Treatment of Complicated Pleural Fluid Collections With Image-Guided Drainage and Intracavitary Urokinase

Moulton, Jeffrey S.; Benkert, Robert E.; Weisiger, Kenneth H.; Chambers, Jodi A.

doi:10.1378/chest.108.5.1252

Cited by 145 publications

(84 citation statements)

References 17 publications

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“…A small amount of pleural effusion was defined when there was difficulty in localizing by physical examination and diagnosis was conducted only by chest CT or ultrasound. Loculated effusion was defined as the situation where a fluid that was in a nondependent location exhibited a convex border toward the lung or a mass effect on the adjacent lung (18). Dry tap was defined as no effusion being sampled in at least one try of thoracentesis.…”

Section: Data Collectionmentioning

confidence: 99%

Incidence and risk factors of iatrogenic pneumothorax after thoracentesis in emergency department settings

Cho

Choi

et al. 2017

J. Thorac. Dis.

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Background: There is a lack of data regarding the incidence and associated factors of pneumothorax following thoracentesis conducted in emergency department (ED) settings. The present study aims to determine the incidence of pneumothorax following thoracentesis in ED settings and evaluate the association of specific demographics, clinical, and procedure factors with thoracentesis-related pneumothorax. Methods:We retrospectively reviewed the medical records of 3,067 thoracentesis cases in the ED of a tertiary care, university-affiliated hospital between January 2009 and December 2014. To evaluate the factors associated with the occurrence of pneumothorax following thoracentesis, matched controls were used with a case to control ratio of 1:5. Results: Of the 3,067 cases that received thoracentesis, 19 cases of pneumothorax were observed (0.62%).Patients with pneumothorax had significantly lower weight and body mass index (BMI) than those without pneumothorax (51.0 vs. 61.2 kg, 20.0 vs. 22.6; P<0.001, respectively). In the multivariate logistic regression analysis, being underweight, defined as a BMI of <18.5 [OR, 5.2 (95% CI, 1.3-21.2); P=0.021] was significantly associated with the occurrence of pneumothorax. Conclusions:The incidence of pneumothorax following thoracentesis was very low in the present study. However, clinicians should be aware of the risk of pneumothorax in underweight patients during thoracentesis. Further prospective studies are required to clarify the results of the present study.

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Section: Data Collectionmentioning

confidence: 99%

Incidence and risk factors of iatrogenic pneumothorax after thoracentesis in emergency department settings

Cho

Choi

et al. 2017

J. Thorac. Dis.

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“…Long-lasting multiloculated haemothorax is an indication for image-guided catheter drainage. Fibrinolytic agents can be safely injected in a pleural haematoma at 1 week following trauma [97,98] (®g. 4).…”

Section: Pleural Collectionsmentioning

confidence: 99%

Imaging guided thoracic interventions

Ghaye¹,

Dondelinger²

2001

Eur Respir J

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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.

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“…fibrinolytic therapy; fibrinolysis; plasminogen activator inhibitor 1; pleural injury; urokinase; tissue plasminogen activator INTRAPLEURAL FIBRINOLYTIC THERAPY (IPFT) activates the endogenous fibrinolytic system, resolving intrapleural adhesions and complex fibrinous deposits that sequester pockets of inflammation loculations, thus improving drainage and clinical outcome, in part by decreasing surgical interventions (10). There are multiple reports of successful (88 -100% efficacy) IPFT in adult (1,7,8,16,17,29,42,47,48,66,67,72) and in pediatric (2,3,6,11,20,40,41,58,59,61,63,67) patients with empyema although outcomes in adult patients are inconsistent in these trials. Thus IPFT represents a less invasive and costly alternative to video-assisted thoracic surgery or other surgical interventions, which demonstrate comparable efficacy (16,44,45,58,60,71) in pediatric practice.…”

mentioning

confidence: 99%

The time course of resolution of adhesions during fibrinolytic therapy in tetracycline-induced pleural injury in rabbits

Komissarov

Florova

Azghani

et al. 2015

American Journal of Physiology-Lung Cellular and Molecular Phys

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The time required for the effective clearance of pleural adhesions/organization after intrapleural fibrinolytic therapy (IPFT) is unknown. Chest ultrasonography and computed tomography (CT) were used to assess the efficacy of IPFT in a rabbit model of tetracycline-induced pleural injury, treated with single-chain (sc) urokinase plasminogen activators (scuPAs) or tissue PAs (sctPA). IPFT with sctPA (0.145 mg/kg; n ϭ 10) and scuPA (0.5 mg/kg; n ϭ 12) was monitored by serial ultrasonography alone (n ϭ 12) or alongside CT scanning (n ϭ 10). IPFT efficacy was assessed with gross lung injury scores (GLIS) and ultrasonography scores (USS). Pleural fluids withdrawn at 0 -240 min and 24 h after IPFT were assayed for PA and fibrinolytic activities, ␣-macroglobulin/ fibrinolysin complexes, and active PA inhibitor 1 (PAI-1). scuPA and sctPA generated comparable steady-state fibrinolytic activities by 20 min. PA activity in the scuPA group decreased slower than the sctPA group (k obs ϭ 0.016 and 0.042 min Ϫ1 ). Significant amounts of bioactive uPA/␣-macroglobulin (but not tPA; P Ͻ 0.05) complexes accumulated at 0 -40 min after IPFT. Despite the differences in intrapleural processing, IPFT with either fibrinolysin was effective (GLIS Յ 10) in animals imaged with ultrasonography only. USS correlated well with postmortem GLIS (r 2 ϭ 0.85) and confirmed relatively slow intrapleural fibrinolysis after IPFT, which coincided with effective clearance of adhesions/organization at 4 -8 h. CT scanning was associated with less effective (GLIS Ͼ 10) IPFT and higher levels of active PAI-1 at 24 h following therapy. We concluded that intrapleural fibrinolysis in tetracycline-induced pleural injury in rabbits is relatively slow (4 -8 h). In CT-scanned animals, elevated PAI-1 activity (possibly radiation induced) reduced the efficacy of IPFT, buttressing the major impact of active PAI-1 on IPFT outcomes. fibrinolytic therapy; fibrinolysis; plasminogen activator inhibitor 1; pleural injury; urokinase; tissue plasminogen activator INTRAPLEURAL FIBRINOLYTIC THERAPY (IPFT) activates the endogenous fibrinolytic system, resolving intrapleural adhesions and complex fibrinous deposits that sequester pockets of inflammation loculations, thus improving drainage and clinical outcome, in part by decreasing surgical interventions (10). There are multiple reports of successful (88 -100% efficacy) IPFT in adult (1,7,8,16,17,29,42,47,48,66,67,72) and in pediatric (2,3,6,11,20,40,41,58,59,61,63,67) patients with empyema although outcomes in adult patients are inconsistent in these trials. Thus IPFT represents a less invasive and costly alternative to video-assisted thoracic surgery or other surgical interventions, which demonstrate comparable efficacy (16,44,45,58,60,71) in pediatric practice. IPFT also represents a preferred choice in high-risk (1, 22) and otherwise inoperable patients (10,43,49,56,57,69) or those with empyema/ loculation who refuse surgery. The reasons for the inconsistent results of IPFT in adult patients remain unclear but likely reflect...

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Treatment of Complicated Pleural Fluid Collections With Image-Guided Drainage and Intracavitary Urokinase

Cited by 145 publications

References 17 publications

Incidence and risk factors of iatrogenic pneumothorax after thoracentesis in emergency department settings

Incidence and risk factors of iatrogenic pneumothorax after thoracentesis in emergency department settings

Imaging guided thoracic interventions

The time course of resolution of adhesions during fibrinolytic therapy in tetracycline-induced pleural injury in rabbits

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