Modern day management of a unilateral pleural effusion

Abstract

Over 50 systemic conditions may affect the pleura and, thus, unilateral pleural effusions may present for a variety of reasons. Investigating the cause is essential to providing appropriate management. Various pleural interventions are available in current practice, but have varying diagnostic sensitivity. It is, therefore, vital to consider the intervention with the highest diagnostic yield appropriate to the particular clinical situation. The diagnostic pathway in unilateral pleural effusion is increasingly outpatient based, avoiding hospitalisation, which is particularly relevant with the recent COVID-19 pandemic.

Local Anaesthetic Thoracoscopy for Pleural Effusion—A Narrative Review

“…Careful patient selection is required prior to LAT: a detailed history regarding the disease process including previous occupational exposure (e.g., asbestos) and previous malignant disease is important. A baseline functional assessment is useful to assess suitability to proceed with the procedure as well as potential treatment, and therefore, a World Health Organisation Performance Status of 2 or above is recommended [ 27 , 28 ]. The patient’s medical comorbidities may provide important information regarding the patient’s risk factors for the procedure, including drug intolerances and allergies.…”

“…Aspirin does not need to be stopped. Formal anticoagulation should be withheld for 24 h for therapeutic low molecular weight heparin, 5 days for warfarin and normally 48 h for direct oral anticoagulants (although dagibatran might need to be stopped 4 days before a procedure if the patient’s creatinine clearance is less than 50 millilitres per minute)) and platelet counts should be greater than 50,000 per microlitre of blood and the international normalised ratio should be less than 1.5 [ 4 , 27 , 28 , 29 ]. Of note, it is our opinion that whilst platelet count is an established level in the BTS guidance [ 28 , 29 ], platelet activity is also important, and advice from haematology might be obtained prior to a procedure in a thrombocytopenic patient.…”

“…Potential major complications occur in 1.8% cases, including empyema, bleeding, post-operative pneumothorax, bronchopleural fistula, pneumonia and port site tumour growth [ 4 , 23 ]. The overall risk of death is 0.1% [ 4 , 27 , 28 ]. However, this mortality was from earlier case series and was associated with talc-induced respiratory failure due to acute respiratory distress syndrome (ARDS)—non-graded talc was in use at the time.…”

“…Minor complications include subcutaneous emphysema, minor bleeding, peri-procedure hypotension as well as raised temperature and atrial fibrillation. These occur in 7.3% of cases [ 4 , 27 , 28 , 29 , 41 ].…”

The association of pleural effusion and pulmonary embolism

“…In addition, a significant number of patients died due to nosocomial COVID-19 infection. 1,2 So, what impact did these changes have on concerns against healthcare services? To explore this, we analysed the data available in the public domain on complaints against medical practitioners in the UK.…”