Disorders of the Pleura |

Should Thoracentesis Be Done in Parapneumonic Pleural Effusion With a Small Volume? FREE TO VIEW

Maria Galarza Jimenez, MD; Deisy Barrios Barreto, MD; Esteban Perez Rodriguez, PhD; Carolina Gotera, MD; Patricia Lazo Meneses, MD; Carolina Jurkojc Mohremberger, MD; Salvador Diaz Lobato, PhD; Sagrario Mayoralas Alises, PhD
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Hospital Universitario Ramon y Cajal, Madrid, Spain

Chest. 2014;145(3_MeetingAbstracts):288A. doi:10.1378/chest.1823994
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SESSION TYPE: Slide Presentations

PRESENTED ON: Sunday, March 23, 2014 at 04:15 PM - 05:15 PM

PURPOSE: Evaluate whether thoracentesis is necessary in all parapneumonic effusions regardless of volume

METHODS: We conducted a retrospective review of 2413 patients with pleural effusion included in the pleura unit database of the Ramón y Cajal Hospital from 1994 through October 2011. Cases were studied according to the guidelines of the unit: age, sex, pretest diagnosis, risk factor, volume and location, pleural fluid character, extraction volume, pH, biochemical parameters (protein, LDH, albumin, glucose, cholesterol, triglycerides, ADA), cell count, cytology, microbiology if the Pretest diagnosis is parapneumonic and biopsy if the Pretest diagnosis is tuberculosis, malignant or generic pleural exudate. All cases were closed with a final diagnosis. Out from the total effusions assessed, 349 (14,5%) were parapneumonics, of which 73 were empyema. In all cases volume, pH, LDH, microbiology and pus were analysed. According to volume, 4 groups were assessed (<10%; 11 to 20%, 21 to 50% and >50%). The volume was assessed by two pulmonologists. Different volume groups were correlated as per volume levels with known prognostic parameters (pH, LDH, pus and microbiology). The completed statistical analysis was descriptive, with average and SD.

RESULTS: Out of the 349 (14,5%) pleural effusions, 276 (11,5%) were parapneumonic and 73 (3%) were empyema, from which 242 (69,3%) were registered in men and 107 in women (30,7%) with an average age of 62,3 with 18,871 of Typical Deviation. Out of the 349 patients with pleural effusion, 109 (33,2%) were found to have a pleural fluid volume <10%, 89 (27,1%) from 11% to 20%, 97 (29,6%) between 21-50% (27,8%) and 33 patients were found levels >50%, representing the (10,1%) of all the parapneumonics pleural effusions. It was observed that of all pleural effusions studied in this series (349) 38 were of purulent content (10,88%) distributed regardless of the volume of the pleural fluid.

CONCLUSIONS: All parapneumonic effusions should be studied by thoracentesis, including those showing low volume levels, as these could be associated with poor prognostic parameters of bad condition progress.

CLINICAL IMPLICATIONS: The study of all parapneumonic effusions may prevent serious complications or detect them early reducing morbidity and improving healthcare

DISCLOSURE: The following authors have nothing to disclose: Maria Galarza Jimenez, Deisy Barrios Barreto, Esteban Perez Rodriguez, Carolina Gotera, Patricia Lazo Meneses, Carolina Jurkojc Mohremberger, Salvador Diaz Lobato, Sagrario Mayoralas Alises

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