Pleural Fluid Analysis: Back to Basics
|
|
- Stephanie Simon
- 5 years ago
- Views:
Transcription
1 Pleural Fluid Analysis: Back to Basics Tonya L. Page, MSN, RN, ACNP-BC Patrick A. Laird, DNP, RN, ACNP-BC 70 y/o female with complaints of shortness of breath and orthopnea for 1 month. Symptoms have worsened in last week. No recent infections. Reports low grade fever. 10 lb weight loss in the past 6 months. History: Hypertension taking Hydrochlorothiazide (Hctz) 100 pack-year history of smoking, Denies ETOH AP Chest X-Ray Pathophysiology Radiology Report: A homogenous opacification is noted in the right lower zone with the opacity seen to track along the lateral chest wall. The right costophrenic angle is obliterated with a meniscus noted Diagnosis: Right Pleural Effusion Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rid: Normal Pleural Fluid Formation (Entry) = Absorption (Exit) Increased Formation Increased permeability Increase in microvascular pressure Decrease in plasma osmotic pressure Decrease in pleural pressure Decreased Absorption Intrinsic factors Inflammation Endocrine abnormalities Injury or Anatomy Cancer Extrinsic factors Respiratory Movement Compression or Blockage Atelectasis Increased Venous Pressure Common Causes Heart Failure Atelectasis Pulmonary Embolism Cirrhosis Autoimmune conditions (lupus) Common Causes Cancers Drug Induced Kidney Disease Infections (Pneumonia or TB) 1
2 Imaging Options Conventional Radiology (Chest X-Ray) Chest Ultrasound Computed Tomography MRI FDG-PET Scanning To tap or not to tap.that is the question! Tap Underlying cause is unknown Not to Tap Small ( 1 cm) Loculated effusions CHF Because the patient was symptomatic, a diagnostic and therapeutic thoracentesis using ultrasound guidance was performed A total of 1100 cc of dark red colored fluid removed Routine Lab Tests Cell count and differential ph Protein Lactate dehydrogenase (LDH) Routine Lab Tests Cytology Glucose Gram stain and culture Selected Lab Tests Amylase Cholesterol Triglycerides Creatinine Adenosine deaminase AFB Stain and Culture 2
3 Fluid Analysis--Gross Appearance Color Character Odor Diagnostic Criteria Light s Criteria Differentiate between transudative and exudative effusions Pleural fluid protein to serum protein ratio > 0.5 Pleural fluid LDH > ⅔ the upper limit of normal Pleural fluid LDH to serum LDH ratio > 0.6 Diagnostic Criteria Two-Test Rule Pleural fluid cholesterol > 45 mg/dl Pleural fluid LDH > 0.45 times the upper limit of normal serum LDH Diagnostic Criteria Three-Test Rule Pleural fluid protein > 2.9 g/dl Pleural fluid pleural fluid cholesterol > 45 mg/dl Pleural fluid LDH > 0.45 times the upper limit of normal of serum LDH Definitive Diagnoses by Pleural Fluid Analysis Definitive Diagnoses by Pleural Fluid Analysis Empyema Disease Diagnostic Pleural Fluid Test Purulent, putrid odor, positive culture Chylothorax Disease Diagnostic Pleural Fluid Test Fluid triglycerides > 110 mg/dl Malignancy Tuberculosis Positive cytology Positive AFB stain, culture Cholesterol Effusion Fluid cholesterol > 200 mg/dl with a cholesterol to triglyceride ratio > 1 Esophageal Rupture Low ph, food fragments 3
4 Definitive Diagnoses by Pleural Fluid Analysis Disease Hemothorax Urinothorax Diagnostic Pleural Fluid Test Ration of pleural fluid to blood hematocrit of > 0.5 Fluid creatinine to serum creatinine > 1.7 Thoracoscopy Symptomatic exudative pleural effusions without a diagnosis Video-assisted Fig. XX: VATS Pleurodesis Obliterates the pleural space to prevent recurrent pleural effusion Chemical pleurodesis Doxycycline Talc pleurodesis most effective Indwelling Pleural Catheter Allows for intermittent drainage Can be left in place indefinitely Fig. XX: Indwelling Pleural Catheter Talc pleurodesis PLUS indwelling catheter Beneficial in patients with malignant pleural effusions Intrapleural fibrinolytic agents --Lab Results Pleural Fluid Serum Protein 8 g/dl 7.5 g/dl LDH 245 U/L 190 U/L 4
5 Pleural Fluid Protein/Serum Protein = 1.07 Pleural Fluid Protein/Serum Protein = 1.07 Pleural Fluid LDH/Serum LDH = 1.29 Pleural Fluid Protein/Serum Protein = 1.07 Pleural Fluid LDH/Serum LDH = 1.29 YES! Cytology revealed adenocarcinoma Patient developed recurrent pleural effusion Drained >1.2 L on two separate occasions Right sided indwelling pleural catheter placed Patient was referred to Heme/Onc for further management References Heffner, J. E. (2018, April 02). Diagnostic evaluation of a pleural effusion in adults: Initial testing. Retrieved August 10, 2018, from evaluation of pleural effusion&source=search_result&selectedtitle=1~150. Myatt, R. (2014). Diagnosis and management of patients with pleural effusions. Nursing standard, 28(41), doi: /ns e8849 Quinn, T., Alam, N., Aminazad, A., Marshall, M. B., & Choong, C. K. (2013). Decision making and algorithm for the management of pleural effusions. Thoracic surgery clinics, 23(1), 11-16, v. doi: /j.thorsurg Saguil, A., Wyrick, K., & Hallgren, J. (2014). Diagnostic approach to pleural effusion. American Family Physician, 90(2), Sahn, S. A. (2012). Getting the most from pleural fluid analysis. Respirology, 17(2), doi: /j x Thomas, R., & Lee, Y. C. (2013). Causes and management of common benign pleural effusions. Thoracic surgery clinics, 23(1), 25-42, v-vi. doi: /j.thorsurg Wilcox, M. E., Chong, C. A., Stanbrook, M. B., Tricco, A. C., Wong, C., & Straus, S. E. (2014). Does this patient have an exudative pleural effusion? The Rational Clinical Examination systematic review. Journal of the American Medical Association, 311(23), doi: /jama
6 References Contact Information Yalcin, N. G., Choong, C. K., & Eizenberg, N. (2013). Anatomy and pathophysiology of the pleura and pleural space. Thoracic surgery clinics, 23(1), 1-10, v. doi: /j.thorsurg Tonya L. Page, MSN, RN, ACNP-BC Patrick A. Laird, DNP, RN, ACNP-BC 6
Management of Pleural Effusion
Management of Pleural Effusion Development of Pleural Effusion pulmonary capillary pressure (CHF) capillary permeability (Pneumonia) intrapleural pressure (atelectasis) plasma oncotic pressure (hypoalbuminemia)
More informationManejo Práctico del Derrame Pleural
Manejo Práctico del Derrame Pleural San José, Costa Rica Junio 29, 2017 Rodrigo Cartín Ceba, MD, MSc Consultant, Pulmonary and Critical Care Medicine Associate Professor of Medicine Mayo Clinic 2010 MFMER
More informationPleural fluid analysis
Pleural fluid analysis Dr Akash Verma Senior Consultant- Department of Respiratory and Critical Care Medicine Tan Tock Seng Hospital, Singapore 308433 Adj A/Professor- Lee Kong Chian School of Medicine
More informationAPPROACH TO PLEURAL EFFUSIONS. Raed Alalawi, MD, FCCP
APPROACH TO PLEURAL EFFUSIONS Raed Alalawi, MD, FCCP CASE 65-year-old woman with H/O breast cancer presented with a 1 week H/O progressively worsening exersional dyspnea. Physical exam: Diminished breath
More informationDiagnostic Approach to Pleural Effusion
Diagnostic Approach to Pleural Effusion Objectives Define the leading causes of pleural effusion Classify the type of effusion Identify procedures and tests associated with diagnosis 2 Agenda Basic anatomy
More informationPleural Effusions. Kyle J Henry, MD Pulmonary/ CCM Fellow PGY4 (210) (602)
Pleural Effusions Kyle J Henry, MD Pulmonary/ CCM Fellow PGY4 (210) 275 8583 (602) 202 0351 None Disclosures Objectives Understand the presentation of a pleural effusion How to diagnose and treat Differentiate
More informationPulmonary Morning Report. Ashley Schmehl D.O. PGY-3 January,
Pulmonary Morning Report Ashley Schmehl D.O. PGY-3 January, 8 2015 Pleural Effusion Unilateral versus Bilateral Associated symptoms Transudate versus Exudate Light s Criteria: Pleural protein: Serum protein
More informationPleural Effusion. Exudative pleural effusion - Involve an increase in capillary permeability and impaired pleural fluid resorption
Pleural Effusion Definition of pleural effusion Accumulation of fluid between the pleural layers Epidemiology of pleural effusion Estimated prevalence of pleural effusion is 320 cases per 100,000 people
More informationDr. A.Torossian, M.D., Ph. D. Department of Respiratory Diseases
Pleural effusions Dr. A.Torossian, M.D., Ph. D. Department of Respiratory Diseases A pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased
More informationPleural Disease. Disclosure. Normal Pleural Anatomy. Outline. Pleural Fluid Origins: Transudates. Pleural Fluid Origins: Exudates
Disclosure Pleural Disease Anne L Fuhlbrigge MD MS Clinical Director Division of Pulmonary and Critical Care Medicine Brigham and Women s Hospital Channing Laboratory Harvard Medical School Boston, MA
More informationBacterial pneumonia with associated pleural empyema pleural effusion
EMPYEMA Synonyms : - Parapneumonic effusion - Empyema thoracis - Bacterial pneumonia - Pleural empyema, pleural effusion - Lung abscess - Complicated parapneumonic effusions (CPE) 1 Bacterial pneumonia
More informationPleural Diseases. Dr Matthew J Knight Consultant Respiratory Physician
Pleural Diseases Dr Matthew J Knight Consultant Respiratory Physician What do you need to know? What do you need to know? Pleura- normal anatomy and physiology Pleural effusions Causes and investigations
More informationMalignant Effusions. Anantham Devanand Respiratory and Critical Care Medicine Singapore General Hospital
Malignant Effusions Anantham Devanand Respiratory and Critical Care Medicine Singapore General Hospital Malignant Effusions Definition: Presence of malignant cells in the pleural space 75% are caused by
More informationTop Tips for Pleural Disease in 2012
Top Tips for Pleural Disease in 2012 The unilateral pleural effusion on the Post Take Ward Round Pleural Effusion on CXR Bedside ultrasound + Pleural aspirate Empyema Nil evidence infection Admit IV antibiotics
More informationPLEURAL EFFUSION. Prof. G. Zuliani
PLEURAL EFFUSION Prof. G. Zuliani Anatomy of pleural membrane and pleural space Pleural membrane consists of parietal pleura and visceral pleura A space situated between parietal and visceral pleura is
More informationMedical Thoracoscopy When to Choose Over a General Anaesthetic VATS
Medical Thoracoscopy When to Choose Over a General Anaesthetic VATS SpR Training Day 07.07.14 Dr Alex West Consultant Chest/Pleural Physician Guy s and St Thomas Hospital Medical Thoracoscopy? No Just
More informationPLEURAL DISEASES. (Pleural effusion & empyema) Menaldi Rasmin
PLEURAL DISEASES (Pleural effusion & empyema) Menaldi Rasmin Department of Pulmonology & Respiratory Medicine Faculty of Medicine, University of Indonesia Introduction Pleural effusion is the most common
More informationFebruary 1, 2016 Body Fluid order changes
February 1, 2016 Body order changes Laboratory will be making the following changes to Body tests: 1. Changing orders in Power plans (see below list). 2. All folders will be updated accordingly: If the
More informationPleurodesis. What is a pleurodesis?
2014 Pleurodesis Pleurodesis What is a pleurodesis? Pleurodesis is a procedure which involves a doctor or nurse practitioner putting a special solution in your chest. This solution is placed between the
More informationGUIDELINES FOR DIAGNOSIS OF UNILATERAL PLEURAL EFFUSION. Pakistan Chest Society
GUIDELINES FOR DIAGNOSIS OF UNILATERAL PLEURAL EFFUSION Pakistan Chest Society Message by chairman guideline committee Guidelines for pleural disease working group Expert review committee INTRODUCTION
More informationModern Approaches to Empyema
Modern Approaches to Empyema Amit Bhargava, MD Attending Thoracic Surgeon Assistant Professor Department of Cardiovascular and Thoracic Surgery 1 Principles of Treatment Adequate drainage Sterilization
More informationCase Study #2. Case Study #1 cont 9/28/2011. CAPA 2011 Christy Wilson PA C. LH is 78 yowf with PMHx of metz breast CA presents
Case Study #1 CAPA 2011 Christy Wilson PA C 46 yo female presents with community acquired PNA (CAP). Her condition worsened and she was transferred to the ICU and placed on mechanical ventilation. Describe
More informationThoracic Surgery; An Overview
Thoracic Surgery What we see Thoracic Surgery; An Overview James P. Locher, Jr, MD Methodist Cardiovascular and Thoracic Surgery Lung cancer Mets Fungus and TB Lung abcess and empyema Pleural based disease
More informationInterventional Pulmonary Case Based Discussions (ATS) Ali Imran Saeed, MD University of New Mexico
Interventional Pulmonary Case Based Discussions (ATS) Ali Imran Saeed, MD University of New Mexico Objectives Interventional Pulmonary in New Mexico Interventional Pulmonary and Advanced Diagnostic Cases
More informationBELLWORK page 343. Apnea Dyspnea Hypoxia pneumo pulmonary Remember the structures of the respiratory system 1
BELLWORK page 343 Apnea Dyspnea Hypoxia pneumo pulmonary respiratory system 1 STANDARDS 42) Review case studies that involve persons with respiratory disorders, diseases, or syndromes. Citing information
More informationSerous fluids. Dr. Mohamed Saad Daoud
Serous fluids 1 Reference Books: Urinanalysis and body fluids (Susan King Strasinger- Marjorie Schaub De Lorenzo) Fifth edition 2 The closed cavities of the body namely, the pleural, pericardial, and peritoneal
More informationBGS Autumn The wet lung - Pleural effusions. Nick Maskell. BGS Autumn Meeting November 2017
The wet lung - Pleural effusions BGS Autumn Meeting November 2017 Nick Maskell Professor of Respiratory Medicine Bristol University, Bristol Conflicts of interest Prof Maskell has sat on advisory boards
More informationPleural fluid. creatinine - urinothorax haematocrit -haemothorax bilirubin gut perforation. Fluid samples 1st Plain Universal ( cell count)
Examination Purpose of test Sample 17725 Fluid Profile (appearance, culture, WBC differential, ph, total protein, glucose, amylase, triglyceride, albumin, HDL) Peritoneal/ascitic and pleural fluid are
More informationÓ Journal of Krishna Institute of Medical Sciences University 106
ISSN 2231-4261 CASE REPORT Transudative Effusion of Malignant Etiology: An Interesting Case Report 1 1 1 1* Swathi Karanth M. P, Ketaki Utpat, Unnati Desai, Jyotsna M. Joshi 1 Department of Pulmonary Medicine,
More informationDiagnosis and Treatment of Pleural Effusion
RECOMMENDATIONS OF THE SPANISH SOCIETY OF PULMONOLOGY AND THORACIC SURGERY (SEPAR) Diagnosis and Treatment of Pleural Effusion 143.719 Victoria Villena Garrido (coordinator), a Jaime Ferrer Sancho, b Hernández
More informationDiagnostic Approach to Pleural Effusion
Original Article GCSMC J Med Sci Vol (IV) No (I) January-June 2015 Diagnostic Approach to Pleural Effusion Rushi Patel*, Viral Shah*, Deepali Kamdar** Abstract : Aim : Normally the pleural cavities contain
More informationPLEURAL EFFUSION: DIAGNOSIS, MANAGEMENT AND DISPOSAL
PLEURAL EFFUSION: DIAGNOSIS, MANAGEMENT AND DISPOSAL 1. This replaces the DGAFMS Medical Memorandum No.63 on Primary (Idiopathic) Pleural Effusion, which dealt with tubercular pleural effusion. 2. Normally
More informationIndwelling Pleural Catheters in Malignant and Non-Malignant Disease
Indwelling Catheters in Malignant and Non-Malignant Disease 20th Hellenic Conference November 2011 Najib Rahman Clinical Lecturer Oxford Centre for Respiratory Medicine University of Oxford, UK Najib.rahman@ndm.ox.ac.uk
More informationChapter 8. Other Important Tests and Procedures. Mosby items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 8 Other Important Tests and Procedures 1 Introduction Additional important diagnostic studies include: Sputum examination Skin tests Endoscopic examination Lung biopsy Thoracentesis Hematology,
More informationInvestigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010
Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010 Clare Hooper, 1 Y C Gary Lee, 2 Nick Maskell, 3 on behalf of the BTS Pleural Guideline
More informationEMPYEMA. Catheter Based Treatment vs. VATS. UCHSC Department of Surgery Grand Rounds August 27 th, Jeremy Hedges, M.D.
EMPYEMA Catheter Based Treatment vs. VATS UCHSC Department of Surgery Grand Rounds August 27 th, 2007 Jeremy Hedges, M.D. OVERVIEW Empyema Pathogenesis Treatment Catheter based treatment Fibrinolytics
More informationTOTAL CHOLESTEROL ANALYSIS FOR DIFFERENTIATING EXUDATES AND TRANSUDATES IN PLEURAL FLUIDS
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Majalah Patologi Klinik Indonesia dan Laboratorium Medik Page 136 2018 March; 24(2): 136-140 p-issn 0854-4263 e-issn 2477-4685 Available
More informationSurgical treatment of empyema in children
Surgical treatment of empyema in children Jacques Janson Pierre Goussard Cardiothoracic Surgery, Paediatric Pulmonology Tygerberg Academic Hospital University of Stellenbosch Pleural space Netter, Frank
More informationBronchial syndrome. Atelectasis Draining bronchus Bronchiectasis
Bronchial syndrome Atelectasis Draining bronchus Bronchiectasis Etienne Leroy Terquem Pierre L Her SPI / ISP Soutien Pneumologique International / International Support for Pulmonology Atelectasis Consequence
More informationBODY FLUID ANALYSIS. Synovial Fluid. Synovial Fluid Classification. CLS 426 Urinalysis and Body Fluid Analysis Body Fluid Lecture Session 1
BODY FLUID ANALYSIS Synovial Fluid Serous fluids the 3 P s Peritoneal Pleural Pericardial Cerebrospinal Fluid Karen Keller, MT(ASCP), SH Synovial Fluid Lubricant and sole nutrient source of joint. Normal
More informationTrust Guideline for the management of Parapneumonic Effusion in children
A clinical guideline recommended for use For Use in: By: For: Division responsible for document: Buxton ward, Children s Assessment Unit (CAU) All staff Children with parapneumonic effusion Women and Children
More informationThoracoscopic Management of Complicated Parapneumonic Effusions in Young Children. Saeed Al Hindi, MD, CABS, FRCSI*
Bahrain Medical Bulletin, Vol. 31, No. 4, December 2009 Thoracoscopic Management of Complicated Parapneumonic Effusions in Young Children Saeed Al Hindi, MD, CABS, FRCSI* Objective: To evaluate the role
More informationA review of the management of complex para-pneumonic effusion in adults
Review Article A review of the management of complex para-pneumonic effusion in adults Vikas Koppurapu, Nikhil Meena Department of Internal Medicine, University of Arkansas for Medical Sciences, Little
More informationA Study On Treatment Of Empyema Thoracis In Children
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 14, Issue 1 Ver. III (Jan. 2015), PP 117-122 www.iosrjournals.org A Study On Treatment Of Empyema Thoracis
More informationPneumothorax lecture no. 3
Pneumothorax lecture no. 3 Is accumulation of air in a pleural space or accumulation of extra pulmonary air within the chest, Is uncommon during childhood, may result from external trauma, iatrogenic,
More informationStudy of Predictors for Successful Pleurodesis in Patients with Malignant Pleural Effusion
Med. J. Cairo Univ., Vol. 85, No. 1, March: 11-20, 2017 www.medicaljournalofcairouniversity.net Study of Predictors for Successful Pleurodesis in Patients with Malignant Pleural Effusion TALAT A. ARAFA,
More informationTable 2: Outcomes measured. Table 1: Intrapleural alteplase instillation therapy protocol
ORIGINAL RESEARCH ARTICLE Intrapleural F brinolytic Therapy with Alteplase in Empyema Thoracis in Children conducted in the Department of Pediatric critical care and Pulmonology unit at our institution
More informationA study of pleural effusion with reference to different diagnostic modalaties
International Journal of Advances in Medicine Jindal S et al. Int J Adv Med. 2015 Nov;2(4):359-364 http://www.ijmedicine.com pissn 2349-3925 eissn 2349-3933 Research Article DOI: http://dx.doi.org/10.18203/2349-3933.ijam20151009
More informationSupplementary Online Content
Supplementary Online Content Rahman NM, Pepperell J, Rehal S, et al. Effect of opioids vs NSAIDs and larger vs smaller chest tube size on pain control and pleurodesis efficacy among patients with malignant
More informationE valuation of the patient with a pleural effusion is
The Diagnostic Value of Pleural Fluid ph* James T. Good, Jr., M.D.; David A. Taryle, M.D.; Robert M. Maulitz, M.D.; Robin L. Kaplan, M.D.; and Steven A. Sahn, M.D., F.C.C.P. One hundred eighty-three patients
More informationDiagnostic and Prognostic Implications of Pleural Adhesions in Malignant Effusions
ORIGINAL ARTICLE Diagnostic and Prognostic Implications of Pleural Adhesions in Malignant Effusions Silvia Bielsa, MD,* José Martín-Juan, MD, José M. Porcel, MD,* and Francisco Rodríguez-Panadero, MD Background
More informationDIAGNOSTIC EVALUATION OF BLOODY PLEURAL EFFUSION
DIAGNOSTIC EVALUATION OF BLOODY PLEURAL EFFUSION Mamatha S, Manish Kumar Singh, Pravati Dutta, Rekha Manjhi, Sudarsan Pothal,Amit Kumar Jha, Nilam Nigam, Sanjay Kumar Nigam 1. Senior Resident, Department
More informationKey Difference - Pleural Effusion vs Pneumonia
Difference Between Pleural Effusion and Pneumonia www.differencebetween.com Key Difference - Pleural Effusion vs Pneumonia Pleural effusion and pneumonia are two conditions that affect our respiratory
More informationImaging of Pleural Effusion: Comparing Ultrasound, X-Ray and CT findings
Imaging of Pleural Effusion: Comparing Ultrasound, X-Ray and CT findings Poster No.: C-2067 Congress: ECR 2017 Type: Educational Exhibit Authors: J. M. Almeida, N. Antunes, C. Leal, L. Figueiredo ; Lisboa/PT,
More informationSome clinical conditions such as congestive heart failure, cirrhosis, acute. Bleomycin in the treatment of 50 cases with malignant pleural effusion
Original Article Bleomycin in the treatment of 5 cases with malignant pleural effusion Novin Nikbakhsh (MD) *1 Ali Pourhasan Amiri (MD) 2 Danial Hoseinzadeh (MD) 3 1- Department of Surgery, Babol University
More informationPost Pneumonic Empyema: Is There Still a Role for Surgery?
Post Pneumonic Empyema: Is There Still a Role for Surgery? M. Blair Marshall, MD Ismael Matus, MD Chief, Thoracic Surgery Interventional Pulmonary Professor of Surgery Medicine MedStar Georgetown University
More informationPage 5. TUBERCULOSIS PLEURAL EFFUSIONS AND A CASE OF EMPYEMA NECESSITATIS (NECESSITANS) David Griffith, MD CASE HISTORY
Page 5 TUBERCULOSIS PLEURAL EFFUSIONS AND A CASE OF EMPYEMA NECESSITATIS (NECESSITANS) David Griffith, MD CASE HISTORY A 15 year old pregnant female presented to the emergency department of a local hospital
More informationGuideline for management of children & adolescents with pleural empyema
CHILD AND ADOLESCENT HEALTH SERVICE PRINCESS MARGARET HOSPITAL FOR CHILDREN Guideline for management of children & adolescents with pleural empyema This guideline provides an evidence-based framework for
More informationPleural fluid collections in critically ill patients Elankumaran Paramasivam MRCP Andrew Bodenham FRCA
in critically ill patients Elankumaran Paramasivam MRCP Andrew Bodenham FRCA Key points Pleural fluid collections are common in the critically ill; they are predominantly transudates that do not require
More informationامعة زهر قسم ا مراض الصدریة
Al- Azhar University Faculty of Medicine Department of Chest diseases امعة زهر كلیة الطب (بنين) قسم ا مراض الصدریة مقرر الصدریة ا مراض الدبلوم لطلبة COURSE of Chest diseases For Diploma Degree 2013-2014
More informationDisclosure. Objectives NONE
Susan Collazo MSN, APN-CNP Thoracic Surgery Northwestern Memorial Hospital Chicago, Illinois NONE Disclosure Objectives 1. The participant will be able to locate at least one pulmonary structure, as a
More informationOne problem above the diaphragm and one problem below the diaphragm
One problem above the diaphragm and one problem below the diaphragm Wouter Meersseman, MD, PhD Universitary Hospital Leuven General Internal Medicine Leuven 13 Dec 2013 83-year old lady Past medical history
More informationPneumothorax and Chest Tube Problems
Pneumothorax and Chest Tube Problems Pneumothorax Definition Air accumulation in the pleural space with secondary lung collapse Sources Visceral pleura Ruptured esophagus Chest wall defect Gas-forming
More informationTHE USE OF PLEURAL FLUID CHOLESTEROL IN IDENTIFYING THE TYPE OF PLEURAL EFFUSION
THE USE OF PLEURAL FLUID CHOLESTEROL IN IDENTIFYING THE TYPE OF PLEURAL EFFUSION Hyacinth D. Jumalon, MD, DPCP West Visayas State University Medical Center Iloilo City Region VI introduction - The first
More informationThe distinction between transudates and exudates
Journal of Biomedical Science (2005) 12:985 990 985 DOI 10.1007/s11373-005-9014-1 The distinction between transudates and exudates Ugur Gonlugur 1, * & Tanseli Efeoglu Gonlugur 2 1 Department of Chest
More informationWorld Journal of Pharmaceutical Research SJIF Impact Factor 8.074
SJIF Impact Factor 8.074 Volume 7, Issue 9, 1433-1446. Research Article ISSN 2277 7105 RETROSPECTIVE STUDY OF PLEURAL DISEASES Roma Raykar* 1, Mansi Deshpande 2, Joanna Baptist 3 and Tushar J Palekar 4
More informationTumor Board Discussions: Case 1
Tumor Board Discussions: Case 1 David S. Ettinger, MD The Alex Grass Professor of Oncology Johns Hopkins University School of Medicine Baltimore, Maryland Case #1 50-year-old Asian female, never smoker
More informationobjectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University
objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University To determine the regions of physiologic activity To understand
More informationCLINICAL PRACTICE. Clinical Practice
Clinical Practice This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines,
More informationANATOMY OF THE PLEURA (contd) III. Histology: covered by a single layer of mesothelial cells. Within the pleura are blood vessels, mainly capillaries,
PLEURAL DISEASES By: SETIA PUTRA TARIGAN Pulmonary Department, Faculty of Medicine, Sumatera Utara University/ Adam Malik Hospital Medan 2008 ANATOMY OF THE PLEURA I. Pleura is the serous membrane: 1.
More informationA Repeat Case of Idiopathic Spontaneous Hemothorax
Case Report A Repeat Case of Idiopathic Spontaneous Hemothorax Felix R. Gaw, MD Jack H. Bloch, MD, PhD, FACS Nolan J. Anderson, MD, FACS Spontaneous hemothorax, a collection of blood in the pleural cavity
More informationPleural Fluid Glucose Routine but Vital Biochemical Parameter for Differential Diagnosis of Effusions
ORIGINAL RESEARCH ARTICLE Pleural Fluid Glucose Routine but Vital Biochemical Parameter for Differential Diagnosis of Effusions Ashish Jadhav 1, Anuradha Jain 2, ArvindYadav 3 and Poonam Kamble 4 Professor
More informationARDS - a must know. Page 1 of 14
ARDS - a must know Poster No.: C-1683 Congress: ECR 2016 Type: Authors: Keywords: DOI: Educational Exhibit M. Cristian; Turda/RO Education and training, Edema, Acute, Localisation, Education, Digital radiography,
More informationPleural Empyema Joseph Junewick, MD FACR
Pleural Empyema Joseph Junewick, MD FACR 03/19/2010 History Teenager with persistent fever and cough. Pneumonia diagnosed 1 week ago. Diagnosis Pleural Empyema Additional Clinical Surgery-Clear fluid with
More informationCauses of pleural effusion and its imaging approach in pediatrics. M. Mearadji International Foundation for Pediatric Imaging Aid
Causes of pleural effusion and its imaging approach in pediatrics M. Mearadji International Foundation for Pediatric Imaging Aid Pleural fluid A tiny amount of fluid in the pleural cavity is physiological.
More informationPleural fluid glucose: A predictor of unsuccessful pleurodesis in a preselected cohort of patients with malignant pleural effusion
JBUON 2014; 19(4): 1018-1023 ISSN: 1107-0625, online ISSN: 2241-6293 www.jbuon.com E-mail: editorial_office@jbuon.com ORIGINAL ARTICLE Pleural fluid glucose: A predictor of unsuccessful pleurodesis in
More informationObjectives. What is a Chest X Ray? CXR Workshop. Definition (diagnostic tool/internal PE) Types. Cost
Objectives CAPA 2011 Christy Wilson, PA C Georgia Lung Associates Identify the radiographic landmarks on a chest radiograph Recognize identifiers of poor quality on the chest radiograph Outline an approach
More informationPATIENT CHARACTERISTICS AND PREOPERATIVE DATA (ecrf 1).
PATIENT CHARACTERISTICS AND PREOPERATIVE DATA (ecrf 1). 1 Inform Consent Date: / / dd / Mmm / yyyy 2 Patient identifier: Please enter the 6 digit Patient identification number from your site patient log
More informationThoraxdrainage SGP Jahresversammlung 2016, Lausanne
Thoraxdrainage SGP Jahresversammlung 2016, Lausanne Dr. med. Lukas Kern a bit of history (incomplete.) a bit of physiology (basic ) indication data guidelines a bit of history (incomplete.) a bit of physiology
More informationThe Dr. Jae Yang Lecture: An Overview of the Radiographic Picture of TB
The Dr. Jae Yang Lecture: An Overview of the Radiographic Picture of TB Harvey H. Wong, MD FRCPC MScCH Assistant Professor Department of Medicine Division of Respirology University of Toronto Financial
More informationData Collection Tool. Standard Study Questions: Admission Date: Admission Time: Age: Gender:
Data Collection Tool Standard Study Questions: Admission Date: Admission Time: Age: Gender: Specifics of Injury: Time of Injury: Mechanism of Injury Blunt vs Penetrating? Injury Severity Score? Injuries:
More informationPleural Effusions. Introduction. Causes of Pleural Effusion. imedpub Journals
Short Communication imedpub Journals http://www.imedpub.com/ Vol. 3 No. 1:1 Pleural Effusions Received: January 15, ; Accepted: January 22, ; Published: February 05, Funda Ozturk Incekara*, Deniz Kaygusuz
More informationCombined efficacy of pleural fluid lymphocyte neutrophil ratio and pleural fluid adenosine deaminase for the diagnosis of tubercular pleural effusion
Original article: Combined efficacy of pleural fluid lymphocyte neutrophil ratio and pleural fluid adenosine deaminase for the diagnosis of tubercular pleural effusion Kavita S Kore, Guruprasad Antin,
More informationElderly Man with Dyspnoea
Asia Pacific Family Medicine, 2004; 3 (1-2): 46-50 RADIOLOGY SERIES Elderly Man with Dyspnoea Wei-Yang LIM Faculty of Medicine National University of Singapore, Singapore Wilfred CG PEH Singapore Health
More informationRespiratory Diseases and Disorders
Chapter 9 Respiratory Diseases and Disorders Anatomy and Physiology Chest, lungs, and conducting airways Two parts: Upper respiratory system consists of nose, mouth, sinuses, pharynx, and larynx Lower
More informationLong term results of pleurodesis in malignant pleural effusions: Doxycycline vs Bleomycin
Original Article Long term results of pleurodesis in malignant pleural effusions: Doxycycline vs Bleomycin Rahmatollah Rafiei, Behnam Yazdani, Sayed Milad Ranjbar, Zahra Torabi, Sedigheh Asgary 1, Somayeh
More informationMalignant Mesothelioma
PATIENT & CAREGIVER EDUCATION Malignant Mesothelioma This information will help you understand malig nant (cancerous) mesothelioma, including risk factors, diag nosis, surg ery, and treatment. About Mesothelioma
More informationLab Values Explained. working at full strength. Other possible causes of an elevated BUN include dehydration and heart failure.
Patient Education Lab Values Explained Common Tests to Help Diagnose Kidney Disease Lab work, urine samples and other tests may be given as you undergo diagnosis and treatment for renal failure. The test
More informationSystemic lupus erythematosus (SLE): Pleuropulmonary Manifestations
08/30/10 09/26/10 Systemic lupus erythematosus (SLE): Pleuropulmonary Manifestations Camila Downey S. Universidad de Chile, School of Medicine, Year VII Harvard University, School of Medicine Sept 17,
More informationDifferent characteristics of tuberculous pleural effusion according to pleural fluid cellular predominance and loculation
Original Article Different characteristics of tuberculous pleural effusion according to pleural fluid cellular predominance and loculation Jaehee Lee 1, Jae Kwang Lim 2, Seung Soo Yoo 1, Shin Yup Lee 1,
More informationPleural Disease in the Intensive Care Unit
Chapter 115 Pleural Disease in the Intensive Care Unit Hiren J. Mehta and Michael A. Jantz Introduction Pleural disease in itself is an unusual cause for admission to the intensive care unit (ICU). Conditions
More informationIntroduction and methods: British Thoracic Society pleural disease guideline 2010
Introduction and methods: British Thoracic Society pleural disease guideline 2010 Ingrid Du Rand, 1 Nick Maskell 2 BTS guidelines < Supplementary data are published online only. To view these files please
More informationA Rare Case of Lymphangioleiomyomatosis in Sri Lanka
A Rare Case of Lymphangioleiomyomatosis in Sri Lanka Author s Details: (1) Dushantha Madegedara (2) Asela Rasika Bandara (3) Sachini Seneviratne (4) Samadara Nakandala (5) Rathnayake R.M.D.H.M - (1) (2)
More informationPosttraumatic Empyema Thoracis
Posttraumatic Empyema Thoracis Dr AG Jacobs STEVE BIKO ACADEMIC HOSPITAL, UNIVERSITY OF PRETORIA EMPYEMA THORACIS Derived from Greek word empyein Means pus-producing Refers to accumulation of pus within
More informationUAMS MEDICAL CENTER TRAUMA SERVICES MANUAL. REVIEWED: New PAGE: 1 of 7. RECOMMENDATION(S): Dr. Michael Sutherland APPROVAL: 04/28/2016
REVIEWED: New PAGE: 1 of 7 PURPOSE: To provide guidelines for the evaluation and management of patients with traumatic chest wall injury including rib fractures, sternal fractures, hemothorax and retained
More informationIntroduction. 23 rd Annual Seminar in Pathology. FLUIDS, Part 1. Pittsburgh, PA Gladwyn Leiman UVMMC, VT
23 rd Annual Seminar in Pathology Pittsburgh, PA Gladwyn Leiman UVMMC, VT FLUIDS, Part 1 "Blue walls", Claudia Hansen, 2009 Introduction o Challenging to everyone o Almost any benign or malignant process
More informationAdam J. Hansen, MD UHC Thoracic Surgery
Adam J. Hansen, MD UHC Thoracic Surgery Sometimes seen on Chest X-ray (CXR) Common incidental findings on computed tomography (CT) chest and abdomen done for other reasons Most lung cancers discovered
More informationWhat is cpt code for chest tube placement
What is cpt code for chest tube placement Search 11-4-2016 Chest Tube Placement (Thoracostomy) and Pleurodesis Thoracostomy inserts a thin plastic tube into the pleural space between the lungs and the
More informationBronchogenic cyst masquerading as malignant pericardial effusion with tamponade
CASE REPORT eissn 2384-0293 Yeungnam Univ J Med 2017;34(1):91-95 https://doi.org/10.12701/yujm.2017.34.1.91 Bronchogenic cyst masquerading as malignant pericardial effusion with tamponade Kang-Un Choi,
More information(SKILLS/HANDS-ON) Chest Tubes. Rebecca Carman, MSN, ACNP-BC. Amanda Shumway, PA-C. Thomas W. White, MD, FACS, CNSC
(SKILLS/HANDS-ON) Chest Tubes Rebecca Carman, MSN, ACNP-BC Nurse Practitioner, Trauma Services, Intermountain Medical Center, Intermountain Healthcare Amanda Shumway, PA-C APC Trauma and Critical Care
More information