Treatment-pleural effusion

• Symptomatic effusion: therapeutic thoracentesis, treat underlying disease process

• Parapneumonic effusion (Chest 2000;118:1158)

uncomplicated → antibiotics for pneumonia

½ hemithorax or complicated or empyema → tube thoracostomy (otherwise risk of organization and subsequent need for surgical decortication)

loculated→ tube thoracostomy or VATS; intrapleural t-PA + DNase ↓ need for surgery

• Malignant effusion: serial thoracenteses vs. tube thoracostomy + pleurodesis (success rate ~80-90%) vs. indwelling pleural catheter, which ↓ hosp days but ↑ adverse events (JAMA 2017;318:1903); systemic steroids & pH <7.2 a/w ↑ pleurodesis failure rate

參考 ➡️ Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalization days in patients with malignant pleural effusion: the AMPLE randomized clinical trial

• TB effusions: effusion will often resolve spontaneously; however, treat Pt for active TB

Hepatic hydrothorax