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Interactive Physiology and Grand Rounds |

Assessment of Pleural Pressure in the Evaluation of Pleural Effusions

David Feller-Kopman, MD, FCCP; Michael J. Parker, MD; Richard M. Schwartzstein, MD, FCCP
Author and Funding Information

*From the Department of Medicine (Dr. Feller-Kopman), Johns Hopkins Hospital, Johns Hopkins University Medical School, Baltimore, MD; and the Department of Medicine (Drs. Parker and Schwartzstein), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Correspondence to: David Feller-Kopman, MD, FCCP, Associate Professor of Medicine, Johns Hopkins University, Director, Interventional Pulmonology, Johns Hopkins Hospital, 1830 E Monument St, Fifth Floor, Baltimore, MD 21205; e-mail: dfellerk@jhmi.edu


Editor's note: In this series, interactive diagrams are an important part of each article and are referred to throughout. You can access these diagrams online at www.chestjournal.org/content/135/1/201.full. Included with the diagrams are “Show Me” videos, animated narrations that walk you through the main points of each diagram. The first time you access the online material, you may be asked to update your Web browser's Flash Player plugin; this will enable you to view the diagrams as intended. If you are not automatically prompted to update the plugin and you have any problems using the diagrams, you can download the latest version of the Flash Player by visiting http://www.adobe.com/go/getflash.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

For editorial comment see page 6


Chest. 2009;135(1):201-209. doi:10.1378/chest.08-1788
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Published online

Extract

Pleural effusion is diagnosed in approximately 1.5 million patients each year in the United States, making therapeutic thoracentesis one of the most commonly performed medical procedures.1 Although investigations into pleural pressures have been undertaken for > 120 years,2 the clinical use of pleural manometry has become increasingly popular only over the past 3 decades. Despite the high incidence of malignant pleural effusions, which account for approximately 36% of all effusions subject to thoracentesis,3 few data concern the prevalence of nonexpandable lung due to lung entrapment or trapped lung in this patient population. This first “Interactive Physiology Grand Rounds” is written with the goals of improving the overall understanding of the physiology underlying the use and interpretation of pleural manometry and elucidating the important role pleural manometry can play in the therapeutic algorithm of patients with malignant pleural effusion.

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Figures

Tables

Pleural Fluid Formation and Reabsorption

Running Time: 4:33

Balance of Forces and Formation of Effusion

Running Time: 5:09

Pleural Manometry

Running Time: 4:54

Self-Assessment: Lung Entrapment vs. Trapped Lung

Running Time: 0:49

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