Beth Isreael Deaconess Medical Center, Newton, MA
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Disorders of the Pleura
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM
PURPOSE: It is estimated that up to 15% of patients with a pleural effusion do not have a diagnosis despite a complete evaluation. A high percentage of these idiopathic effusions turn out to be malignant if followed up. This has led to a more aggressive approach with medical thoracoscopy and pleural biopsies. There are only a few case reports in the literature of patients with persistent pleural effusion after mechanical trauma and thus their optimal management has not yet been defined.
METHODS: We retrospectively collected information on adult patients at our institution, including 5 cases that had chronic non-specific pleuritis after a mechanical fall. All of these patients were initially treated as inpatients and were subsequently followed in the outpatient clinic until resolution of their pleural effusion. We collected data on their comorbidities, initial and subsequent pleural fluid analysis, number of thoracentesis, the treatment underwent as well as outcome.
RESULTS: A total of 5 patients between 61 and 88 years old (median 72 years) had recurrent pleural effusion after chest trauma. There was no evidence of malignancy or infection in any of these patients defined as negative cultures, negative cytology for malignant cells and a negative flow cytometry. All effusions were considered to be exudates according to Light’s modified criteria. Three of our patients underwent tunneled pleural catheter placement (median length of time in place 30 days). Three of our patients underwent medical thoracoscopy and pleural biopsy. All three biopsies showed no evidence of malignancy or infection as well. Two of our patients underwent pleurodesis with talc pouldrage, only one of these being successful. All 5 patients had resolution of their pleural effusion.
CONCLUSIONS: Patients that present with a recurrent exudative pleural effusion after chest trauma without evidence of malignancy or infection tend to resolve spontaneously over time. The extent of diagnostic and therapeutic procdures done in these patients has not been defined yet.
CLINICAL IMPLICATIONS: In these patients, conservative management with close follow-up might be a better option than medical thoracoscopy and pleurodesis. However, the best treatment and other factors that predict which patients benefit the most from an aggressive approach are yet to be determined.
DISCLOSURE: The following authors have nothing to disclose: Alejandro Folch, Adnan Majid, Daniel Alape, Jose Cardenas-Garcia, Christopher Manley, George Cheng, Erik Folch
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