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Findings of Local Anesthetic Thoracoscopy for Parapneumonic Pleural Effusions
October 2013, Vol 144, No. 4_MeetingAbstracts Disorders of the Pleura | October 2013
Findings of Local Anesthetic Thoracoscopy for Parapneumonic Pleural Effusions Kosuke Tsuruno, MD; Kazunori Tobino, MD; Keisuke Anan, MD; Mina Asaji, MD; Yuichiro Yasuda, MD; Yoshikazu Yamaji, MD; Noriyuki Ebi, MD Iizuka Hospital, Iizuka, Japan Chest. 2013;144(4_MeetingAbstracts):519A. doi:10.1378/chest.1705000
Abstract SESSION TITLE: Pleural Effusions SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PM PURPOSE: To compare the characteristics of CT findings of thoracic cavity with local anesthetic thoracoscopic (LAT) findings and also examine the usefulness of LAT for the selection of the management for parapneumonic pleural effusions. METHODS: This retrospective study included 23 patients admitted to our hospital for parapneumonic pleural effusions between April 2009 and March 2013, who had undergone local anesthetic thoracoscopy. We investigated the patients’ backgrounds, findings of pleural effusion, finding of computed tomography (CT), treatment (antibiotics, surgery, intrapleural administration of urokinase), outcome and LAT findings, using medical records. Finally, we examined the correlation between the findings of thoracic cavity and these data. RESULTS: Findings of pleural cavity were classified into two types; pleura mostly (> 50%) covered by pus (P-type) or fibrin (F-type). Both two types had adhesions between the visceral and parietal pleura with various severities. The duration from the onset of symptoms to the date of thoracoscopy did not correlate with LAT findings. Patients with P-type had the following characteristics; higher rate of positive pleural fluid culture (especially, Streptococcus aureus, Staphylococcus pneumonia and α-Streptococcus) and lower PH level than the F-type patients. We could not identify the correlation between LAT findings and chest CT findings. Of 23 patients, 14 patients were received thoracic drainage using urokinase, and this treatment was more effective in patients who had soft adhesions of pleura (72.7% in soft adhesion group and 0% in hard adhesion group) regardless of the classification by LAT findings (60% in P-type and 50% in F-type). The mortality and the duration of admission did not differ in both groups. CONCLUSIONS: Our study showed that LAT might be useful for the prediction of the success rate of thoracic drainage using fibrinolytic agents. CLINICAL IMPLICATIONS: LAT may allow us to choose the optimal therapy for the patients with parapneumonic pleural effusions.
DISCLOSURE: The following authors have nothing to disclose: Kosuke Tsuruno, Kazunori Tobino, Keisuke Anan, Mina Asaji, Yuichiro Yasuda, Yoshikazu Yamaji, Noriyuki Ebi No Product/Research Disclosure Information
Findings of Local Anesthetic Thoracoscopy for Parapneumonic Pleural Effusions Kosuke Tsuruno, MD; Kazunori Tobino, MD; Keisuke Anan, MD; Mina Asaji, MD; Yuichiro Yasuda, MD; Yoshikazu Yamaji, MD; Noriyuki Ebi, MD Iizuka Hospital, Iizuka, Japan Chest. 2013;144(4_MeetingAbstracts):519A. doi:10.1378/chest.1705000
Abstract SESSION TITLE: Pleural Effusions SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PM PURPOSE: To compare the characteristics of CT findings of thoracic cavity with local anesthetic thoracoscopic (LAT) findings and also examine the usefulness of LAT for the selection of the management for parapneumonic pleural effusions. METHODS: This retrospective study included 23 patients admitted to our hospital for parapneumonic pleural effusions between April 2009 and March 2013, who had undergone local anesthetic thoracoscopy. We investigated the patients’ backgrounds, findings of pleural effusion, finding of computed tomography (CT), treatment (antibiotics, surgery, intrapleural administration of urokinase), outcome and LAT findings, using medical records. Finally, we examined the correlation between the findings of thoracic cavity and these data. RESULTS: Findings of pleural cavity were classified into two types; pleura mostly (> 50%) covered by pus (P-type) or fibrin (F-type). Both two types had adhesions between the visceral and parietal pleura with various severities. The duration from the onset of symptoms to the date of thoracoscopy did not correlate with LAT findings. Patients with P-type had the following characteristics; higher rate of positive pleural fluid culture (especially, Streptococcus aureus, Staphylococcus pneumonia and α-Streptococcus) and lower PH level than the F-type patients. We could not identify the correlation between LAT findings and chest CT findings. Of 23 patients, 14 patients were received thoracic drainage using urokinase, and this treatment was more effective in patients who had soft adhesions of pleura (72.7% in soft adhesion group and 0% in hard adhesion group) regardless of the classification by LAT findings (60% in P-type and 50% in F-type). The mortality and the duration of admission did not differ in both groups. CONCLUSIONS: Our study showed that LAT might be useful for the prediction of the success rate of thoracic drainage using fibrinolytic agents. CLINICAL IMPLICATIONS: LAT may allow us to choose the optimal therapy for the patients with parapneumonic pleural effusions.
DISCLOSURE: The following authors have nothing to disclose: Kosuke Tsuruno, Kazunori Tobino, Keisuke Anan, Mina Asaji, Yuichiro Yasuda, Yoshikazu Yamaji, Noriyuki Ebi No Product/Research Disclosure Information