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The European Respiratory Journal Jul 2018Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed... (Review)
Review
Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.
Topics: Advisory Committees; Drainage; Europe; Humans; Palliative Care; Pleural Effusion, Malignant; Pleurodesis; Recurrence; Retreatment; Risk Factors; Societies, Medical; Thoracentesis
PubMed: 30054348
DOI: 10.1183/13993003.00349-2018 -
Annals of Hepatology 2018Hepatic hydrothorax (HH) is a pleural effusion that develops in a patient with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. Although the... (Review)
Review
Hepatic hydrothorax (HH) is a pleural effusion that develops in a patient with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. Although the development of HH remains incompletely understood, the most acceptable explanation is that the pleural effusion is a result of a direct passage of ascitic fluid into the pleural cavity through a defect in the diaphragm due to the raised abdominal pressure and the negative pressure within the pleural space. Patients with HH can be asymptomatic or present with pulmonary symptoms such as shortness of breath, cough, hypoxemia, or respiratory failure associated with large pleural effusions. The diagnosis is established clinically by finding a serous transudate after exclusion of cardiopulmonary disease and is confirmed by radionuclide imaging demonstrating communication between the peritoneal and pleural spaces when necessary. Spontaneous bacterial empyema is serious complication of HH, which manifest by increased pleural fluid neutrophils or a positive bacterial culture and will require antibiotic therapy. The mainstay of therapy of HH is sodium restriction and administration of diuretics. When medical therapy fails, the only definitive treatment is liver transplantation. Therapeutic thoracentesis, indwelling tunneled pleural catheters, transjugular intrahepatic portosystemic shunt and thoracoscopic repair of diaphragmatic defects with pleural sclerosis can provide symptomatic relief, but the morbidity and mortality is high in these extremely ill patients.
Topics: Bacterial Infections; Empyema; Humans; Hydrothorax; Hypertension, Portal; Liver Cirrhosis; Liver Transplantation; Pleural Effusion; Portasystemic Shunt, Transjugular Intrahepatic; Predictive Value of Tests; Risk Factors; Thoracentesis; Thoracoscopy; Treatment Outcome
PubMed: 29311408
DOI: 10.5604/01.3001.0010.7533 -
EBioMedicine Aug 2020This study aimed to establish and validate a novel scoring system based on a nomogram for the differential diagnosis of malignant pleural effusion (MPE) and benign... (Clinical Trial)
Clinical Trial
BACKGROUND
This study aimed to establish and validate a novel scoring system based on a nomogram for the differential diagnosis of malignant pleural effusion (MPE) and benign pleural effusion (BPE).
METHODS
Patients with PE and confirmed aetiology who underwent diagnostic thoracentesis were included in this study. One retrospective set (N = 1261) was used to develop and internally validate the predictive model. The clinical, radiological and laboratory features were collected and subjected to logistic regression analyses. The primary predictive model was displayed as a nomogram and then modified into a novel scoring system, which was externally validated in an independent set (N = 172).
FINDINGS
The novel scoring system was composed of fever (3 points), erythrocyte sedimentation rate (4 points), effusion adenosine deaminase (7 points), serum carcinoembryonic antigen (CEA) (4 points), effusion CEA (10 points) and effusion/serum CEA (8 points). With a cutoff value of 15 points, the area under the curve, specificity and sensitivity for identifying MPE were 0.913, 89.10%, and 82.63%, respectively, in the training set, 0.922, 93.48%, 81.51%, respectively, in the internal validation set and 0.912, 87.61%, 81.36%, respectively, in the external validation set. Moreover, this scoring system was exclusively applied to distinguish lung cancer with PE from tuberculous pleurisy and showed a favourable diagnostic performance in the training and validation sets.
INTERPRETATION
This novel scoring system was developed from a retrospective study and externally validated in an independent set based on six easily accessible clinical variables, and it exhibited good diagnostic performance for identifying MPE.
FUNDING
NFSC grants (no. 81572942, no. 81800094).
Topics: Adenosine Deaminase; Adult; Aged; Blood Sedimentation; Carcinoembryonic Antigen; Diagnosis, Differential; Female; Fever; Humans; Logistic Models; Lung Neoplasms; Male; Middle Aged; Nomograms; Pleural Effusion; Pleural Effusion, Malignant; Retrospective Studies; Sensitivity and Specificity; Thoracentesis; Tuberculosis, Pleural
PubMed: 32739872
DOI: 10.1016/j.ebiom.2020.102924 -
Ugeskrift For Laeger Apr 2021Malignant pleural effusion (MPE) is a common condition, often associated with a high level of symptoms. In this review, several palliative treatments for symptomatic MPE... (Review)
Review
Malignant pleural effusion (MPE) is a common condition, often associated with a high level of symptoms. In this review, several palliative treatments for symptomatic MPE are summarised, including repeated thoracentesis, pleurodesis and insertion of indwelling pleural catheters. Choice of treatment depends on patient symptoms, life expectancy, pleural fluid production, expected effect of oncological treatment, whether trapped lung is suspected or not, and patient preferences. Treatment should be discussed with a pulmonary specialist with knowledge of pleural diseases.
Topics: Catheters, Indwelling; Drainage; Humans; Pleural Effusion, Malignant; Pleurodesis; Thoracentesis
PubMed: 33913425
DOI: No ID Found -
Journal of Visualized Surgery 2018Malignant pleural effusion (MPE) is a very disabling condition that often affects patients with advanced neoplasm. Conservative approach, repeated thoracentesis,... (Review)
Review
Malignant pleural effusion (MPE) is a very disabling condition that often affects patients with advanced neoplasm. Conservative approach, repeated thoracentesis, pleurodesis and use of indwelling pleural catheters (IPC) are the main methods to deal with this condition. The ideal treatment must focus on symptom relief and has to take into account patient underlying diseases, performance status and necessity of adequate tissue sample for diagnosis. In a video we show techniques to perform video assisted thoracic surgery (VATS) pleural biopsy and talc poudrage pleurodesis.
PubMed: 29963399
DOI: 10.21037/jovs.2018.05.02 -
Seminars in Interventional Radiology Jun 2022
Review
PubMed: 36062231
DOI: 10.1055/s-0042-1753501 -
Chicago Medical Examiner Jan 1861
PubMed: 37472588
DOI: No ID Found