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Current Pulmonology Reports
Published in: Current Pulmonology Reports 2/2013

01-06-2013 | Pleural Diseases and Mesothelioma (YCG Lee, Section Editor)

Management options for the complicated pleural space

Authors: David Hsia, Ali I. Musani

Published in: Current Pulmonology Reports | Issue 2/2013

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Abstract

Clinicians frequently encounter patients with malignant and benign diseases involving the pleural space. Complications from these disease processes pose clinical challenges that often require a multi-disciplinary management approach. Here we discuss therapeutic options available for complicated diseases of the pleural space, including loculated malignant effusions, complicated pleural infections, hemothorax, nonexpanding lung, pleural thickening, and persistent bronchopleural fistulas. Our objective is to review current literature on management of these complex issues.
Literature
1.
Du Rand I, Maskell N. Introduction and methods: British thoracic society pleural disease guideline 2010. Thorax. 2010;65:ii1–3.PubMedCrossRef
2.
Hsia D, Musani AI. Management of malignant pleural effusions. Curr Respir Care Rep. 2012;1(2):73–81.CrossRef
3.
Mason AC, Miller BH, Krasna MJ, et al. Accuracy of CT for the detection of pleural adhesions. Correlation with video-assisted thoracoscopic surgery. Chest. 1999;115:423–7.PubMedCrossRef
4.
Cassanelli N, Caroli G, Dolci G, et al. Accuracy of transthoracic ultrasound for the detection of pleural adhesions. Eur J Cardiothorac Surg. 2012;45:813–8.CrossRef
5.
Wei B, Wang T, Jiang F, et al. Use of transthoracic ultrasound to predict pleural adhesions: a prospective blinded study. Thorac Cardiovasc Surg. 2012;60:101–4.PubMedCrossRef
6.
• Hsia D, Musani AI. Interventional pulmonology procedures for the diagnosis and therapeutic management of lung cancer. Minerva Pneumol. 2012;51:27–43. Review of endobronchial and pleural intervention for lung cancer available to the interventional pulmonologist.
7.
Davies CW, Traill ZC, Gleeson FV, et al. Intrapleural streptokinase in the management of malignant multiloculated pleural effusions. Chest. 1999;115:729–33.PubMedCrossRef
8.
Hsu LH, Soong TC, Feng AC, et al. Intrapleural urokinase for the treatment of loculated malignant pleural effusions and trapped lungs in medically inoperable cancer patients. J Thorac Oncol. 2006;1:460–7.PubMedCrossRef
9.
Okur E, Baysungur V, Tezel C, et al. Streptokinase for malignant pleural effusions: a randomized controlled study. Asian Cardiovasc Thorac Ann. 2011;19:238–43.PubMed
10.
Maskell NA, Davies CW, Nunn AJ, et al. U.K. controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005;352:865–74.PubMedCrossRef
11.
•• Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011;365:518–26. Trial evaluating the potential role of t-PA and DNase in the treatment of complicated pleural infections.PubMedCrossRef
12.
Cheng G, Vintch JR. A retrospective analysis of the management of parapneumonic empyemas in a County teaching facility from 1992 to 2004. Chest. 2005;128:3284–90.PubMedCrossRef
13.
14.
Colice GL, Curtis A, Deslauriers J, et al. Medical and surgical treatment of parapneumonic effusions. An evidence-based guideline. Chest. 2000;18:1158–71.CrossRef
15.
•• Davies HE, Davies RJ, Davies CW, et al. Management of pleural infection in adults: British thoracic society pleural disease guideline 2010. Thorax. 2010;65 Suppl 2:ii41–53. Recent large societal guidelines on the management of pleural infections.PubMedCrossRef
16.
Rahman NM, Maskell NA, Davies CW, et al. The relationship between chest tube size and clinical outcome in pleural infection. Chest. 2010;137:536–43.PubMedCrossRef
17.
Liu YH, Lin YC, Liang SJ, et al. Ultrasound-guided pigtail catheters for drainage of various pleural diseases. Am J Emerg Med. 2010;28:915–21.PubMedCrossRef
18.
Tokuda Y, Matsushima D, Stein GH, et al. Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis. Chest. 2006;129:783–90.PubMedCrossRef
19.
Doelken P. Clinical implications of unexpandable lung due to pleural disease. Am J Med Sci. 2008;335:21–5.PubMedCrossRef
20.
Molnar TF. Current surgical treatment of thoracic empyema in adults. Eur J Cardiothorac Surg. 2007;32:422–30.PubMedCrossRef
21.
Tassi GF, Davis RJ, Noppen M. Advanced techniques in medical thoracoscopy. Eur Respir J. 2006;28:1051–9.PubMedCrossRef
22.
Zahid I, Nagendran M, Routledge T, et al. Comparison of video-assisted thoracoscopic surgery and open surgery in the management of primary empyema. Curr Opin Pulm Med. 2011;17:255–9.PubMedCrossRef
23.
Tong BC, Hanna J, Toloza EM, et al. Outcomes of video-assisted thoracoscopic decortications. Ann Thorac Surg. 2010;89:220–5.PubMedCrossRef
24.
Brutsche MH, Tassi GF, Gyorik S, et al. Treatment of sonographically stratified multiloculated thoracic empyema by medical thoracoscopy. Chest. 2005;128:3303–9.PubMedCrossRef
25.
Naranjo Gomez JM, Carbajo Carbajo M, Valdivia Concha D, et al. Conservative treatment of post-lobectomy bronchopleural fistula. Interact Cardiovasc Thorac Surg. 2012;15:152–4.PubMedCrossRef
26.
Ucvet A, Gursoy S, Sirzai S, et al. Bronchial closure methods and risks for bronchopleural fistula in pulmonary resections: how a surgeon may choose the optimum method? Interact Cardiovasc Thorac Surg. 2011;12:558–5562.PubMedCrossRef
27.
Darling GE, Abdurahman A, Yi QL, et al. Risk of right pneumonectomy: role of bronchopleural fistula. Ann Thorac Surg. 2005;79:433–77.PubMedCrossRef
28.
Thourani VH, Lancaster RT, Mansour KA, et al. Twenty-six years of experience with the modified eloesser flap. Ann Thorac Surg. 2003;76:401–5.PubMedCrossRef
29.
Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest. 2001;119:590–602.PubMedCrossRef
30.
Brooks A, Davies B, Smethhurst M, et al. Emergency ultrasound in the acute assessment of haemothorax. Emerg Med J. 2004;21:44–6.PubMedCrossRef
31.
Inaba K, Lustenberger T, Recinos G, et al. Does size matter? a prospective analysis of 28–32 versus 36–40 French chest tube size in trauma. J Trauma. 2012;72:422–7.
32.
Luchette FA, Barrie PS, Oswanski MF, et al. Practice management guidelines for prophylactic antibiotic use in tube thoracostomy for traumatic hemopneumothorax: the EAST Practice Management Guidelines Work Group. J Trauma. 2000;48:753–7.PubMedCrossRef
33.
Maxwell RA, Campbell DJ, Fabian TC, et al. Use of presumptive antibiotics following tube thoracostomy for traumatic hemopneumothorax in the prevention of empyema and pneumonia – a multi-center trial. J Trauma. 2004;57:742–8.PubMedCrossRef
34.
Bosman A, de Jong MB, Debeij J, et al. Systematic review and meta-analysis of antibiotic prophylaxis to prevent infections from chest drains in blunt and penetrating thoracic injuries. Br J Surg. 2012;99:506–13.PubMedCrossRef
35.
Dubose J, Inaba K, Okoye O, et al. Development of posttraumatic empyema in patients with retained hemothorax: Results of a prospective observational AAST study. J Trauma 73:752–757.
36.
DuBose J, Inaba K, Demetriades D, et al. Management of post-traumatic retained hemothorax: a prospective, observational, multicenter AAST study. J Trauma. 2012;72:11–24.
37.
Meyer DM, Jessen ME, Wait MA, et al. Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial. Ann Thorac Surg. 1997;64:1396–400.PubMedCrossRef
38.
Heidecker J, Huggins JT, Sahn SA, et al. Pathophysiology of pneumothorax following ultrasound-guided thoracentesis. Chest. 2006;130:1173–84.PubMedCrossRef
39.
Rzyman W, Skokowski J, Romanowicz G, et al. Decortication in chronic pleural empyema – effect on lung function. Eur J Cardiothorac Surg. 2002;21:502–7.PubMedCrossRef
40.
Gokce M, Okur E, Baysungur V, et al. Lung decortication for chronic empyaema: effects on pulmonary function and thoracic asymmetry in the late period. Eur J Cardiothorac Surg. 2009;36:754–8.PubMedCrossRef
41.
Celik S, Celik M, Aydemir B, et al. Long-term results of lung decortications in patients with trapped lung secondary to coronary artery bypass grafting. Ann Thorac Cardiovasc Surg. 2012;18:109–14.PubMedCrossRef
42.
Kho P, Karunanantham J, Leung M, et al. Debridement alone without decortications can achieve lung re-expansion in patients with empyema: an observational study. Interact Cardiovasc Thorac Surg. 2011;12:724–7.PubMedCrossRef
43.
Milanez RC, Vargas FS, Filomeno LB, et al. Intrapleural talc for the treatment of malignant pleural effusions secondary to breast cancer. Cancer. 1995;75:2688–92.PubMedCrossRef
44.
Lan RS, Lo SK, Chuang ML, et al. Elastance of the pleural space: a predictor for the outcome of pleurodesis in patients with malignant pleural effusion. Ann Intern Med. 1997;126:768–74.PubMedCrossRef
45.
Bernard A, de Dompsure RB, Hagry O, et al. Early and late mortality after pleurodesis for malignant pleural effusion. Ann Thorac Surg. 2002;74:213–7.PubMedCrossRef
46.
Schulze M, Boehle AS, Kurdow R, et al. Effective treatment of malignant pleural effusion by minimal invasive thoracic surgery: thoracoscopic talc pleurodesis and pleuroperitoneal shunts in 101 patients. Ann Thorac Surg. 2001;71:1809–12.PubMedCrossRef
47.
Pien GW, Gant MJ, Washam CL, et al. Use of an implantable pleural catheter for trapped lung syndrome in patients with malignant pleural effusion. Chest. 2001;119:1641–6.PubMedCrossRef
48.
Efthymiou CA, Masudi T, Thorpe JA, et al. Malignant pleural effusion in the presence of trapped lung. Five-year experience of PleurX tunneled catheters. Interact Cardiovasc Thorac Surg. 2009;9:961–4.PubMedCrossRef
49.
Qureshi RA, Collinson SL, Powell RJ, et al. Management of malignant pleural effusion associated with trapped lung syndrome. Asian Cardiovasc Thorac Ann. 2008;16:120–3.PubMed
50.
Hsu LH, Soong TC, Feng AC, et al. Intrapleural urokinase for the treatment of loculated malignant pleural effusions and trapped lungs in medically inoperable cancer patients. J Thorac Oncol. 2006;5:460–7.CrossRef
51.
52.
American Thoracic Society. “Diagnosis and initial management of nonmalignant diseases related to asbestos. Am J Respir Crit Care Med. 2004;170:691–715.CrossRef
53.
Larson TC, Meyer CA, Kapil V, et al. Workers with Libby amphibole exposure; retrospective identification and progression of radiographic changes. Radiology. 2010;255:924–33.PubMedCrossRef
54.
Epler GR, McLoud TC, Gaensler EA. Prevalence and incidence of benign asbestos pleural effusion in a working population. JAMA. 1982;247:617–22.PubMedCrossRef
55.
56.
Aberle DR, Balmes JR. Computed tomography of asbestos-related pulmonary parenchymal and pleural diseases. Clin Chest Med. 1991;12:115–31.PubMed
57.
Sison RF, Hruban RH, Moore GW, et al. Pulmonary disease associated with pleural “asbestos” plaques. Chest. 1989;95:831–5.PubMedCrossRef
58.
Rogan WJ, Gladen BC, Ragan NB, et al. US prevalence of occupational pleural thickening: a look at x-rays from the First National Health and Nutrition Examination Survey. Am J Epidemiol. 1987;126:893–900.PubMed
59.
60.
Hillerdal G, Henderson DW. Asbestos, asbestosis, pleural plaques and lung cancer. Scand J Work Environ Health. 1997;23:93–103.PubMedCrossRef
61.
Hillerdal G. Pleural plaques and the risk for bronchial carcinoma and mesothelioma. Chest. 1994;105:144–50.PubMedCrossRef
62.
Miller A, Miller JA. Diffuse pleural thickening superimposed on circumscribed pleural thickening related to asbestos exposure. Am J Ind Med. 1993;23:859–71.PubMedCrossRef
63.
Lilis R, Lerman Y, Selikoff IJ. Symptomatic benign pleural effusions among asbestos insulation workers: residual radiographic abnormalities. Br J Ind Med. 1988;45:443–9.PubMed
64.
Schwartz DA, Fuortes LJ, Galvin JR, et al. Asbestos-induced pleural fibrosis and impaired lung function. Am Rev Respir Dis. 1990;141:321–6.PubMedCrossRef
65.
Batra P, Brown K, Hayashi K, et al. Rounded atelectasis. J Thorac Imaging. 1996;11:187–97.PubMed
66.
67.
• Scherpereel A, Astoul P, Baas P, et al. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J. 2010;35:479–95. Recent large societal guidelines on the management of mesothelioma.PubMedCrossRef
68.
•• Treasure T, Lang-Lazdunski L, Waller D, et al. Extra-pleural pneumonectomy versus no extra-pleural pneumonetomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study. Lancet. 2011;12:763–72. Randomized evaluation of EPP for mesothelioma.CrossRef
69.
Zellos L, Jaklitsch MT, Al-Mourgi MA, et al. Complications of extrapleural pneumonectomy. Semin Thorac Cardiovasc Surg. 2007;19:355–9.PubMedCrossRef
70.
Soysal O, Karaoglanoglu N, Demiracan S, et al. Pleurectomy/decortications for palliation in malignant pleural mesothelioma: results of surgery. Eur J Cardiothorac Surg. 1997;11:210–3.PubMedCrossRef
71.
Aelony Y, Yao JF. Prolonged survival alter talc poudrage for malignant pleural mesothelioma: case series. Respirology. 2005;10:649–55.PubMedCrossRef
72.
Boutin C, Rey F, Viallat JR. Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. A randomized trial of local radiotherapy. Chest. 1995;108:754–8.PubMedCrossRef
73.
O’Rourke N, Garcia JC, Paul J, et al. A randomised controlled trial of intervention site radiotherapy in malignant pleural mesothelioma. Radiother Oncol. 2007;84:18–22.PubMedCrossRef
74.
Bydder S, Phillips M, Joseph DJ, et al. A randomised trial of single-dose radiotherapy to prevent procedure tract metastasis by malignant mesothelioma. Br J Cancer. 2004;91:9–10.PubMedCrossRef
75.
76.
Batchelder TL, Morris KA. Critical factors in determining adequate pleural drainage in both the operated and nonoperated chest. Am Surg. 1962;28:296–302.PubMed
77.
Powner DJ, Cline D, Rodman GH. Effect of chest-tube suction on gas flow through a bronchopleural fistula. Crit Care Med. 1985;13:99–101.PubMedCrossRef
78.
Rusch VW, Capps JS, Tyler ML, et al. The performance of four pleural drainage systems in an animal model of bronchopleural fistula. Chest. 1988;93:859–63.PubMedCrossRef
79.
Baumann MH. What size chest tube? What drainage system is ideal? And other chest tube management questions. Curr Opin Pulm Med. 2003;9:276–81.PubMedCrossRef
80.
Miller KS, Sahn SA. Chest tubes. Indications, technique, management and complications. Chest. 1987;91:258–64.PubMedCrossRef
81.
Maung AA, Kaplan LJ. Mechanical ventilation after injury. J Intensive Care Med. 2012 Sep 6. [epub ahead of print]
82.
Lois M, Noppen M. Bronchopleural fistulas. An overview of the problem with special focus on endoscopic management. Chest. 2005;128:3955–65.PubMedCrossRef
83.
Downs JB, Chapman RL. Treatment of bronchopleural fistulas during continuous positive pressure ventilation. Chest. 1976;69:363–6.PubMedCrossRef
84.
Zimmerman JE, Colgan DL, Mills M. Management of bronchopleural fistula complicating therapy with positive end expiratory pressure (PEEP). Chest. 1973;64:526–9.PubMedCrossRef
85.
Feely TW, Keating D, Nishimura T. Independent lung ventilation using high-frequency ventilation in the management of a bronchopleural fistula. Anesthesiology. 1988;69:420–2.CrossRef
86.
Ha DV, Johnson D. High frequency oscillatory ventilation in the management of a high output bronchopleural fistula: a case report. Can J Anaesth. 2004;51:78–83.PubMedCrossRef
87.
Ricci ZJ, Haramati LB, Rosenbaum AT, et al. Role of computed tomography in guiding the management of peripheral bronchopleural fistula. J Thorac Imaging. 2002;17:214–8.PubMedCrossRef
88.
Travaline JM, McKenna RJ, De Giacomo T, et al. Treatment of persistent pulmonary air leaks using endobronchial valves. Chest. 2009;136:355–60.PubMedCrossRef
89.
Gillespie CT, Sterman DH, Cerfolio RJ, et al. Endobronchial valve treatment for prolonged air leaks of the lung: a case series. Ann Thorac Surg. 2011;91:270–3.PubMedCrossRef
Metadata
Title
Management options for the complicated pleural space
Authors
David Hsia
Ali I. Musani
Publication date
01-06-2013
Publisher
Current Science Inc.
Published in
Current Pulmonology Reports / Issue 2/2013
Electronic ISSN: 2199-2428
DOI
https://doi.org/10.1007/s13665-013-0044-2

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