Management of malignant pleural effusion

Greenwald, David W.; Phillips, Clay E.; Bennett, John M.

doi:10.1002/jso.2930100411

Cited by 16 publications

(1 citation statement)

References 13 publications

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“…This occurrence may result in maternal liver toxicity or placental transfer of the drug to the developing fetus (or both). 22,23 Although the decision to proceed with surgical treatment is easier in a nonpregnant patient than in a pregnant patient, the same criteria should be considered. Nonpregnant or SPONTANEOUS PNEUMOTHORAX DURING PREGNANCY 251 pregnant patients with continued air leak and incomplete lung expansion, bilateral pneumothoraxes, or a hemopneumothorax require thoracotomy or thoracoscopy.…”

Section: Discussionmentioning

confidence: 99%

Management of Spontaneous Pneumothorax During Pregnancy: Case Report and Review of the Literature

Winter

Nichols

Pairolero

et al. 1996

Mayo Clinic Proceedings

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Spontaneous pneumothorax rarely occurs during pregnancy. Only 22 nonmalignancy-related cases have been previously published. Herein we report a case of recurrent spontaneous pneumothorax during the third trimester of pregnancy that necessitated surgical intervention. At thoracotomy, a large bulla was excised from the lower lobe of the right lung; abrasive pleurodesis was subsequently done. Postoperatively, Spontaneous pneumothorax during pregnancy is rare. Twenty-two nonmalignancy-related cases have been previously reported in the English literature (Table 1).1-20 Most patients had pneumothorax at term, during labor, or immediately postpartum and were treated conservatively with tube thoracostomy. Five cases of spontaneous pneumothorax that occurred during the first or second trimester of pregnancy necessitated either thoracotomy or thoracoscopy to prevent future recurrences.tv'P" Herein we report a case of spontaneous pneumothorax that necessitated surgical intervention early during the third trimester of pregnancy. REPORT OF CASEA 26-year-old woman (gravida 2, para 1) sought medical attention because of the development of a large, symptomatic, right-sided pneumothorax at 23 weeks' gestation. She was a nonsmoker. She had no previous pulmonary history or family history of bullous disease and had not previously undergone chest roentgenography. The pneumothorax was managed on an outpatient basis by her local physician, who used chest tube thoracostomy and a Heimlich valve. Three From the Department of Obstetrics and Gynecology (J.T.V.W., J.A.N., MN 55905.the patient had regular contractions, which were successfully stopped with intravenous administration of magnesium sulfate. Indications, procedures, and precautions for operative intervention during pregnancy are discussed.(Mayo Clin Proc 1996; 71:249-252) ICT = computed tomographic I days after removal of the chest tube, a symptomatic right pneumothorax recurred. A second chest tube was placed, connected to suction, and the patient was transferred to Mayo Clinic Rochester. At the time ofthis admission, no air leak was noted, and the right lung was fully expanded. Chest roentgenography demonstrated a thin-walled, air-filled structure within the lower lobe of the right lung (Fig. 1). Suction was continued, and on the fourth hospital day, the chest tube was clamped. Forty-eight hours later, no recurrent pneumothorax was evident, and the chest tube was successfully removed. The patient's condition remained stable, and she was dismissed on the eighth hospital day. A decision was made to delay obtaining a computed tomographic (CT) scan of the chest until after delivery unless the pneumothorax recurred. Unfortunately, the right-sided pneumothorax recurred 2 weeks after the patient had been dismissed. A chest tube was again placed, and the lung was fully reexpanded without an air leak. A shielded CT scan of the chest without use of contrast medium showed that the previously detected mass was a 5-cm air-containing cystic structure within the lower lobe of the right lung (F...

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Section: Discussionmentioning

confidence: 99%

Management of Spontaneous Pneumothorax During Pregnancy: Case Report and Review of the Literature

Winter

Nichols

Pairolero

et al. 1996

Mayo Clinic Proceedings

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Chemical Pleurodesis With Doxycycline 1 g

Herrington,

Gora‐Harper,

Salley

1996

Pharmacotherapy

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We evaluated the utility of a single 1‐g dose of doxycycline in the treatment of malignant and nonmalignant pleural effusions and refractory pneumothoraces in 27 consecutive patients requiring pleurodesis. After the evacuation of all retained air or fluid, and premedication with intravenous narcotic analgesics and intrapleural lidocaine 200 mg, the patients received doxycycline 1 g in 50 ml normal saline instilled through the chest tube. This was followed by instillation of 100–200 ml of air to facilitate dispersion. The chest tube was removed when the drainage was less than 150 ml/day. Twenty‐three of 27 patients were evaluated at 30 days. Six (67%) of the nine patients with pneumothoraces achieved a response, and both patients with nonmalignant pleural effusions had a complete response. Of the 12 patients with malignant pleural effusion, 8 (67%) achieved a complete response, 2 had a partial response, and 2 had no response. Twenty‐two (81%) of 27 patients experienced adverse effects with pleurodesis, with pain (81%) and fever (11%) being the most prevalent. In this limited number of patients, doxycycline 1 g appeared to be safe and effective for the treatment of pleural effusions and pneumothoraces. The 1‐g dose must be compared with the standard 500‐mg dose and with other established agents.

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Intracavitary bleomycin for the control of malignant effusions

Bitran¹,

Brown²,

Desser³

et al. 1981

Journal of Surgical Oncology

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The results of treatment with intracavitary bleomycin are reported in twenty patients with a malignant pleural effusion and five patients with malignant ascites. The control rate was 17/20 (85%) patients with malignant pleural effusions and 3/5 (60%) patients with malignant ascites. Toxicities were minimal with fever being the most common side effect in four patients (16%. Bleomycin is an effective and nontoxic sclerosing agent.

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Management of malignant pleural effusion

Cited by 16 publications

References 13 publications

Management of Spontaneous Pneumothorax During Pregnancy: Case Report and Review of the Literature

Management of Spontaneous Pneumothorax During Pregnancy: Case Report and Review of the Literature

Chemical Pleurodesis With Doxycycline 1 g

Intracavitary bleomycin for the control of malignant effusions

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