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Critical Care |

Comparison of Chest CT Scan Versus Chest X-ray in Evaluating Radiologic Improvement After Treatment With Intrapleural Tissue Plasminogen Activator (TPA) and Deoxiribonuclease (DNase) for Chest Tube Refractory Complex Pleural Effusions

Aishatu Aloma, MD; Erik Folch, MD; Matt Del Guzzo, MD; Sebastian Ochoa, MD; George Cheng, MD; Adnan Majid, MD
Author and Funding Information

Beth Israel Deaconess Medical Center, Boston, MA


Chest. 2015;148(4_MeetingAbstracts):329A. doi:10.1378/chest.2278052
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Abstract

SESSION TITLE: Pulmonary & Critical Care Imaging

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 27, 2015 at 11:00 AM - 12:15 PM

PURPOSE: Exudative pleural effusions complicated by formation of loculations often fail chest-tube drainage and require intrapleural instillation of TPA DNAse or surgical decortication. Chest CT scans and conventional chest x-rays (CXR) are frequent imaging techniques used for evaluating radiologic improvement after these interventions. However, CXR may fail to accurately assess volume changes in complex, loculated effusions with multiple pockets. This study aims to compare the accuracy of CXR to low dose CT Scan in detecting radiological improvement of loculated pleural effusions refractory to chest-tube drainage after treatment with TPA DNase

METHODS: We retrospectively reviewed medical records and selected those with evidence of exudative effusion and failure to chest-tube drainage. The following data was collected: demographics, presenting symptoms, etiology of effusion, and pleural fluid analysis. We performed 3D reconstruction of pleural effusions using OsiriX Lite 6.5 from low dose Chest CT scans, and previously described area measurements using ImageJ from CXRs to assess radiological improvement before and after TPA DNase treatment. Pearson correlation was used to compare percent radiological improvement between the two imaging modalities.

RESULTS: Fifteen patients (9 male, 6 female, mean age 50 years) with loculated pleural effusions failed chest tube drainage from 2010 to 2015. Etiologies were sympathetic (n=12) and parapneumonic effusion (n=3). Presenting symptoms were pleuritic chest pain (n=7), dyspnea (n=2), cough (n=1) and fever (n=2). Mean pleural fluid volume measured by Chest CT scan pre and post treatment with TPA-DNAse were 552ml and 165ml, respectively. Mean pleural fluid volume measured by chest x-ray pre and post treatment were 99cm2 and 35cm2, respectively. The mean radiologic improvement measured by CT scan was 387ml (55%) while that measured by chest x-ray was 64ml (61%). Correlation coefficient was -0.026 .

CONCLUSIONS: Our study suggests that in patients with loculated pleural effusions refractory to chest tube drainage treated with intrapleural TPA-DNAse there is no correlation between chest CT scan and CXR when assessing radiographic improvement.. This suggests that CXR may not be a reliable tool for radiological follow-up in this patient population. Further studies are needed to validate these findings.

CLINICAL IMPLICATIONS: Our data suggests that CXR may not be a reliable tool to assess this patient population and other methods like low dose chest CT or chest US should be considered

DISCLOSURE: The following authors have nothing to disclose: Aishatu Aloma, Erik Folch, Matt Del Guzzo, Sebastian Ochoa, George Cheng, Adnan Majid

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