Image-Guided Management of Complicated Pleural Fluid Collections

Moulton, Jeffrey S.

doi:10.1016/s0033-8389(05)70167-6

Cited by 47 publications

(40 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…2,3 Aspiration alone without catheter placement avoids the discomfort related to the presence of an indwelling catheter, the risk of potential catheterrelated complications, and the cost of the catheter. The decision-making process of the interventional radiologists and physicians was not standardized and therefore could not be analyzed retrospectively.…”

Section: Discussionmentioning

confidence: 99%

“…Image-guided percutaneous procedures are precise and relatively noninvasive alternatives to surgical management. 2,3 Two such image-guided techniques are aspiration and percutaneous catheter drainage.Although it is standard practice to analyze the pleural fluid in children with parapneumonic effusions at our institution, the decision of whether to proceed to percutaneous catheter drainage after aspiration is not based on evidence-based data. This retrospective, nonrandomized, single-center study compares 2 primary image-guided drainage procedures: needle aspiration and percutaneous catheter drainage.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Outcomes of Primary Image-Guided Drainage of Parapneumonic Effusions in Children

Mitri

Brown

Zurakowski³

et al. 2002

Pediatrics

View full text Add to dashboard Cite

ABSTRACT. Objective. To assess the outcome of image-guided needle aspiration when compared with image-guided percutaneous catheter drainage in the management of parapneumonic effusions in children.Methods. A retrospective chart review was conducted of the medical records, microbiology, and radiology reports of 67 children who presented with parapneumonic effusions and underwent primary image-guided drainage between April 1, 1995, and April 1, 2000.Results. Thirty-four patients had aspiration only, and 33 patients had pigtail catheters placed. The 2 drainage methods had similar median length of stay and complication rates. The reintervention rate in this study was 27% (18 patients). Children who underwent primary aspiration without catheter placement had significantly higher rates of reintervention. Method of drainage, pH lower than 7.2, and loculation of the fluid collection were independent predictors of reintervention. A low glucose level was an additive predictor of reintervention when the pH was low.Conclusions. Aspiration and catheter drainage of parapneumonic effusions had similar complication rates and lengths of stay, but children who underwent primary aspiration had significantly higher reintervention rates, particularly when pH and glucose levels were low. Therefore, primary catheter placement for parapneumonic effusions should be considered in children who undergo diagnostic thoracentesis. The decision regarding tube placement could be facilitated by the on-site availability of a pH meter and a glucometer. Pediatrics 2002; 110(3). URL: http://www.pediatrics.org/cgi/content/full/ 110/3/e37; pneumonia, pleural effusions, parapneumonic effusion, drainage, thoracentesis, simple aspiration, percutaneous catheter drainage.ABBREVIATIONS. VATS, video assisted thoracoscopic surgery; LDH, lactate dehydrogenase; WBC, white blood cell; OR, odds ratio; CI, confidence interval. P neumonia is the most common cause of the development of thoracic fluid collections in children. Evidence-based guidelines for the treatment of parapneumonic effusions in adults 1 have recently become available, but the optimal treatment of children remains controversial. The reasons for draining parapneumonic pleural effusions include reliable diagnosis of the infectious agent, removal of infected fluid or pus, and, less frequently, alleviation of symptoms related to the volume effect of fluid accumulation.Various procedures are available to drain pleural effusions. These include needle aspiration, tube thoracostomy, video-assisted thoracoscopy, and thoracotomy with or without decortication. Image-guided percutaneous procedures are precise and relatively noninvasive alternatives to surgical management. 2,3 Two such image-guided techniques are aspiration and percutaneous catheter drainage.Although it is standard practice to analyze the pleural fluid in children with parapneumonic effusions at our institution, the decision of whether to proceed to percutaneous catheter drainage after aspiration is not based on evidence-based data. This retro...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of Primary Image-Guided Drainage of Parapneumonic Effusions in Children

Mitri

Brown

Zurakowski³

et al. 2002

Pediatrics

View full text Add to dashboard Cite

show abstract

“…Imaging guided percutaneous drainage avoids the potential failures associated with blind chest tube placement, which can occur in about 50% of patients due to inadequate positioning of the tube or to undrained satellite pleural pockets [86,87]. The size of the percutaneous catheters that are in regular use varies from 7F±30F and is chosen according to the viscosity of the¯uid to be drained.…”

Section: Pleural Collectionsmentioning

confidence: 99%

Imaging guided thoracic interventions

Ghaye¹,

Dondelinger²

2001

Eur Respir J

View full text Add to dashboard Cite

Interventional Radiology is a technique based medical specialty, using all available imaging modalities (¯uoroscopy, ultrasound, computed tomography, magnetic resonance, angiography) for guidance of interventional techniques for diagnostic or therapeutic purposes.Actual, percutaneous transthoracic needle biopsy includes core needle biopsy besides ®ne needle aspiration. Any pleural, pulmonary or mediastinal¯uid or gas collection is amenable to percutaneous pulmonary catheter drainage.Treatment of haemoptysis of the bronchial artery or pulmonary artery origin, transcatheter embolization of pulmonary arteriovenous malformations and pseudoaneurysms, angioplasty and stenting of the superior vena caval system and percutaneous foreign body retrieval are well established routine procedures, precluding unnecessary surgery. These techniques are safe and effective in experienced hands.Computed tomography is helpful in pre-and postoperative imaging of patients being considered for endobronchial stenting. Many procedures can be performed on an outpatient basis, thus increasing the cost-effectiveness of radiologically guided interventions in the thorax.

show abstract

“…Also, patients on whom large bore tubes were used complained of significantly higher level of pain. Chest tube insertions for complicated effusions must be done under imaging guidance as the added cost for the procedure is expected to be more than compensated by the increased success of drainage (31). Some studies have shown that performer skills in chest tube insertion may be better in those who undergo training on cadavers and medical simulators compared to the conventional methods of training (32,33).…”

Section: Tube Thoracostomymentioning

confidence: 99%

A review of the management of complex para-pneumonic effusion in adults

Koppurapu¹,

Meena²

2017

J. Thorac. Dis.

View full text Add to dashboard Cite

A complex para-pneumonic effusion is a descriptive term for exudative effusions, which complicate or are likely to complicate the anatomy of the pleural space after pneumonia. We performed an online search was performed using the resources PubMed and Google Scholar to provide an update on the management of such effusions based on review of published literature. Search terms including pleural effusion (PE), parapneumonic effusion, and empyema were used. Relevant studies were identified and original articles were studied, compared and summarized. References in these articles were examined for relevance and included where appropriate. Studies involving pediatric patients were excluded. Management of para-pneumonic PE has changed tremendously over the last decade. As we accumulate more evidence in this area, approach to pleural fluid drainage is becoming more specific and guideline based. An example of a practice changing study in this aspect is the Multi-center Intrapleural Streptokinase Trial (MIST) 2 trial which demonstrated that a combination of intra-pleural tPA and DNAse improved outcomes in pleural infections compared to DNase or t-PA alone. More randomized control trials are needed to describe the role of surgical techniques like VATS (video-assisted thoracoscopic surgery) when MIST 2 protocol fails; this combination has revolutionized the management of empyema in recently.

show abstract

Image-Guided Management of Complicated Pleural Fluid Collections

Cited by 47 publications

References 24 publications

Outcomes of Primary Image-Guided Drainage of Parapneumonic Effusions in Children

Outcomes of Primary Image-Guided Drainage of Parapneumonic Effusions in Children

Imaging guided thoracic interventions

A review of the management of complex para-pneumonic effusion in adults

Contact Info

Product

Resources

About