlessness, cough, or fatigue, or as an incidental finding on imaging. There are approximately 1.5 million new pleural effusions identified per year in the United States, and the costs to healthcare systems are significant, with recent US data showing the cost of hospitalization with pleural disease to be over $10 billion per year and readmissions costing over $1 billion annually[1,2]. The need for effective diagnostics in this vulnerable population of patients cannot therefore be understated, with key priorities for emergency and pleural physicians revolving around providing effective, specialized care earlier to minimize the need for hospital admission and repeated pleural procedures. Ascertaining a rapid, accurate diagnosis however is challenging in itself, with over 50 known conditions resulting in pleural disease, and clinical presentation that is often non-specific[3].
Influenza virus infection complicated by bacterial necrotising pneumonia: two case reports
Published in Paediatrics and International Child Health, 2020
Augusta Aragão Arruda, Joana Pacheco Fortuna, Ana Teresa Raposo, Marina Rita Paulo Soares, Juan António Gonçalves, Maria Fernanda Gomes
The management of NP with associated pleural effusion does not differ from that of empyema owing to other causes and may include pleural drainage (with or without fibrinolytic agents) and/or surgery, specifically video-assisted thoracoscopic or thoracotomy depending on hospital experience [11]. To date, no randomised trial has been performed to compare these therapeutic approaches. Surgical intervention is often undertaken if there is persisting fever, signs of sepsis and/or progressive respiratory distress despite chest tube insertion, also when there is a large pyopneumothorax, tension pneumatocele and/or loculated empyema, especially in the presence of mass effects compromising ventilation [9]. Surgery can reduce the pleural disease and facilitate lung re-expansion and symptomatic relief. Surgery can help debride pyogenic material that can contribute to underlying inflammatory processes [9]. Despite the acute morbidity associated with NP, the general outcome is excellent and most children make a full recovery. In major series published to date, the mortality rate was 0–7.5% [4,7,16,20,21].
Interventional pulmonary medicine
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Chrystal Chan, Christopher A. Hergott
Despite the challenges of 2020, significant advances have been made in the field of IPM. A long-accepted paradigm for pneumothorax management has been questioned. Minimally invasive techniques for mediastinal staging and management of pleural disease continue to be refined. Bronchoscopic access to peripheral pulmonary lesions and interventions for emphysema are growing rapidly. Despite these advances, there is still much work to do. The lack of robust randomized trials in IPM research is a deficiency the IPM community must endeavor to remedy. As more technologically advanced tools and techniques are developed, it behooves us to study them in a manner that allows us to truly assess their efficacy and usefulness.