Imaging of Pleural Disease

Qureshi, Nagmi R.; Gleeson, Fergus

doi:10.1016/j.ccm.2006.02.001

Cited by 145 publications

(95 citation statements)

References 103 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Chest radiograph findings that suggest the need for pleural space drainage include an effusion involving 150% of the hemothorax [5], loculation, and an air-fluid level. Stranding or septation noted on an ultrasound suggests the need for pleural space drainage [13]; marked pleural enhancement, pleural thickening, and the split pleura sign noted by chest CT indicate the necessity for pleural space drainage [18]. The split pleura sign clearly demarcates loculations, because both the visceral and parietal pleurae are enhanced from the inflammatory process.…”

Section: Managementmentioning

confidence: 99%

“…In patients with a CPPE or empyema, chest CT can demonstrate pleural abnormalities at an early stage; the use of contrast provides the best visualization of the pleural space because of pleural enhancement [18]. Chest CT can distinguish pleural from parenchymal abnormalities, determine the precise location and extent of the pleural disease, detect loculations, and find airway and parenchymal abnormalities that may be relevant to the etiology of the pleural infection.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Chest CT can distinguish pleural from parenchymal abnormalities, determine the precise location and extent of the pleural disease, detect loculations, and find airway and parenchymal abnormalities that may be relevant to the etiology of the pleural infection. If a chest tube has been placed, its precise location can be documented [18].…”

Section: Clinical Presentationmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis and Management of Parapneumonic Effusions and Empyema

2007

Clinical Infectious Diseases

173

144

View full text Add to dashboard Cite

Approximately 1 million patients develop parapneumonic effusions (PPEs) annually in the United States. The outcome of these effusions is related to the interval between the onset of clinical symptoms and presentation to the physician, comorbidities, and timely management. Early antibiotic treatment usually prevents the development of a PPE and its progression to a complicated PPE and empyema. Pleural fluid analysis provides diagnostic information and guides therapy. If the PPE is small to moderate in size, free-flowing, and nonpurulent (pH, 17.30), it is highly likely that antibiotic treatment alone will be effective. Prolonged pneumonia symptoms before evaluation, pleural fluid with a pH !7.20, and loculated pleural fluid suggest the need for pleural space drainage. The presence of pus (empyema) aspirated from the pleural space always requires drainage. Fibrinolytics are most likely to be effective during the early fibrinolytic stage and may make surgical drainage unnecessary. If pleural space drainage is ineffective, video-assisted thoracic surgery should be performed without delay.Parapneumonic effusion (PPE; i.e., pleural fluid that results from pneumonia or lung abscess) is the most common cause of an exudative pleural effusion. PPE may be the consequence of either community-acquired or nosocomial pneumonia. Between 20% and 57% of the 1 million patients hospitalized yearly in the United States with pneumonia develop a PPE [1][2][3]. Although PPEs are relatively common, empyema (i.e., the accumulation of pus in the pleural space) is less common, occurring in 5%-10% of patients who experience PPE [4]. In a review of 14 studies of empyema that involved a total of 1383 patients, 70% of PPEs were secondary to pneumonia (figure 1) [4]. CLASSIFICATIONA practical, clinical classification of PPE is as follows: (1) an uncomplicated parapneumonic effusion (UPPE) resolves with antibiotic therapy alone, without pleural space sequelae; (2) a complicated parapneumonic effusion (CPPE) requires pleural space drainage to resolve pleural sepsis and prevent progression to an empyema; and (3) empyema, the end stage of a PPE, occurs. Empyema is defined by its appearance; it is an opaque, whitish-yellow, viscous fluid that is the result of serum coagulation proteins, cellular debris, and fibrin deposition. Empyemas develop primarily because of delayed presentation by the patient with advanced pneumonia and progressive pleural infection and, less often, from inappropriate clinical management. Early antibiotic treatment prevents progression of pneumonia and the development of a PPE. Early antibiotic treatment will prevent development of an UPPE and progression to empyema. Risk factors for empyema include age (empyemas occur most frequently among children and elderly persons), debilitation, male sex, pneumonia requiring hospitalization, and comorbid diseases, such as bronchiectasis, chronic obstructive pulmonary disease, rheumatoid arthritis, alcoholism, diabetes, and gastroesophageal reflux disease [5]. Bacterial pneumonia, pneumon...

show abstract

Section: Managementmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Management of Parapneumonic Effusions and Empyema

2007

Clinical Infectious Diseases

173

144

View full text Add to dashboard Cite

show abstract

“…Typically on physical examination of the chest, a pleural syndrome is confirmed by the chest radiograph, which shows the extent of the pleural effusion [3, 4]. About 25% of the patients are totally asymptomatic and pleural effusion is discovered only after a routine chest radiograph [17]. The synthesis of the symptoms and signs from the clinical assessment and history must at least suggest the differential diagnosis in up to 75% of the cases, differentiating between the possibility and probability of a transudate or exudate [13].…”

Section: Clinical History and Assessmentmentioning

confidence: 99%

“…The presence of massive effusion will lead to a malignant etiology. Furthermore, chest radiography may show additional lesions, either pleural (pleural thickening, plaques, masses), pulmonary parenchymal (consolidation, atelectasis, tumor, diffuse reticulonodular), or mediastinal (enlargement), that will direct diagnosis [17]. …”

Section: Imagingmentioning

confidence: 99%

Diagnostic Work-Up of Pleural Effusions

Froudarakis¹

2008

Respiration

115

112

View full text Add to dashboard Cite

A wide range of diseases may be the cause of an accumulation of fluid in the pleural space. Pleural effusion is a major diagnostic problem, since the pleura is an inner cavity with no direct access. The aim of this review is to provide a practical approach to the investigation of the patient presenting with pleural effusion. This should help to accurately diagnose pleural effusion and keep time-consuming, but necessary, invasive investigations to the minimum.

show abstract

Lung Imaging

Oikonomou¹

2019

Medical Imaging for Health Professionals

View full text Add to dashboard Cite

Imaging of Pleural Disease

Cited by 145 publications

References 103 publications

Diagnosis and Management of Parapneumonic Effusions and Empyema

Diagnosis and Management of Parapneumonic Effusions and Empyema

Diagnostic Work-Up of Pleural Effusions

Lung Imaging

Contact Info

Product

Resources

About